Gargajiya Hodgkin lymphoma: nodular sclerosis

Nodular sclerosis - a histological iri-iri na Hodgkin ta cuta, halin da m girma na connective nama, rarraba da taro na irregularly dimbin yawa Kwayoyin da lobules. Sun ƙunshi overgrown lymphoid al'amari tare da wata babbar dama Berezovsky-Sternberg Kwayoyin. Haka kuma cutar ta fara da karuwa daga nodes. Wannan Pathology ne daya daga cikin bambance-bambancen karatu na gargajiya Hodgkin ta lymphoma.

Hodgkin ta cuta ne dauke da wani tsanani rashin lafiya cewa rinjayar da lymphatic tsarin. A cuta na iya samar da ko'ina a cikin jiki, da cewa yana da lymphoid kyallen takarda (thymus, tonsils, saifa, kuma adenoids al.).

Nodular sclerosis cututtuka

Hodgkin ta lymphoma iya zama wani mutum, idan ya na da irin wannan cututtuka kamar:

• nauyi asara.
• Kumbura Lymph nodes (akai-akai a sashi daga cikin wuyansa).
• asarar ci.
• shortness na numfashi;
• rika zufa da dare ko da yawan zafin jiki.
• ciwon kirji.
• kara girman hanta (5% da marasa lafiya) ko baƙin ciki (30% da marasa lafiya).
• nauyi ko jin zafi a ciki (a cikin yara).
• itchy fata (kawai 1/3 na mutanen da ke fama da rashin lafiya).
• wuya numfashi.
• tari.

dalilai

Hodgkin ta cutar za a iya ƙulla a kowane zamani, amma mafi sau da yawa shi ya auku a cikin matasa maza a cikin shekaru category na 16 zuwa shekaru 30 da haihuwa, ko a tsofaffi mutane fiye da shekaru 50. Yara har zuwa 5 shekaru, kusan ba su samu lafiya. Me daidai triggers wannan cuta ne har yanzu ba a sani ba. Duk da haka, akwai wani zato cewa tushen - ƙwayoyin cuta. An yi imani da cewa hanyar da wannan rashin lafiya zai iya fara:

• immunodeficiency.
• dauke da kwayar cutar mononucleosis (m da Epstein-Barr virus).

Nodular sclerosis Hodgkin ta lymphoma iya tafi nan take, na karshe daga 3 zuwa 6 watanni, ko na karshe domin shekaru 20.

Abin da mataki yana da cuta?

Degree hodzhinskoy lymphoma m daga dakin gwaje-gwaje da bincike da a kan tushen da wadannan Manuniya:

• da yawan shafa Lymph nodes, kazalika da wuri.
• samuwan data nodes a fagage daban-daban na diaphragm.
• marurai a sauran gabobin (msl, hanta ko baƙin ciki).

A mataki na farko. A wannan yanayin shafa daya kawai Lymph kumburi ko lymphoid sashin jiki (baƙin ciki, zobe Pirogov-Valdera).

A mataki na biyu. Akwai yawanci mamaki Lymph nodes a garesu daga cikin kirji, diaphragm, kuma lymphoid gabobin.

The uku mataki. Wannan mataki Hodgkin wuya ya bambanta daga mataki na biyu. Duk da haka, shi yana da nau'o'i biyu na nodular sclerosis uku mataki:

• a farko idan ana shafa gabobin located kasa da diaphragm (celiac Lymph nodes, saifa).
• Baya ga yankunan da aka jera a cikin na farko iri-iri, har yanzu mamakin, da sauran wurare tare da Lymph nodes dake kusa da diaphragm.

A karo na hudu mataki. Ana rinjayar ba kawai da aka gyara, amma kuma ba lymphoid gabobin - bargo, hanta, kasusuwa, huhu da kuma fata.

Zane-zane da darajõji Hodgkin ta lymphoma

Index na asibiti halin da ake ciki da kuma mai tsanani da cuta hanya na sauran tsokoki da kuma gabobin da aka alama tare da haruffa.

A - tsanani janar bayyanar cututtuka da cutar ba.

B - gaban daya ko fiye cututtuka (tushe da karin yawan zafin jiki, ya kuma rika zufa da dare, m nauyi asara).

E - foci shafi tsokoki da kuma gabobin dake kusa da shafa Lymph nodes.

S - Shin splenic rauni.

X - akwai wani tsanani kumburi na babban size.

Histological iri cuta

Game da salon salula tsarin Hodgkin ta cuta ne 4 siffofin ailments.

1. Nodular sclerosis Hodgkin ta lymphoma - ya fi na kowa nau'i na cuta, game da 40-50% na duk lokuta. Suna samun rashin lafiya mafi sau da yawa fiye da mata matasa, wanda su ne yafi shafa Lymph nodes na mediastinum. A biopsy abu, ban da Berezovsky-Sternberg Kwayoyin ne ma manyan lacunar Kwayoyin tare da foamy cytoplasm da kuma yin la'akari nuclei. Hasashen a wannan cuta ne yawanci kyau.
2. Lymphohistiocytic lymphoma wanda kafa 15% na misalai. Mafi sau da yawa shi za a iya samu a samari karkashin shekaru 35 da haihuwa. Shi yana da wani m shekara biyar rayuwa kudi na Kwayoyin, kuma yana da balagagge limfaitov da Shtrenberga. Wannan irin cuta da kananan m da taped shi a matakin farko.
3. Hada jinsin aka yawanci kamu a cikin tsofaffi da yara. Daban-daban halayyar hankula na asibiti hoto da kuma hali magana take da mataki. Histological jarrabawa saukar daban-daban versions na cell sadarwa, gami da Sternberg. Samu a 30% na marasa lafiya da lymphoma. Nodular sclerosis a wannan yanayin yana da wani gwada da kyau hangen nesa, kuma idan lokacin jiyya da aka wajabta, da m gafarar auku ba tare da matsaloli.
4. M granuloma halakar lymphoid nama lura infrequently, kawai 5% daga cikin misalai da (mafi yawa daga cikin tsofaffi). A halayyar alama a nan shi ne cewa akwai wani sel da aka mamaye Sternberg Kwayoyin. Wannan nau'i na lymphoma halin da magangara mafi ƙasƙanci kashi na shekaru biyar-biyar rayuwa.

bincikowa da

A ganewar asali da "lymphoma" aka bayyana ne kawai ta hanyar histological jarrabawa na Lymph nodes da za a tsaya takara kawai a cikin akwati inda na musamman Multi-Sternberg Kwayoyin an samu a sakamakon wannan binciken. A tsanani lokutta bukatar immunophenotyping. Cytological bincike na Lymph kumburi ko kodan yawanci kananan huda tabbatar nodular sclerosis, irin 1. Me ake bukatar a yi su tsayar da cutar da cutar:

• janar da kuma biochemical jini gwajin.
• X-haskoki daga cikin huhu (m, a gefe kuma frontal tsinkaya).
• Lymph kumburi biopsy.
• ultrasonic dubawa, daga dukan nau'i na gefe da kuma intraabdominal Lymph nodes, thyroid, hanta, da kuma baƙin ciki.
• CT scan don kawar da imperceptible mediastinal Lymph nodes a al'ada radiography.
• trephine biopsy na iliac kashi hana bargo.
• duba da X-haskoki ƙasũsuwa.

far

Ya ƙunshi radiation far, tiyata da jiyyar cutar sankara. Zabi hanyar zuwa saita mataki na rashin lafiya da kuma gaban tabbatacce ko korau prognostic dalilai. The m dalilai sun hada da:

• tapped a histological jarrabawa nodular sclerosis, kuma lymphohistiocytic irin;
• tsufa da kasa da shekaru 40.
• kundin Lymph nodes cewa kada ku ƙẽtare 6 cm a diamita.
• rashin kowa manifestations na nazarin halittu tasiri (aukuwa biochemical fihirisa na jini).
• gaban wani fiye da 3 rauni wurare.

Idan ka yi ba a kalla daya daga wadannan dalilai, sa'an nan da mãsu haƙuri ake da kungiyar tare da matalauta hangen nesa.

radiation far

Cikakken radiotherapy matsayin mutum Hanyar da ake amfani da marasa lafiya da mataki IA da IIA, ya tabbatar a laparotomy, da kuma ciwon mai kyau prognostic dalilai. An sanya free filayen tare da daukan hotuna zuwa duk iri shafi Lymph nodes kuma Lymph magudanun Tsarki.

Rabo daga cikin jimlar tunawa a metastases rauni ne 40-45 g for 4-6 makonni a cikin filin na prophylactic sakawa a iska mai guba - 30-40 g 1-4 makonni. Har ila yau, tare da widefield dabaru amfani da Multi-filin sakawa a iska mai guba na wasu raunuka a hana nodular sclerosis ns1.

Radiation magani iya haifar da rikitarwa kamar subcutaneous nama fibrosis, radiation pneumonitis da pericarditis. Tabarbarewar faruwa a daban-daban lokaci - daga watanni 3 zuwa 5 bayan shekara magani. Su rikitaccen dogara da yin amfani da kashi.

yadda ake gudanar da

M magani ne da wuya amfani da shi kadai onoobychno ne wani ɓangare na wani hadadden far. Yi splenectomy, kazalika da yadda ake gudanar a kan trachea, da esophagus, da ciki da kuma sauran gabobin (tare da hadarin asphyxia, tada da nassi na abinci). Gano a lokacin gudãna chlamydia ciki ya kamata ka shakka a katse.

jiyyar cutar sankara

Wannan nau'i ake amfani da matsayin daya bangaren na hadaddun magani. Don bi nodular sclerosis, amfani da daban-daban shirye-shirye:

• alkaloids ( "Vinblastine" ko "rozevin", "Etoposide" ko "Vincristine," Oncovin ");
• Alkire cakuda ( "Mustargen", "Cyclophosphamide" ko "embihina", "nitrosomethylurea" ko "hlorbutin");
• roba jamiái ( "Natulan" ko "procarbazine," "Dacarbazine" ko "Imidazole-carboxamide");
• antitumor maganin rigakafi ( "Bleomycin", "adriablastin").

monochemotherapy

Ana amfani ne kawai a lokuta na musamman tare da dalili na bayyananniyar. Yawanci mafi medicaments bukatar far da daban-daban inji na mataki (jiyyar cutar sankara). A karo na hudu mataki a cikin marasa lafiya da yaxuwa cutar hanta ko bargo irin wannan magani ne kawai hanya - wannan ne na gargajiya Hodgkin lymphoma. Nodular sclerosis bi da tare da irin wannan makirci:

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

Far ne a takaicce (2, 7, 14 days) Darussan da biyu-mako jinkiri. Yawan hawan keke dabam saboda girma da na farko rauni da laulayi magani. Yawancin dukan gafarar cimma tare da sayen magani 2-6 darussa. Bayan da cewa, shi ne shawarar yin kara 2 hawan keke na far. Idan sakamakon da aka m gafarta musu, alhãli kuwa da magani regimen aka canja, da kuma yawan darussa ƙaruwa.

Yanayin aiki ne matsa magani hematopoiesis, alopecia, dyspeptic cututtuka, wanda bar a karshen magani. Nodular sclerosis har yanzu take kaiwa zuwa marigayi rikitarwa, kamar rashin haihuwa, leukaemias da sauran malignancies (secondary marurai).

Outlook

Hodgkin ta cuta ne ya sa ta kwarara halaye, asibiti mataki na cuta, shekaru na haƙuri, da sauran histological irin. Tare da kaifi da kuma subacute hanya da cuta ne ba mai kyau hangen nesa: marasa lafiya yawanci mutu a wani lokaci na 1-3 watanni to 1 shekara. Amma a kullum chlamydia forecast yanaye positive. Cutar na iya wuce wa mai dogon lokaci, har zuwa shekaru 15 (a wasu lokuta ya fi tsayi).

A 40% na dukkan kamuwa da mutane, musamman a cikin 1st da 2nd mataki, kazalika da m prognostic dalilai, domin a shekaru 10 da kuma fiye da recurrences aka lura. Ability don aiki a sakamakon tsawon lokaci na gafarta musu ba karye.

rigakafin

Kamar yadda mai mulkin, shi ne zuwa ga rigakafin, komowan cutar. Marasa lafiya da Hodgkin a binciki dispensary oncologist. A cikin binciken, wanda shi ne na farko shekaru 3 da ake bukata domin a za'ayi kowane watanni shida, sa'an nan sau daya a shekara, kana bukatar ka mayar da hankali a kan tasiri na nazarin halittu Manuniya sau da yawa ne na farko ãyõyin komawa (karuwa a matakin na fibrinogen da globulins, baba kara). Marasa lafiya da Hodgkin ta cutar cutarwa thermal physiotherapy, zafi fiye da kima da kuma kai tsaye insolation. Kafa karuwa a yawan dakwai, komowan cutar saboda ciki.

To, lalle ne, mutane da yawa san cewa Hodgkin ta lymphoma - wani bambanci nodular sclerosis, wanda shi ne mai matukar m, kuma da wuya mu bi cutar.