Classic Hodgkin lymphoma: nodular sclerosis

Nodular sclerosis - e histological mefuta e fapaneng ya lefu Hodgkin e, e tšoauoa ka sa kgolo ya le letšo-letšo la dinama tse nyenyane tse connective, arola le boima ba lisele tse irregularly e bōpehileng joaloka le lobules. Ba na le overgrown lymphoid taba le palo e khōlō ea lisele Berezovsky-Sternberg. Lefu lena le e qala ka ho eketseha ha nodes. bolwetse ena ke e 'ngoe ea variants ea lymphoma classic Hodgkin e.

lefu Hodgkin e ho nkoa e boloetse bo tebileng boo bo amang tsamaiso lymphatic. Lefu lena le ka 'na theha kae kapa kae ka' mele, e nang le lisele tse lymphoid (thymus, tonsils, spleen le adenoids a al.).

Nodular sclerosis le matšoao

lymphoma Hodgkin e ka ba motho, haeba a ena le matšoao a kang:

• boima ba 'mele;
• Ruruha lisele tsa mmele nodes (hangata ka libaka tsa molaleng);
• tahlehelo ea takatso ea lijo;
• bokhutšoanyane phefumoloho;
• bosiu fufuleloa kapa mocheso;
• bohloko sefubeng;
• atolositsoeng sebete (5% ea bakuli) kapa spleen (30% ea bakuli);
• Boima kapa bohloko ka mpeng (bana);
• itchy letlalo (feela 1/3 tsa batho ba nang ho kula);
• thata ho hema;
• khohlela.

mabaka a

lefu Hodgkin ya ka tumellano ha a le lilemo leha e le efe, empa hangata ka ho fetisisa e le hlaha ka ba batona ba bacha ba lilemo dihlopha tsa lilemo tse 16 ho tse 30 tsa lilemo, kapa ka batho ba hōlileng ba fetang lilemo tse 50. Bana ho fihlela ho lilemo tse 5, hoo e ka bang ha ba kula. Hantle-ntle ho etsa hore le lefu lena e ntse e le e sa tsejoeng. Leha ho le joalo, ho na le khopolo ea hore mohloli - likokoana-hloko. Ho lumeloa hore sesosa sa boloetse lena le ka qala:

• immunodeficiency;
• tšoaetsanoang mononucleosis (thabile ke Epstein-Barr kokoana-hloko).

Nodular sclerosis lymphoma Hodgkin o ka tsamaea hang-hang, ho qetela ho tloha likhoeli tse 3 ho 6, kapa ho qetela bakeng sa dilemo tse 20.

Seo sethaleng o na le lefu lena?

Lengolo la hodzhinskoy lymphoma ikemiselitse ho tloha lithuto tsa laboratori, le ka lebaka la ho litsupa latelang:

• palo ea ameha nodes lisele tsa mmele, hammoho le sebaka se bona;
• fumaneha ha nodes ya data libakeng tse fapaneng tsa diaphragm ea;
• lihlahala ka makala a mang (mohlala, sebete kapa spleen).

Mokhahlelo oa pele. Tabeng ena ameha le 'ngoe feela lisele tsa mmele noute kapa lymphoid lekala (spleen, lesale Pirogov-Valdera).

Mokhahlelo oa bobeli. Ho na le hangata ka hlolloa lisele tsa mmele nodes ka mahlakoreng a mabeli a litho tsa ka hare sefubeng, diaphragm, le lymphoid.

Mokhahlelo oa boraro. Sena Hodgkin isa tekanyong hang fapane le ho ba sethaleng bobeli. Leha ho le joalo, ho na le mefuta e 'meli ea nodular sclerosis sethaleng boraro:

• tabeng ea pele ba angoa makala teng ka tlase ho diaphragm (nodes celiac lisele tsa mmele, spleen);
• ho phaella ho tse boletsoeng ka ka tse fapa-fapaneng la pele, a ntse a hlolloa, 'me libaka tse ling le nodes ya lisele tsa mmele haufi diaphragm ena.

Mokhahlelo oa bone. E ama metsoako e seng feela, empa hape bao e seng lymphoid makala - lesapo moko, sebete, masapo, matšoafo le letlalo.

Litlotla likhato lymphoma Hodgkin e

Index boemo ea tleleniki le ho tiea tsa 'nete hore lefu le tsa lisele tse ling le litho tsa ka hare e tšoailoe ka mangolo.

A - haholo kakaretso matšoao a lefu lena le ha ho joalo.

B - ho ba teng ha matšoao a le 'ngoe kapa ho feta (se nang motheo e se e eketsehile mocheso, ho fufuleloa bosiu, ka potlako boima ba' mele).

E - foci sebetsa ho lisele tse le ho makala haufi le ba anngoeng le nodes lisele tsa mmele.

S - Na splenic lethopa.

X - ho na le ke ho ruruha ka botebo boholo haholo.

Mefuta Histological ea lefu

Mabapi le sebopeho sa lisele tsa lefu Hodgkin li 4 mefuta e meng ea ho kula.

1. Nodular sclerosis lymphoma Hodgkin e - ho atileng ka ho fetisisa mofuta o mong oa lefu lena le, ka 40-50% ya maemong 'ohle. Ba fumana kula hangata ho feta basali ba bacha, ba neng ba haholo-holo bao e ba ammeng lisele tsa mmele nodes ya mediastinum ena. The biopsy lintho tse bonahalang, ho phaella ho lisele tse Berezovsky-Sternberg boetse ho na le e kholo lacunar lisele tse le foamy cytoplasm le bekha nuclei. Bolela lintho esale pele ka lefu lena hangata molemo.
2. Lymphohistiocytic lymphoma eo thehoa 15% ea mehlala eo. Hangata ka ho fetisisa e ka fumanoa bahlankana tlas'a lilemo li 35. Ho na le o babatsehang ea lilemo tse hlano ho pholoha lebelo la lisele le na le limfaitov ba hōlileng tsebong 'me Shtrenberga. Ea mofuta ona e lefu le bolaeang tse nyenyane le tse rekotoa ho eona ka mekhahlelo e ka lekhetlo la pele.
3. Kopantswe mefuta hangata fumanoa ka batho ba hōlileng le ho bana. Fapaneng bath tloaelehileng litleleniki tsa setšoantšong le tšekamelo ea ho generalize ketso. Histological tlhlahlobo senola version e fapaneng ya dikgokelo seleng ea, ho akarelletsa le Sternberg. Fumanoa ka 30% ea bakuli le lymphoma. Nodular sclerosis tabeng ena e na le itse'ng batlang e le molemo, 'me ha ho kalafo nako e hlophisitsweng, le bolelang ho leballa motho ba tiile le hlaha ka ntle ho mathata.
4. Kotsi granuloma timetso ea dinama tse nyenyane tse lymphoid boletsoe infrequently, feela 5% ea mehlala ea (boholo har'a batho ba hōlileng). A tsobotsi bath mona ke hore ha ho na lisele le e laoloa ke lisele tse Sternberg. mofuta ona oa lymphoma tšoauoa ka peresente ya tlaase-tlaase tsa ho pholoha ea lilemo tse hlano.

tlhathoba

The phumano ya "lymphoma" e hlalosoa feela ka ho hlahloba ka histological tsa nodes lisele tsa mmele le ho hanyetsa feela tabeng ea moo e khethehileng lisele tse selotlolo Sternberg 'nile ha fumanoa e le lebaka la ho ithuta hona. Maemong a matla hloka immunophenotyping. Cytological and analysis ea lisele tsa mmele noute kapa liphio hangata nyane puncture ho netefatsa sclerosis nodular, mofuta 1. Seo lokelang ho se etsa ho tiisa le phumano ya lefu lena:

• kakaretso le skeletal teko ea mali;
• X-ray tsa matšoafong (e tlamang ka lehlakoreng le tse tobileng boqapi);
• lisele tsa mmele noute biopsy;
• galena hlahloba mefuta eohle ea pheriferale le intraabdominal lisele tsa mmele nodes, thyroid, sebete le spleen;
• CT scan ninemanga.com ho felisa imperceptible mediastinal lisele tsa mmele nodes ka radiography tloaelehileng;
• trephine biopsy tsa iliac lesapo ho thibela lesapo moko;
• Scan le X-ray masapo.

phekolo

E na le mahlaseli a phekolo, ho buuoa le chemotherapy. Khetha tsela ea ho beha ho ba sethaleng sa boloetse le ho ba teng ha lintlha-positive kapa mpe prognostic. Mabaka a molemo a kenyeletsa:

• ile ka kokota: ka histological tlhlahlobo nodular sclerosis, 'me lymphohistiocytic mofuta;
• hōla ka tlase ho lilemo tse 40;
• meqolo lisele tsa mmele nodes hore u se ke ua feta cm, 6 le bophara;
• ho hloka liponahatso le tloaelehileng la ho atleha tsa likokoana-hloko (liphetoho tsa indices skeletal mali);
• ho ba teng ha ho na libaka tse fetang 3 lethopa.

Ha o se ke la etsa bonyane e mong oa mabaka ana, joale ba le mamello le ho buuoa ho sehlopha ka itse'ng mafutsana.

phekolo mahlaseli

Feletseng radiotherapy e le mokhoa motho e sebediswa bakeng sa bakuli ba le sethaleng IA le IIA, o ile a tiisa ho laparotomy, 'me le e ntle lintlha prognostic. E e etswa masimo a lokolohile le ho pepesehela tsohle mefuta ya ameha nodes lisele tsa mmele le litemana lisele tsa mmele drainage.

Karolo e itseng ea kakaretso ea ikakhela ka setotsoana metastases lethopa ke 40-45 g, ka libeke tse 4-6 tšimong ea ts'ebetso ea ho lelefatsa bophelo ba lijo prophylactic - 30-40 g, ka ho ya ka libeke tse 1-4. Hape le dithekeniki widefield sebelisa selotlolo tšimo ts'ebetso ea ho lelefatsa bophelo ba lijo tsa diso tse ling ho thibela nodular sclerosis ns1.

Mahlaseli kalafo ho ka baka mathata a kang dinama tse nyenyane tse subcutaneous fibrosis, mahlaseli pneumonitis le pericarditis. Senyeha etsahala nako e fapaneng - ho tloha likhoeli tse 3 ho lilemo tse 5 mora kalafo. rarahana bona e itšetlehile ka ho sebelisa lethal dose.

tshebetso

Ho buoa kalafo ke ka seoelo sebediswa feela onoobychno ke karolo ea phekolo e rarahaneng. Phetha splenectomy, hammoho le tshebetso ka trachea, ea metso, ka mpa 'me litho tsa ka hare tse ling tse (le kotsing ea ho asphyxia, ferekanya temana lijo). Sibolloa ka nako e phallang chlamydia bokhachane lokela ho sebele ho sitisoa.

phekolo ea lik'hemik'hale

foromo ena e sebelisoa e le motsoako o mong oa kalafo rarahaneng. Ho tšoara sclerosis nodular, sebelisoa litokisetso fapaneng:

• alkaloids ( "Vinblastine" kapa "rozevin", "Etoposide" kapa "Vincristine," Oncovin ");
• Alkire motsoako ( "Mustargen", "Cyclophosphamide" kapa "embihina", "nitrosomethylurea" kapa "hlorbutin");
• mahlahana a maiketsetso ( "Natulan" kapa "procarbazine," "Dacarbazine" kapa "Imidazole-carboxamide");
• antitumor lithibela-mafu ( "Bleomycin", "adriablastin").

monochemotherapy

E e sebediswa feela maemong a khethehileng ka morero oa ho senoloa. Ka tloaelo ho medicaments ho feta hlokang phekolo ka mochine e fapaneng ya bohato (phekolo ea lik'hemik'hale). Ka ho ba sethaleng bone ka bakuli ba lefu diffuse sebete kapa lesapo moko kalafo joalo ke tsela feela - sena ke khale Hodgkin lymphoma. Nodular sclerosis tšoaroa ka merero e joalo:

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

Phekolo e ka bokhutšoanyane (2, 7, matsatsi a 14) dithuto ka dikgao tsa libeke tse peli. palo ea lipotoloho tse fapana ka lebaka la boholo ba lethopa ka lekhetlo la pele 'me susceptibility ho kalafo. Hangata e bolelang ho leballa motho kaofela fihlellwa le lengolo la ngaka 2-6 dithuto. Ka mor'a moo, e kgothaletswa ho etsa ho eketsehileng 2 lipotolohong tsa phekolo. Ha Phello e bile leeme kokobetse, athe kalafo Melao e fetohile, 'me palo ea dithuto eketseha.

Baeti ba fihlelang ho ke pressurized meriana hematopoiesis, alopecia, matšoao dyspeptic, e siea qetellong ea phekolo. Nodular ntse sclerosis isang mathata ka mor'a nako, tse kang ho kgaolela basadi thari, leukaemias le malignancies tse ling (lihlahala mahareng).

pono

lefu Hodgkin o ile a etsa hore ke litšobotsi phallo, litleleniki tsa sethaleng sa lefu lena, ea lilemo li ba le mamello, 'me tse ling tse histological mofuta. Ka tsela e hlabang le subacute ea lefu lena le ha e itse'ng molemo: bakuli ba hangata shoa ka nako ya dikgwedi 1-3 ho 1 selemo. Empa sa foleng chlamydia prognoza tlas'a maemo a matle. Lefu lena le ka ba teng ka bakeng sa nako e telele haholo, ho fihlela ho lilemo tse 15 (ka linako tse ling e telele).

Ka 40% ea batho bohle ba nang le tšoaetso, haholo-holo ka ho ba sethaleng 1st le 2nd, hammoho le ka mabaka a tšoanelang prognostic, ka lilemo tse fetang 10 lilemo tse 'me recurrences ho feta ba ile ba o ile a hlokomela. Matla a ho sebetsa ka lebaka la ho nako ya ho leballa motho hase robehile.

thibelo

E le busa, e lebisoa ho ho thibela relapses. Bakuli ba Hodgkin ho hlahloba dispensary oncologist. Ka ho ithuta, e leng ea pele lilemo tse 3 e hlokehang ho ho phethahatsoa mong le o mong ka likhoeli tse tšeletseng, 'me joale hang ka selemo, u lokela ho nahana ka ho atleha ha litsupa likokoana-hloko hangata o ne a ke matšoao pele ea boipheto (keketseho ea boemo ba fibrinogen le globulin, Pops eketsa). Bakuli ba Hodgkin ya lefu le kotsi mogote ea physiotherapy, overheating le insolation tobileng. Thehilwe keketseho palong ea relapses ka lebaka la ho ima.

Hona joale batho ba ka sebele ba bangata ba tseba hore Hodgkin o lymphoma - e fapaneng nodular sclerosis, eo ke sa thabiseng haholo le thata ho phekola maloetse.