Chakale Hodgkin lymphoma: nodular sclerosis

Nodular sclerosis - ndi histological zosiyanasiyana matenda Hodgkin a, amakhala ndi kukula wandiweyani minofu connective, nagawira unyinji wa maselo zoumbika mosiyanasiyana ndi lobules. Iwo ali atachuluka lymphoid kanthu ndi nambala yaikulu maselo Berezovsky-Sternberg. Matendawa amayamba ndi kuchuluka kwa mfundo. matenda ndi imodzi mwa mitundu ya lymphoma chakale Hodgkin a.

matenda Hodgkin ali ankaona matenda aakulu amene amakhudza dongosolo lymphatic. Matendawa akhoza kupanga paliponse mu thupi, kuti ali zimakhala lymphoid (thymus, tonsils, ndulu ndi adenoids Al.).

Nodular ofoola ziwalo zizindikiro

lymphoma Hodgkin a akhoza kukhala munthu, ngati iye ali ndi zizindikiro monga:

• kuwonda;
• Kutupa lymph mfundo (kawirikawiri mu zone ya khosi);
• kusafuna kudya;
• kufupika kwa mpweya;
• usiku Thukuta kapena kutentha;
• ululu pachifuwa;
• yatupa chiwindi (5% odwala) kapena ndulu (30% odwala);
• kulemera kapena kupweteka kwa m'mimba (ana);
• kuyabwa khungu (kokha 1/3 anthu amadwala matenda);
• amavutika kupuma;
• kutsokomola.

zifukwa

matenda Hodgkin a angatengedwe pa m'badwo uliwonse, koma nthawi zambiri kumachitika amuna achichepere mu m'badwo gulu la zaka 16 mpaka 30 ya zaka kapena anthu okalamba zaka zoposa 50. Ana kwa zaka 5, pafupifupi kudwala. Kodi kwenikweni akapsa matenda akadali osadziwika. Komabe, pali maganizo oti gwero - mavairasi. Akukhulupirira kuti chifukwa cha matenda uyu akhoza kuyamba:

• immunodeficiency;
• opatsirana mononucleosis (wokonda Epstein-Barr HIV).

Nodular ofoola ziwalo lymphoma Hodgkin akhoza kupita nthawi yomweyo, lapitali miyezi 3 mpaka 6, kapena yotsiriza kwa zaka 20.

Kodi siteji ali matendawa?

Digiri hodzhinskoy lymphoma anatsimikiza ku maphunziro zasayansi ndipo pa maziko a zizindikiro zotsatirazi:

• wa anakhudzidwa mwanabele, komanso malo awo;
• kupezeka kwa mfundo deta m'madera osiyanasiyana chifundamtima;
• zotupa mu ziwalo zina (mwachitsanzo, chiwindi kapena ndulu).

Gawo loyamba. Pankhaniyi anakhudzidwa chimodzi chokha lymph mfundo kapena lymphoid limba (ndulu, mphete Pirogov-Valdera).

Gawo lachiwiri. Pali zambiri anadabwa lymph mfundo mbali zonse za ziwalo pachifuwa, zakulera, ndi lymphoid.

Mbali yachitatu. Izi Hodgkin digiri nkomwe isiyana ndi gawo lachiwiri. Komabe, ali mitundu iwiri ya nodular sclerosis gawo lachitatu:

• mu yoyamba ndi ziwalo akhudzidwa ili pansi pa kabowo (celiac lymph mfundo, ndulu);
• kuwonjezera pa madera kutchulidwa zosiyanasiyana choyamba, komabe napyo, ndi malo ena ndi mfundo za lymph ili pafupi chifundamtima.

Mbali chachinayi. Iwo zimakhudza mfundo osati, si lymphoid komanso ziwalo - mafupa ndi chiwindi, mafupa, mapapo ndi khungu.

Mayina madigiri lymphoma Hodgkin a

Index zinthu matenda ndi zovuta njira matenda a zimakhala zina ndi ziwalo ikusonyezedwa ndi makalata.

A - aakulu ambiri zizindikiro za matendawo ayi.

B - pamaso zizindikiro chimodzi kapena zingapo (zoona chodziwa kutentha, Thukuta usiku, mofulumira kuwonda).

E - foci ntchito kuti zimakhala ndi ziwalo lili akhudzidwa mwanabele.

S - Ali splenic chotupa.

X - pali chotupa chachikulu cha kukula kwambiri.

Mitundu Histological matenda

Ponena kukonza ma matenda Hodgkin ali 4 mitundu ya matenda.

1. Nodular ofoola ziwalo lymphoma Hodgkin a - ambiri mawonekedwe a matenda, za 40-50% milandu onse. Iwo kudwala zambiri kuposa atsikana, amene ali makamaka akhudzidwa lymph mfundo za mediastinum lapansi. The biopsy chuma, kuwonjezera maselo Berezovsky-Sternberg komanso lalikulu lacunar maselo ndi foamy cytoplasm ndi masekeli mtima. Kuneneratu matenda nthawi zambiri zabwino.
2. Lymphohistiocytic lymphoma amene anapanga 15% ya zitsanzo. Nthawi zambiri angapezeke mu anyamata osaposa zaka 35. Iwo ali wabwino zaka zisanu kupulumuka mlingo wa maselo ali limfaitov okhwima ndi Shtrenberga. mtundu uwu matenda ndi zilonda zing'onozing'ono ndi kujambulidwa mu magawo koyamba.
3. Amaphatikiza mitundu kawirikawiri matenda okalamba ndi ana. Osiyana khalidwe lililonse matenda chithunzi ndi chizolowezi zambiri kanthu. Histological Kupenda anaulula Mabaibulo osiyanasiyana kugwirizana selo, kuphatikizapo Sternberg. Zopezeka 30% odwala ndi lymphoma. Nodular sclerosis Pankhaniyi ali ndi madokotala ananena zawo ndi wabwino, ndipo ngati mankhwala nthawi Kwalamulidwa, chikhululukiro olimba amapezeka mosavuta.
4. Woopsawo granuloma kuwonongedwa kwa minofu lymphoid taonera infrequently okha 5% ya zitsanzo (makamaka kwa anthu okalamba). Mbali khalidwe pano palibe maselo chimakhala chogwidwa ndi maselo Sternberg. mawonekedwe lymphoma yodziwika ndi kuchuluka wotsikitsitsa kupulumuka zaka zisanu.

diagnostics

The matenda a "lymphoma" amatanthauza kokha mwa Kupenda histological kwa mwanabele ndi mikangano Koma ngati kumene wapadera maselo Mipikisano Sternberg zapezeka chifukwa cha phunziroli. Nthawi aakulu muyenera immunophenotyping. Cytological Kupenda lymph mfundo kapena impso kawirikawiri amakhala aang'ono puncture kutsimikiza sclerosis nodular, mtundu 1. Kodi ayenera kuchita kukhazikitsa matenda a matenda:

• ambiri ndi amuzolengedwa magazi;
• X-ray ya m'mapapo (kuvomerezedwa mu mbali ndi mazunzo ziyerekezo);
• lymph mfundo biopsy;
• akupanga anayendera mitundu yonse ya zotumphukira ndi intraabdominal lymph mfundo, chithokomiro, chiwindi ndi ndulu;
• CT jambulani kuthetsa imperceptible mediastinal lymph mfundo mu radiography ochiritsira;
• trephine biopsy wa iliac fupa kuteteza mafupa;
• aone ndi X-ray mafupa.

mankhwala

Lili cheza mankhwala opaleshoni ndi mankhwala amphamvu. Posankha njira anakhazikitsa maziko a matenda ndi kukhalapo kwa zinthu zabwino kapena zoipa prognostic. Mfundo yabwino monga:

• amapatutsidwa pa histological Kupenda nodular sclerosis, ndi lymphohistiocytic mtundu;
• zaka zosakwana zaka 40;
• mabuku lymph mfundo kuti musalumphe masentimita 6 awiri;
• kusowa kwa mawonetseredwe wamba mphamvu kwachilengedwenso (zikuchitika akalozera amuzolengedwa magazi);
• pamaso pa Palibe malo oposa 3 chotupa.

Ngati inu simutero chimodzi mwa zifukwa zimenezi, ndiye mtima amatchedwa gulu ndi madokotala ananena zawo osauka.

mankhwala cheza

Full radiotherapy ngati njira mmodzi ntchito kwa odwala ndi gawo IA ndi IIA, anatsimikizira pa laparotomy, ndi kukhala bwino zinthu prognostic. Linapangidwa minda ufulu ndi kukhudzana ndi mitundu yonse ya anakhudzidwa mwanabele ndi mavesi lymph ngalande.

Gawo la okwana odzipereka mu metastases chotupa ndi 40-45 ga kwa masabata 4-6 m'munda wa walitsa prophylactic - 30-40 ga pa masabata 1-4. Komanso ndi njira widefield ntchito Mipikisano munda walitsa wa zotupa ena kuteteza nodular ofoola ziwalo ns1.

Cheza chithandizo zingachititse mavuto monga minofu subcutaneous fibrosis, cheza pneumonitis ndi pericarditis. Kuwonongeka zimachitika nthawi osiyana - kuchokera miyezi 3 mpaka zaka 5 mankhwala. Kuvuta timadalira pa ntchito mlingo.

ntchito

Opaleshoni mankhwala sikawirikawiri ntchito nokha onoobychno ndi mbali ya mankhwala zovuta. Kuchita splenectomy, komanso ntchito pa trachea, ndi kum'mero, m'mimba ndi ziwalo zina (ndi chiopsezo asphyxia, kutsegula Ndime ya chakudya). Anapeza pa loyenda chlamydia mimba kudziwa kumasulira udzasokonezedwa.

Morning

fomu iyi ndi ntchito ngati chimodzi cha mankhwala zovuta. Kuchitira sclerosis nodular, ntchito yokonzekera osiyana:

• alkaloids ( "Vinblastine" kapena "rozevin", "Etoposide" kapena "Vincristine," Oncovin ");
• Alkire osakaniza ( "Mustargen", "Cyclophosphamide" kapena "embihina", "nitrosomethylurea" kapena "hlorbutin");
• wothandizila kupanga ( "Natulan" kapena "procarbazine," "Dacarbazine" kapena "Imidazole-carboxamide");
• antitumor mankhwala ( "Bleomycin", "adriablastin").

monochemotherapy

Izo ntchito pokha pokha wapadera ndi cholinga kuwulula. Childs medicaments zambiri amafuna mankhwala ndi njira zosiyanasiyana kanthu (Morning). Mu siteji yachinayi pa odwala matenda akakufunsani chiwindi kapena mafupa zimenezi ndiyo njira yokha - ichi ndi Agiriki Hodgkin lymphoma. Nodular sclerosis mankhwala njira zimenezi:

• ABVD ( "Bleomycin", "Dacarbazine", "adriablastin" "Vinblastine");
• MOTAPMs ( "Oncovin", "prednisolone", "Mustargen", "procarbazine");
• TSVPP ( "Vinblastine", "prednisolone", "Cyclophosphamide", "procarbazine").

Therapy ndi mwachidule (2, 7, masiku 14) maphunziro ndi intervals iwiri. chiwerengero cha m'zinthu zimasiyanasiyana chifukwa ukulu wa chotupa koyamba ndi chiwopsezo mankhwala. Kawirikawiri chikhululukiro lonse akwaniritsa ndi mankhwala 2-6 maphunziro. Pambuyo pake, Mpofunika kuchita zina 2 m'zinthu wa mankhwala. Ngati chifukwa anali tsankho chikhululukiro, koma chithandizo kamwedwe lisinthike komanso chiwerengero cha maphunziro ukuwonjezeka.

Phwando ndi pressurized mankhwala hematopoiesis, alopecia, zizindikiro dyspeptic, amene kusiya kumapeto kwa chithandizo. Nodular akadali ofoola ziwalo kumabweretsa mavuto mochedwa, monga osabereka, leukaemias ndi malignancies ena (zotupa sekondale).

kaonedwe

matenda Hodgkin a amayamba ndi makhalidwe otaya, matenda siteji ya matenda, m'badwo wa mtima, ndi zina histological mtundu. Ndi njira lakuthwa, subacute matenda si madokotala ananena zawo zabwino: odwala zambiri kumwalira kwa miyezi 1-3 1 chaka. Koma aakulu chlamydia Mapa salembedwa positive. Matendawa ukhoza kwa nthawi yaitali kwambiri, mpaka zaka 15 (zina yaitali).

40% ya anthu onse ndi matenda makamaka gawo 1 ndi 2, komanso zifukwa zabwino prognostic, kwa zaka zoposa 10 ndipo recurrences ambiri anali kudziŵika. Kuchita chifukwa cha nthawi ya chikhululukiro si wosweka.

kupewa

Monga ulamuliro, izo walangizidwa kupewa musabise. Odwala Hodgkin kukhala anayendera dispensary oncologist. Mu phunziro, ndilo zaka 3 chofunika kuti miyezi sikisi iliyonse, kenako kamodzi pachaka, muyenera kuganizira mphamvu ya zizindikiro kwachilengedwenso zambiri ndi zizindikiro koyamba zisadzachitikenso (kuwonjezeka mlingo wa fibrinogen ndi globulins, pops kuonjezera). Odwala Hodgkin ndi matenda zoipa matenthedwe physiotherapy, kutenthedwa ndi insolation mwachindunji. Kukhazikika kuchuluka kwa musabise chifukwa cha mimba.

Tsopano anthu ndithu ambiri kudziwa kuti Hodgkin a lymphoma - ndi zosinthika nodular sclerosis, umene ndi zosasangalatsa kwambiri ndi ovuta kuchiza matenda.