Classical Hodgkin lymphoma: sclerosis nodular

sclerosis Nodular - ezahlukeneyo histological sifo Hodgkin kaThixo, lubonakala ngokuba ukukhula oxineneyo kwizicwili, ngokwahlula ubunzima iiseli ezimile okudodobalisa kunye lobules. Bona ziqulathe udaba lymphoid sene inani elikhulu leeseli Berezovsky-Sternberg. Isifo iqala kunye nokwanda ezalathelwe uphuhliso. Lo ngezifo yenye zabo lymphoma yamandulo Hodgkin kaThixo.

isifo Hodgkin xa kuthathwa kokugula kakhulu echaphazela inkqubo emithanjeni. Isifo ingenziwa naphi na emzimbeni, oluthixo izicwili lymphoid (thymus, tonsils, udakada kunye adenoids al.).

Nodular sclerosis iimpawu

lymphoma Hodgkin kaThixo inokuba umntu, ukuba uneempawu ezifana:

• komzimba;
• iindawo nkovu kalanga (lixhaphakile izowuni entanyeni);
• ukulahleka emnyama;
• ukuphelelwa umoya;
• ukubila okanye lobushushu ebusuku;
• ubuhlungu esifubeni;
• isibindi ezandisiweyo (5% ezigulane) okanye udakada (30% ezigulane);
• ubunzinyana okanye intlungu esiswini (ebantwaneni);
• isikhumba sakho silume (1/3 kuphela abantu abagulayo);
• ukuphefumla nzima;
• isikhohlela.

izizathu

isifo Hodgkin kaThixo ezinokungena na ubudala, kodwa kaninzi kwenzeka eziselula kwicandelo beminyaka engama-16 ukuya kwengama-30 ubudala okanye kubantu abadala abangaphezu kweminyaka engama-50. Abantwana ukuya kwiminyaka-5, phantse musani begula. Yintoni kanye ekwenyukeni esi sifo akwaziwa. Noko ke, kukho uluvo lokuba lo mthombo - iintsholongwane. Kukholelwa ukuba unobangela kugula ingaqala:

• immunodeficiency;
• mononucleosis esosulelayo (sichulumancile yi Epstein-Barr virus).

Nodular sclerosis lymphoma Hodgkin xa ungaya nangoko, yokugqibela ukususela kwiinyanga ezi-3 ukuya ku-6, okanye yokugqibela iminyaka engama-20.

Yintoni isigaba na esi sifo?

Degree hodzhinskoy lymphoma waqondisisa kakuhle kwizifundo elebhu kunye ngokwesiseko zikhombisi zilandelayo:

• inani iindawo nkovu ochaphazelekayo, ngokunjalo indawo yabo;
• ukufumaneka nodes data kwiindawo ezahlukeneyo uvalo;
• yamathumba kwezinye izigqeba (umz, isibindi okanye udakada).

Isigaba sokuqala. Kulo mzekelo ochaphazelekayo node nkovu kuphela omnye okanye ilungu lymphoid (udakada, isangqa Pirogov-Valdera).

Isigaba sesibini. ngokuqhelekileyo Kukho iindawo nkovu nqa kumacala omabini amalungu zesifuba, uvalo, kunye lymphoid.

Isigaba sesithathu. Le Hodgkin degree ngenkankulu olwahlukileyo lesibini ibakala. Nangona kunjalo, iye iintlobo ezimbini kwisigaba nodular sclerosis lesithathu:

• kwimeko yokuqala zichatshazelwa amalungu ibekwe ngezantsi uvalo (iindawo celiac nkovu, udakada);
• ukongeza iindawo kuluhlu udidi yokuqala, kodwa bakhwankqiswa, kunye nezinye iindawo kunye kwiindawo nkovu ibekwe kufuphi uvalo.

Isigaba sesine. Oku kuchaphazela kuphela amacandelo, kodwa amalungu ezingezo-lymphoid - lomongo wethambo, isibindi, amathambo, imiphunga kunye nesikhumba.

Amagama degrees lymphoma Hodgkin kaThixo

Index imeko yezonyango kunye ubukhulu ke sifo kwezinye ancedisana amalungu ephawulwe iileta.

A - iimpawu ngokubanzi kakhulu kwesi sifo hayi.

B - ubukho iimpawu omnye okanye ngaphezulu (lobushushu aluhlaza okwandileyo, ukubila ebusuku, ngokukhawuleza ilahleko weight).

E - nakujoliso olutsha kusebenza ancedisana amalungu ekufuphi kwiindawo nkovu achaphazelekayo.

S - Ingabe sisilonda esidumbileyoesingaphakathi splenic.

X - kukho ukufukuka ngokunzulu ubukhulu.

iintlobo Histological zezifo

Ngokuphathelele isakhiwo zeselula sifo Hodgkin kukho iintlobo-4 zezifo.

1. Nodular sclerosis lymphoma Hodgkin kaThixo - lolona hlobo luqhelekileyo zesi sifo, malunga 40-50% yazo zonke iimeko. Ziyifumana rhoqo abagulayo ngaphezu amabhinqa aselula, abo ubukhulu becala abachaphazelekayo iindawo nkovu le mediastinum. Okubhalwe biopsy, ukongeza kwiiseli Berezovsky-Sternberg nabo iiseli ezinkulu lacunar kunye foamy kukho icytoplasm kunye nuclei ezikhathaza. Ipredikshini kule sifo idla okulungileyo.
2. Lymphohistiocytic lymphoma leyo wambumba-15% le mizekelo. Amaninzi ingafunyanwa kumadoda asematsha phantsi engama-35 ubudala. Kuye kakhulu izinga seminyaka emihlanu-ukusinda eziseleni kwaye limfaitov oqolileyo kunye Shtrenberga. Olu hlobo lwesifo abulalayo encinane duct ukuba sikwinqanaba lokuqala.
3. uhlobo Ludityanisiwe lidla olufunyanwa abadala kunye nabantwana. Ezahlukeneyo iimpawu picture lwezonyango ngazo nento utyekelo ukuba iimeko isenzo. iimviwo Histological kutyhilwa iinguqulelo ezahlukileyo kokufakelwa iseli, kuquka Sternberg. Kufunyenwe ngo-30% ezigulane lymphoma. sclerosis Nodular kule meko iba ALS elungileyo, yaye ukuba unyango ixesha emiselweyo, lelwa ngokuqinileyo lwenzeka ngaphandle iingxaki.
4. granuloma enobungozi ukutshatyalaliswa izihlunu lymphoid kuqatshelwe kungafane, 5% kuphela imizekelo (ingakumbi phakathi abadala). Eyona Uphawu apha kukuba akukho iiseli kwaye ilawulwa iiseli Sternberg. Olu hlobo lymphoma luphawulwa ipesenti lisezantsi ukusinda seminyaka emihlanu.

ekuxilongweni

Lokufunyaniswa "lymphoma" sichazwa kuphela iimviwo histological ye kwiindawo nkovu kunye iphikisane kuphela kwimeko apho iiseli ezikhethekileyo multi-Sternberg sele kufunyenwe ngenxa yale sifundo. Kwiimeko kakhulu kufuneka immunophenotyping. Uhlalutyo Cytological ye esiludumbo nkovu okanye izintso ngokuqhelekileyo okuhlatywa ezincinane ukuqinisekisa sclerosis nodular, uhlobo 1. Yintoni ekufuneka yenziwe ukuba ukumisela lokufunyaniswa kwesifo:

• uvavanyo lwegazi jikelele kunye nemvelo;
• -X-reyi kwemiphunga (mandatory ecaleni kwelivi ngokungqalileyo);
• zamanzi node biopsy;
• ukuhlolwa cuke zonke iintlobo peripheral kunye intraabdominal nkovu iindawo, lengqula, isibindi, yaye udakada;
• CT scan ukuphelisa imperceptible iindawo nkovu mediastinal kwi ray eqhelekileyo;
• biopsy trephine of iliac ithambo ukuthintela lomongo wethambo;
• scan ze-X-reyi ngamathambo.

therapy

Iqulethe unyango imitha, utyando kunye nechemotherapy. Ukukhetha le ndlela ukucwangcisa iqonga izifo kunye nobukho izinto ezintle okanye ezimbi prognostic. Imiba elilungileyo ziquka:

• yasentabeni e histological iimviwo nodular sclerosis, kunye nohlobo lymphohistiocytic;
• yokuguga ngaphantsi kwama-40;
• miqulu zamanzi ukuba ingadluli 6 cm ubukhulu;
• ukungabikho ukwenza izinto eziqhelekileyo impumelelo eziphilayo (uphuhliso indices kwemichiza igazi);
• ubukho akukho iindawo sisilonda esidumbileyoesingaphakathi ngaphezulu kwama-3.

Ukuba awukwazi ubuncinane enye yezi zizathu, ngoko ke isigulane sithunyelwa leqela abane olihlwempu.

therapy radiation

Full radiotherapy njenge indlela ngamnye lisetyenziswa izigulane abanenqanaba IA kunye IIA, kuqinisekiswa laparotomy, nokuba zizinto ezilungileyo prognostic. Oku kwenziwa amasimi sesisa sesichengeni kuzo zonke iintlobo ezalathelwe nkovu ezichaphazelekayo iindinyana nkovu yamanzi.

Inxalenye itotali wendele metastases sisilonda esidumbileyoesingaphakathi yi 40-45 g kwiiveki 4-6 entsimini zokukhanya umbala - 30-40 g nganye kwiiveki 1-4. Kwakhona kunye ubuchule widefield usebenzisa zokukhanya multi-entsimini ezinye izitshanguba ukuthintela nodular sclerosis ns1.

unyango Imitha kungabangela iingxaki ezifana abanesigulo izihlunu ongama, pneumonitis kwemitha kunye pericarditis. Ngokonakala kwenzeka ngamaxesha ezahlukeneyo - ukusuka kwiinyanga ezi-3 ukuya kwiminyaka-5 emva konyango. ukuntsokotha kwawo kuxhomekeke ekusetyenzisweni kwe ithamo.

imisebenzi

unyango Surgical lunqabe kusetyenziswa yedwa onoobychno yinxalenye kwanonyango ezintsonkothileyo. Yenza splenectomy, kwakunye imisebenzi uqhoqhoqho, emphinjeni, nesisu kunye nezinye izigqeba (kunye ingozi zizalwa, akonwabanga sicatshulwa lokutya). Bufunyenwe ngethuba elibaleka chlamydia lokukhulelwa kufuneka ngokuqinisekileyo ayiphazamiseki.

chemotherapy

Le fomu lisetyenziswa eyodwa ye zonyango ezintsonkothileyo. Ukuba aphathe sclerosis nodular, wasebenzisa amalungiselelo ezahlukeneyo:

• sezakhi ( "Vinblastine" okanye "rozevin", "Etoposide" okanye "Vincristine," Oncovin ");
• Alkire umxube ( "Mustargen", "Cyclophosphamide" okanye "embihina", "nitrosomethylurea" okanye "hlorbutin");
• arhente zokwenziwa ( "Natulan" okanye "procarbazine," "Dacarbazine" okanye "Imidazole-carboxamide");
• antitumor antibiotics ( "Bleomycin", "adriablastin").

monochemotherapy

Oku kusetyenziswa kuphela kwiimeko ezizodwa ngenjongo ukutyhilwa. Ngokuqhelekileyo imithi ngaphezulu zidinga unyango kunye ngeendlela ezahlukeneyo isenzo (chemotherapy). Kwinqanaba yesine izigulane abanesifo sesibindi ehlasela okanye lomongo wethambo loo unyango kuphela kwendlela - oku ke Hodgkin lymphoma zoqobo. sclerosis Nodular ziphathwe kumacebo:

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

Therapy yi ngokufutshane (2, 7, kwiintsuku ezili-14) kwizifundo kwizithuba kwiveki ezimbini-. Inani imijikelo iyahluka ngenxa yokuba ubukhulu bezinto sisilonda esidumbileyoesingaphakathi lokuqala susceptibility kunyango. Ngokuqhelekileyo lonke kuxolelwe kwafezwa kagqirha izifundo 2-6. Emva koko, kucetyiswa ukwenza ezinye imijikelo 2 unyango. Ukuba isiphumo waba uxolelo buso, kanti kwirejimeni unyango itshintshiwe, kwaye inani lezifundo ukunyuka.

Reception yi enoxinzelelo amayeza hematopoiesis, alopecia, iimpawu dyspeptic, ikhefu ekupheleni unyango. Nodular sclerosis nangoku kukhokelela iingxaki kade, ezifana nenzalo, leukaemias kunye nezinye ezinezigulo (yamathumba eziziisekondari).

Outlook

isifo Hodgkin ibangelwa iimpawu flow, isigaba kwezonyango sifo, ubudala yomguli, kunye nezinye uhlobo histological. Ahlabayo kwaye subacute ikhosi esi sifo ayisiso ALS elungileyo: izigulane zifa kwisithuba seenyanga 1-3 ukuya kunyaka 1. Kodwa ezingapheliyo chlamydia eliqikelelweyo ngoku kakuhle. Isifo ingahlala ixesha elide kakhulu, ukuya kutsho kwiminyaka eli-15 (kwezinye iimeko ixesha elide).

Ngowe-40% yabo bonke abantu abosulelekileyo, ingakumbi kwi-1 no 2 eqongeni, kwakunye nezizathu entle prognostic, iminyaka engaphezu-10 kunye sisifo ezininzi kwaqwalaselwa. Ukukwazi ukusebenza ngenxa ubude kuxolelwe uqhawulwe.

ukuvimbela

Ngokuqhelekileyo, oko mayibhekiswe yokuthintela likakade. Izigulane Hodgkin kuhlolwa somdlavuza lemithi. Kweso sifundo, nto leyo kwiminyaka yokuqala-3 ekufuneka wenziwe rhoqo emva kweenyanga ezintandathu, kwaye ke kanye ngonyaka, kufuneka unikele ingqalelo ukusebenza lwezibonisi zebhayoloji badla zimpawu kokuqala ukuphinda (ukunyuka kwizinga lwefibrinogen kunye globulin, pops kwandisa). Ezinesifo physiotherapy Hodgkin kaThixo eziyingozi thermal, nobushushu kunye elihlala livelile ngqo. ukwanda esekwe inani likakade ngenxa lokukhulelwa.

Ngoku ukuba abantu abaninzi bayazi ukuba lymphoma Hodgkin kaThixo - a sclerosis eyongeziweyo lobeko nodular, nto leyo a zingambi kakhulu, kwaye kunzima ukunyanga izifo.