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16DOI: 10.24411/2181-0443/2020-10162
КЛИНИКО-МОРФОЛОГИЧЕСКИЕ
АСПЕКТЫ ПРОГНОЗИРОВАНИЯ МЕТАСТАЗОВ В КОСТИ БОЛЬНЫХ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ
Тайлокова Муштари Баходировна Аманов Акмалжон Каримжонугли Субхонов Улугбек Журакулович Каримова Мавлуда Нематовна Юлдашева Азиза Нодиржоновна Эсанкулова Бустоной Собировна Низомова Икбола Бахтиёр кизи
Самаркандский Государственный медицинский институт
Заболеваемость раком молочной железы растет во всем мире. По данным ВОЗ в мире ежегодно выявляется более 1,4 млн. случаев рака данной локализации, из них почти 3000 в Республике Узбекистан. Метастатический рак характеризуется распространенном опухолевых клеток в различные органы и ткани. У 50 до 70% больных уже при поступлении имеют запущенные формы болезни (местно - распространенные формы, в виде поражения регионарных лимфоузлов и отдаленные метастазы в различные органы). Характер и частота отдаленных метастазов рака молочной железы весьма разнообразны. В 40-80% случаев рак молочной железы метастазирует в кости. РМЖ распространяется в кость в 70 % случаев в виде отдаленных метастазов. РМЖ метастазирует в позвоночник, ребра, таз и проксимальные конечности. Эти поражения чаще остеобластические, но могут быть остеолитическими, с плохой маргинацией, отсутствием матрикса и кортикальной деструкцией. Из других проявлений могут быть также компрессионные переломы позвоночника и кисты в результате остеоартрита, вызванные опухолью.
Ключивые слова: рак молочной железы, протоковый рак, дольковый рак, метастаз, остеобластический, остеолитический.
CLINICAL AND MORPHOLOGICAL ASPECTS OF PREDICTING BONE METASTASES IN PATIENTS WITH
BREAST CANCER
The incidence of breast cancer is increasing worldwide. According to WHO, more than 1.4 million cases of cancer of this localization are detected annually in the world, of which almost 3000 in the Republic of Uzbekistan. Metastatic cancer is characterized by proliferation of tumor cells in various organs and tissues. In 50 to 70% of patients, already upon admission, they have advanced forms of the disease (locally widespread forms, in the form of lesions of regional lymph nodes and distant metastases to various organs). The nature and frequency of distant metastases of breast cancer are very diverse. In 40-80% of cases, breast cancer metastasizes to the bone. BC spreads to the bone in 70% of cases in the form of distant metastases. BC metastases to the spine, ribs, pelvis, and proximal limbs. These lesions are more often osteoblastic, but can be osteolytic, with poor margination, lack of matrix, and cortical destruction. Other manifestations may also include spinal compression fractures and cysts as a result of osteoarthritis caused by a tumor.
Key words: breast cancer, ductal cancer, lobular cancer, metastasis, osteoblastic, osteolytic.
KO'KRAK SUT BEZI SARATONIGA CHALINGAN BEMORLARDA SUYAK METASTAZLARINI ANIQLASHNING KLINIK VA MORFOLOGIK AXAMIYATI
Sut bezi raki bilan kasallanish Butun dunyoda kundan kunga o'sib bormoqda. BDSST ma'lumotlariga ko'ra yiliga dunyo bo'ylab 1,4 milliondan ortiq bemorda sut bezi raki aniqlanadi. Shundan 3000 ga yaqini O'zbekiston Respublikasiga to'g'ri keladi. 50% dan to 70%gacha bemorlar kasallikni kechiktirilgan bosqichi bilan ya'ni mahalliy regional limfa tugunlarga yoki uzoq a'zolarga metastazlar bilan aniqlanadi. Sut bezi rakining uzoqlarga metastazlarining soni va xususiyatlari har xiligi bilan farqlanadi. 40%-80% holatlarda suyaklarga metastaz beradi. Sut bezi rakining suyaklarga tarqalishi 70% holatlarda uzoq metastazlar ko'rinishida bo'ladi. Sut bezi raki umurtqaga, qovurg aga va oyoq suyaklariga metastaz beradi. Bu esa ko'pincha osteoblastic va osteolitik ko'rinishda kartikal qavatning destruksiyasi va materksning yo'qolishi bilan kichadi.
Kalit so'zlar: sut bezi raki, sut yo'llari raki,sut bo'laklari raki, osteoblastik, osteolitik.
Relevance. The problem of breast cancer is one of the most urgent in modern oncology, since this disease is the most common among the female population. The incidence of breast cancer is increasing worldwide. According to WHO, more than 1.4 million cases of cancer of this localization are detected annually in the world, of which almost 3000 in the Republic of Uzbekistan. Breast cancer metastasis is a big and difficult problem in oncomammology [1, 2, 3, 4, 7]. Metastatic breast cancer is, for the most part, the last stage of breast cancer, or the final stage of tumor development. Metastatic cancer is characterized by proliferation of tumor cells in various organs and tissues.
According to most authors, especially in developing countries, from 50 to 70% of patients already on admission have advanced forms of the disease (locally widespread forms, in the form of lesions of regional lymph nodes and distant metastases to various organs). The nature and frequency of distant metastases of breast cancer are very diverse. In 40-80% of cases, breast cancer metastasizes to the bone.
According to Peintinger F. (TheBumham Institute), breast cancer spreads to the bone in 70% of cases in the form of distant metastases [5, 8]. Patients with bone metastases often suffer from broken bones, severe pain, hypercalcemia, and paralysis. However, the mechanism of bone metastasis is still not clear. One of the possible reasons is the penetration of the tumor into the bone marrow through the influence of cytokines and growth factors, which are responsible for the proliferation of breast cancer cells. Breast cancer accounts for about half of all pathological fractures. BC metastases to the spine, ribs, pelvis, and proximal limbs. These lesions are more often osteoblastic, but may be osteolytic, with poor margination, matrix absence, and
cortical destruction. Other
manifestations include spinal compression fractures and cysts from osteoarthritis caused by a tumor. On average, survival after the diagnosis of bone metastasis improved to 24-36 months. Bisphosphonates increase these periods somewhat longer [6]. Diagnosis and treatment of distant metastases of breast cancer is an urgent problem in mammology oncommology, since mortality in these forms remains very high, and the long-term and immediate results of treatment are still very unsatisfactory.
The tumor is characterized by significant variability in the clinical course. There are many factors affecting prognosis and long-term results. Among them, first of all, experts distinguish age, reproductive and hormonal status, histological form and some others.
Purpose of the study. Improvement of methods for early diagnosis of bone metastases in breast cancer patients.
Materials and methods. A retrospective analysis of case histories and outpatient records of 98 breast cancer patients with bone metastases, who received treatment in the SF RSNPTSOiR Samarkand from 2009 to 2019, was carried out. The patients were between 30 and 70 years old. The largest group consisted of breast cancer patients with bone metastases in the age group 41-50 years old (38.75%) and 5160 years old (22.5%). Thus, almost 60% of patients with bone metastases were women in these age groups. When studying the hormonal status of 98 patients, 78 (80%) women were in pre-and postmenapause. When studying the localization of the primary tumor in the mammary gland, out of 98 patients in 40 (40.1%) patients, the tumor was localized in the central quadrant of the mammary gland, in 32 (33%), the tumor was localized in the upper-outer
quadrant, in 26 (26.9%) other quadrants of the breast.
The following histological types of tumors have been identified; infiltrating cancers - 80%, among which 54% -ductal infiltrating cancer; 19% invasive ductal cancer with a predominance of the intraductal component; 7% - lobular infiltrative cancer; adenocarcinoma -10%; non-infiltrating intraductal cancer was 10%. X-ray examination of the skeletal system was performed in 96% of patients; OSG - 65% of patients; CT scan in 25% of patients.
Results. When analyzing the results of radiation methods of research, localizations of bone metastases characteristic of breast cancer were revealed; the lumbar spine in 61% of cases, in 45% of patients in L5, in 43% in L2, in 42% in L1, in 40% in L3, in 30% in L4; 44% had lesions of the thoracic spine; in 30% - metastasis in the ilium and ribs. Combined damage to various parts of the skeletal system was more common. Most often, bone metastasis of breast cancer occurred when the tumor was localized in the central part of the breast (in 40 cases out of 98, 40.1%) and in the upper outer quadrant of the breast (in 32 cases, 33%).
With radiation diagnostics, osteolytic damage was observed in 38 patients. Such a lesion is characterized
by the washing out of the mineral part of the bone, its thinning, and fractures. In our cases, there were no fractures. Osteoblastic metastases, on the other hand, are characterized by compaction of the mineral part. This pathology was found in 58 women. In two cases, it was difficult to determine the type of lesion radiographically.
In patients in the analyzed group, the level of calcium in the blood serum was investigated. The level of calcium remained within the normal range in 43% of patients, hypercalcemia was observed in 51%, among whom 91% of patients had multiple bone metastases, and only 9% had single metastases. The serum calcium level in 43% is within the normal range: of this group, 80% of patients have single metastases, 9% of patients have multiple metastases. In 5% of patients, hypocalcemia was observed in the presence of single metastases.
Conclusions. 1) in patients with bone metastasis of breast cancer, ductal infiltrating histological type of tumor most often appeared; 2) most often bone metastases of breast cancer are localized in the lumbar spine; 3) in the presence of multiple bone metastases in breast cancer patients, the development of hypercalcemia is most likely.
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