Download Ситуационные задачи

Problem №1.
A patient of 52 years one year after surgical removal of the cancer of lung and subsequent chemotherapy was found to
increase the left subclavian lymph nodes. When their biopsy detected cancer cells in structure resembling cell lung
removed tumor.
Questions: 1. How can you explain this phenomenon?
- the development of a new tumor?
- recurrence of lung cancer?
- metastasis of lung cancer?
2. Explain your answer by describing the possible mechanism of the phenomenon.
Problem №2.
The patient 50 years complains of general weakness, unexplained loss of appetite, nausea.
Recently there has been a significant weight loss, fever, pallor. Results of laboratory tests of blood and gastric juice
indicates anemia and reduced gastric acidity.
When gastropically study revealed a tumor. The patient further reported that the 30 years he was sick atrophic gastritis.
Questions:
1. Can a chronic atrophic gastritis lead to the development of stomach cancer? If so, which one - benign or malignant?
2. What additional research is needed to conduct to determine the type of tumor?
3. What is the mechanism of wasting (cachexia) in a patient?
Problem №3.
Patient 46 years complained of frequent urination with blood in the urine, and general weakness. Spend a cystoscopy,
found a tumor proliferation, biopsy of the tissue and adjacent mucosa. Histological examination of the biopsy, tissue
proliferation of tumor composed of cells of the correct location. Patient over 10 years working on a weaving mill dyeing
workshop where using aniline dyes.
Questions:
1. What type of tumors develop in patients?
2. What is the possible cause of tumor development?
3. To what kind of carcinogens include aniline dyes?
4. What are the mechanisms of antitumor resistance proved ineffective in the patient.
Problem №4.
Patient S., 52 years old, was admitted to the surgical department for surgical treatment for cancer of the lower lip. Disease
began a year ago. On the lower lip palpable solid tumor with sharply defined boundaries and upbeat cartilaginous
consistency roller. The skin over the tumor ulcerated and crusted. Submental and submandibular lymph nodes are
enlarged; mobile, very tight to the touch, painless.
Questions:
1. What is the probable cause of the tumor in the patient?
2. Which stage of the pathogenesis of tumor growth corresponds to the clinical symptoms?
3. Why is the patient increased regional lymph nodes and the skin over the tumor changed?
Problem №5.
Patient D., 62 years old, a former fireman, was admitted to the hospital with complaints of general weakness, sudden
weight loss, hoarseness, shortness of breath, bad breath, dry cough. When laryngoscopy larynx revealed nodular ulcerated
tumor, exciting more than half of the larynx. The tumor grows in the vocal cords and epiglottis. Cervical lymph nodes are
enlarged, firm to the touch, painless. In the analysis of the blood revealed severe anemia.
1. How to explain the change in the general condition of the patient?
2. What is the nature of the described tumor growth, and for what it is peculiar to tumors?
3. Characteristic whether metastasis of these tumors?
Problem №6.
Patient 7 months after the surgical resection of carcinoma of the stomach and the subsequent chemotherapeutic treatment
was found to increase in the left supraclavicular lymph node field. Biopsy one of them detected cancer cells, including
cells morphologically similar to the remote tumor.
Questions:
1. Is there any reason to believe the appearance of cancer cells in the lymph nodes of the result of the phenomenon of
tumor progression? Answer justify giving the characteristic of this phenomenon (the mechanisms of biological
significance).
2. Is it possible to regard the presence of cancer cells in the lymph node as: - gastric tumor metastasis? - Primary multiple
(polifocal) tumor growth? - Recurrence of gastric carcinoma? - New (yet another) tumor?
3. What factors anticellular antitumor protection proved ineffective in this case?
4. What are the possible mechanisms of depression of these factors?