Sažetak
Uvod. Utvrđivanje uzroka bola u ramenu predstavlja izazov zbog mnogih oboljenja i stanja koja mogu izazvati slične simptome (reumatoidni artritis, osteoartritis, osteonekroza, artropatija rotatorne manžetne, traumatski artritis, prelomi, različita stanja vratne kičme i neoplazme). Dijagnoza se obično postavlja slučajno, međutim, u literaturi do sada, po našem saznanju, nije objavljen slučaj postavljene dijagnoze hronične limfocitne leukemije (HLL) na osnovu histopatološke procene limfnih čvorova uklonjenih tokom operacije ramena. Prikazujemo slučaj HLL-limfoma malih limfocita (LML) koji je slučajno otkriven tokom reverzne atroplastike ramena. Prikaz bolesnika. Bolesnica, stara 69 godina, javila se na pregled na ortopedsku kliniku zbog bola u levom ramenu, sa podatkom o prelomu proksimalnog humerusa prethodne godine. Radiografski je ustanovljeno nesrastanje proksimalnog humerusa i urađena je artroplastika ramena. Tokom operacije u blizini leve cefalične vene je uočen limfni čvor veličine 2,5 × 1,5 × 1 cm čijom biopsijom je utvđena HLL-MLL. Bolesnica nije imala rane postoperativne komplikacije i otpuštena je posle dva dana. Na završnoj proceni zaključeno je da je bez ortopedskih tegoba i upućena je na hematološku kliniku radi daljeg lečenja HLL-MLL. Zaključak. Ukoliko imaju nejasne simptome, treba pažljivo ispitati starije bolesnike, kod kojih nije došlo do zarastanja preloma. Limfne čvorove oko mesta koje nije zaraslo treba pažljivo ispitati i svaki sumnjivi limfni čvor zapažen tokom ortopedske hirurgije treba odstraniti i uputiti patologu na analizu.
Ključne reči
prelomi;
histološke tehnike;
humerus;
leukemija, b-ćelije, hronična;
limfne žlezde;
ortopedske procedure.
Reference
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