Download - EPITHELIOMA SPINOCELLULARE
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EPITHELIOMA SPINOCELLULARE
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Sinonimi: carcinoma planocellulare, spinalioma, carcinoma spinocellulare
Def: ES je neoplazija keratinocita epiderma koja u svojoj invazivnoj formi ima sve osobine malignog tumora:1) anaplazija2) brz rast3) invazija lokalnih tkiva4) sposobnost metastaziranja.
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Etiopatogeneza
Ucectalost ES je manja nego kod bazocelularnog epitelioma
ES je oko 2x cesci kod muskaraca najcesce se javlja kod osoba svetle
puti ES nastaje kao rezultat kumulativnih
efekata razlicitih noksi koje deluju karcinogeno uticuci na DNK odnosno na mehanizme reparacije DNK.
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Faktori
1) UV zracenje (UVB 280-320nm)2) IC zraci3) X zraci4) katrani5) mineralna ulja6) pusenje (predeo usana i jezika)7) hronicna iritacija i inflamacija
( neleceni lupus vulgaris, dugotrajne venske ulceracije na potkolenicama, oziljci od opekotina)
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Faktori
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Klinicka slika ES moze nastati na bazi solarne
keratoze, morbus bowen ili leukoplakije Predilekciona mesta su fotoeksponirane
regije manifestuje se kao cvrst nodulus koji
brzo raste na povrsini promene se prvo javlja
skvama a potom i ulceracija (infiltrovana baza i izdignute ivice)
usled pojave limfogenih metastaza dolazi do uvecanja lokalnih limfnih zlezda
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Klinicka slika
ES koji nastaje na kozi izmenjenoj solarnom radijacijom, vrlo retko metastazira
ES na mukokutanim prelazima metastazira cesce
ES koji nastaje na oziljcima od opekotina vrlo cesto metastazira
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Diferencijalna dijagnoza
ES treba razlikovati od: keratoakantoma, solarne keratoze, leukoplakije i bazocelularnog karcinoma.
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Histologija ES je maligni tumor plocasto
slojevitog epitela pa se javlja svuda gde je taj tip epitela prisutan!
Tumorsko tkivo se sastoji od dobro diferentovanih do atipicnih celija
Stepen diferentovanosti se izrazava gradusima po Brodersu (procenat atipicnih celija u preparatu)
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Histologija
Brodersov sistem:1) gradusI: <25% atipicnih celija2) gradusII: 25-50%3) gradusIII: 50-75%4) gradusIV: >75%
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Histologija Vide se trake i plaze tumorskih celija
koje polaze od povrsnog epiderma i urastaju u derm i hipoderm
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Histologija
Dobro diferentovani tumori :1. tumorske celije imaju sposobnost
keratinizacije2. grade koncentricne strukture-
lukovice3. u centru lukovica nalaze se
keratinizovane celije sa piknoticnim jedrima- “rakove perle”
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Dobro diferentovani tumori
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Histologija Anaplasticni (nediferentovani
tumori): 1. tumorske celije nemaju sposobnost
keratinizacije2. tumorske celije imaju veci volumen,
hiperhromaticno jedro i eozinofilnu citoplazmu
Vezivno tkivo oko tumora infiltrovano je inflamatornim celijama: limfocitima, neytrofilima, histiocitima
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Dobro dif.tumor DD Nediferentovani
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Lecenje
1. Hirurska ekscizija (sa marginom od 5mm u zdravo tkivo)
2. radioterapija (ako je operativno lecenje kontraindikovano)
3. hemioterapija (metastaze na unutrasnjim organima- bleomicin)
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