Match each patient's clinical presentation with the most appropriate surgical management or preoperative intervention.
- A 25-year-old woman with a rapidly growing, 4-cm mobile breast mass; core needle biopsy reveals stromal overgrowth and a leaf-like architectural pattern.Wide local excision with at least 1-cm margins without axillary staging.
- A 32-year-old woman with episodic diaphoresis, tachycardia, and severe hypertension; biochemical testing and imaging confirm a 4-cm unilateral adrenal mass.Preoperative alpha-adrenergic blockade followed by laparoscopic adrenalectomy.
- A 55-year-old man with recurrent nephrolithiasis and hypercalcemia; a sestamibi scan demonstrates a solitary focus of persistent uptake in the lower right neck.Targeted parathyroidectomy utilizing intraoperative parathyroid hormone monitoring.
- A 45-year-old man with a 3-cm thyroid nodule; fine-needle aspiration confirms papillary carcinoma and ultrasound reveals suspicious central compartment lymph nodes.Total thyroidectomy accompanied by central compartment neck dissection.
Cevap
The correct pairings are: the phyllodes tumor requires wide local excision without axillary staging; the pheochromocytoma requires alpha-adrenergic blockade prior to laparoscopic adrenalectomy; the parathyroid adenoma requires targeted parathyroidectomy with intraoperative PTH monitoring; and the papillary thyroid carcinoma with positive nodes requires total thyroidectomy with central compartment neck dissection.
Each clinical scenario corresponds uniquely to a specific surgical principle in breast and endocrine surgery: phyllodes tumors require wide margins without nodal staging; pheochromocytomas require alpha-blockade; localized parathyroid adenomas are treated with targeted excision and PTH monitoring; and node-positive thyroid cancers require total resection and lymphadenectomy.
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Anahtar Kavram
Surgical indications and appropriate preoperative/intraoperative adjuncts for common breast and endocrine pathologies.