Lymphoma Hodgkin Qadiimiga ah: sclerosis nodular

sclerosis nodular - noocyo kala duwan oo histological ee cudurka Hodgkin, waxa lagu gartaa koritaanka ah oo cufan oo ah unugyo, qaybintii mass unugyada caadi ahayn qaabeeya iyo lobules. Waxay ka kooban yihiin arrinta lymphoid baxda tirada weyn ee unugyada Berezovsky-Sternberg. Cudurku wuxuu ku bilaabmaa kororka of qanjidhada. cudurada Tani waa mid ka mid ah Lahjadaha of lymphoma classical Hodgkin.

cudurka Hodgkin waxaa loo arkaa hadyada meejeeda, halisa oo ku dhaca nidaamka durey. Cudurku wuxuu aasaas u noqon karaan meel kasta oo jidhka, in uu leeyahay unugyada lymphoid (thymus, qumanka, beeryarada iyo adenoids al.).

Nodular scleros calaamadaha

lymphoma Hodgkin noqon kartaa qof, haddii waxa uu leeyahay astaamo sida:

• miisaanka oo yaraada;
• qanjidhada oo barara (si joogta ah aaga ay of qoorta);
• rabitaanka cuntada oo luma;
• neefta oo ku qabata;
• dhidid ama heerkulka habeenkii,
• feedho xanuun,
• beerka weyneyn (5% bukaannada) ama beeryarada (30% bukaannada);
• caloolxumo ama xanuun caloosha (carruurta);
• maqaarka cuncun leh (oo kaliya 1/3 dadka qaba cudur);
• neefsiga oo ku adag,
• qufacdo.

sababaha

cudurka Hodgkin la qandaraas karaa da 'kasta, laakiin inta badan waxay dhacdaa ragga dhallinyarada ah ee category da'da 16 ilaa 30 sano jirka ah ama dadka waayeelka ka weyn 50 sano. Caruurta ilaa 5 sano, ku dhowaad aanay u bukoon. Waxa ay dhab ahaan ku kicin kara cudurkan weli la ogeyn. Si kastaba ha ahaatee, waxaa jira malo ah in isha - fayrusyada. Waxaa la rumeysan yahay in sababta meejeeda this bilaabi kartaa:

• difaaca,
• mononucleosis faafa (faraxsan virus Epstein-Barr).

Nodular scleros lymphoma Hodgkin ee isla tegi karo, la soo dhaafay 3 ilaa 6 bilood, ama ugu danbeysay ee muddo 20 sano ah.

Maxaa marxaladda uu leeyahay cudurka?

lymphoma hodzhinskoy Degree go'aamiyo ka cilmiga shaybaarka iyo ku saleysan oo ka mid ah tilmaamayaasha soo socda:

• tirada qanjidhada saameeyeen, iyo sidoo kale ay goobta;
• helitaanka xogta qanjidhada qaybaha kala duwan ee diaphragm ka,
• burooyinka in xubnaha kale (tus, beerka ama beeryarada).

Wejiga kowaad. Xaaladdan oo kale ay saameeyeen oo keliya mid ka mid ah Guntin lymph ama xubin lymphoid (beeryarada, giraanta Pirogov-Valdera).

Heerka labaad. Badanaa waxaa jira qanjidhada yaabeen labada dhinac oo ka mid ah xubnaha xabadka, diaphragm, iyo lymphoid.

Heerka saddexaad. Tani degree Hodgkin si dhib leh ka duwan marxaladda labaad. Si kastaba ha ahaatee, waxa uu leeyahay laba nooc oo ah marxaladda saddexaad sclerosis nodular:

• in qofkii ugu horreeyey ee saameeyo xubnaha hoos ku diaphragm ku yaal (qanjidhada cøliaki, beeryarada);
• marka lagu daro goobaha ay ku qoran kala duwan ugu horeysay, weli yaabeen, iyo meelaha kale ee la mergiga ku yaalla meel u dhow diaphragm ka.

Marxaladda afaraad. Wuxuu saameeyaa ma aha oo kaliya ka kooban, laakiin sidoo kale xubnaha aan lymphoid - dhuuxa lafta, beerka, lafaha, sambabada iyo maqaarka.

Tilmaamood fashay lymphoma Hodgkin

Index xaaladda caafimaad iyo darnaanta dabcan cudurka unugyada iyo xubnaha kale ee la calaamadeeyay warqadihii.

A - calaamadaha guud daran cudurka ma.

B - joogitaanka mid ama ka badan calaamadaha (heerkulka soo kordha aan sal lahayn, dhidid habeenkii ah, miisaanka si degdeg ah khasaaro).

E - Axdigu codsan unugyada iyo xubnaha ku yaal meel u dhaw qanjidhada saameysey.

S - Leh nabar splenic.

X - waxaa jira barar halis ah oo size weyn.

noocyada Histological cudurka

Ku saabsan qaab dhismeedka gacanta cudurka Hodgkin waa 4 nooc oo nno.

1. Nodular scleros lymphoma Hodgkin - nooca ugu badan ee cudurka, oo ku saabsan 40-50% ee kiisaska oo dhan. Waxay ku xanuunsadaan inta badan haweenka dhallinyarada ah, kuwaas oo inta badan waa ay dhibaatadu saameysey qanjidhada of mediastinum ah. wax biopsy The, marka lagu daro unugyada Berezovsky-Sternberg sidoo kale unugyada lacunar ballaaran leh cytoplasm foamy iyo nuclei ah oo miisaankeedu yahay. Saadaasha in cudurkan uu yahay inta badan wanaagsan.
2. Lymphohistiocytic lymphoma oo la sameeyey 15% tusaalooyin ah. Inta badan waxaa laga heli karaa rag da'doodu ka yar tahay 35 sano jir. Waxay leedahay heerka badbaadista u fiican oo shan sanno ah unugyada oo uu leeyahay limfaitov a baaluq iyo Shtrenberga. Noocan ah cudurka la yar malignant iyo waxa duubay ku jira marxaladaha hore.
3. noocyada la isku daro waxaa inta badan laga helay ee dadka waayeelka ah iyo carruurta. sawir oo kala duwan sifo la mid ah rugaha caafimaadka iyo u janjeera in ay guud tallaabada. Baaritaanka Histological shaaca ka qaaday versions kala duwan oo xiriir gacanta, oo ay ku jiraan Sternberg. Helay 30% bukaannada qaba lymphoma. sclerosis nodular kiiskan ayaa saadaal ka yara wanaagsan, iyo haddii daaweyn wakhtiga waa la soo qoray, dembidhaafkooda adag dhacdaa dhibaato la'aan.
4. granuloma Halista qabsiyada xusay burburinta ah unugyada lymphoid, kaliya 5% ka mid ah tusaalayaal ah (inta badan ka mid ah dadka waayeelka ah). halkan feature A caan ku yahay in ay jiraan unugyada lahayn oo waxaa ku badan unugyada Sternberg. Qaabkan lymphoma lagu gartaa boqolkiiba ugu hooseeya ee ay noloshoodu shan sanno ah.

Baadhista xanuunada

ogaanshaha ah "lymphoma" waxaa lagu qeexaa oo keliya by baaritaan histological ee qanjidhada iyo in la isku haysto oo kaliya in kiiska halkaas oo unugyada gaarka ah multi-Sternberg ayaa laga helay iyadoo ay sabab u daraasaddan. Xaaladaha daran u baahan immunophenotyping. Falanqaynta Cytological of Guntin lymph ama kelyaha sida caadiga ah dalool yar si loo xaqiijiyo sclerosis nodular, type 1. Maxaa loo baahan yahay in la sameeyo si loo ogaado cudurka cudurka:

• baaritaanka dhiigga iyo guud lagmamaarmaanna;
• X-rays ee sambabada (khasab ah in kooxda ka dhisan iyo qiyaas aad kaliga);
• dheecaanka biopsy Guntin;
• kormeerka ultrasonic of dhammaan noocyada durugsan iyo intraabdominal qanjidhada, thyroid, beerka, iyo beeryarada,
• CT scan si loo baabi'iyo qanjidhada dismo lymph mediastinal in raajada caadiga ah,
• biopsy trephine ee lafta iliac si looga hortago dhuuxa lafta,
• iskaan iyo X-rays lafaha.

therapy

Waxaa ku jira Dawaynta ilayska, qalliin iyo chemotherapy. Xulashada jidka loo gogol xaadhayaa ee hadyada meejeeda, iyo joogitaanka arrimood prognostic togan ama taban. Sababaha wanaagsan waxa ka mid ah:

• taabtay at histological sclerosis nodular baaritaanka, iyo nooca lymphohistiocytic;
• gabowdid ka yar 40 sano;
• Muga dheecaanka qanjidhada in aan ka badnayn 6 cm dhexroor,
• la'aanta daliilka caadiga ah ee waxtarka noolaha (horumar indices lagmamaarmaanna u ah dhiig);
• joogitaanka aan ka badnayn 3 goobood oo nabar.

Haddii aad ee aan ugu yaraan mid ka mid ah sababahaas, markaas qofka bukaanka ah waa in loo gudbiyaa kooxda saadaal miskiin ah.

Dawaynta ilayska

Full radiotherapy hab u gaar ah waxaa loo isticmaalaa bukaannada qaba stage IA iyo IIA, ayaa xaqiijiyay at laparotomy, oo ah arrimo prognostic wanaagsan. Waxaa la sameeyey beeraha free la gaadhista nooc kasta oo qanjidhada saameeyeen iyo meelihii dheecaan lymph.

Qayb ka mid ah wadarta guud ee nuugo in nabar metastases waa 40-45 g 4-6 todobaad oo duurka ku jaho profilatikada - 30-40 g halkii 1-4 todobaad. Sidoo kale la farsamooyinka widefield isticmaalaya cindiga multi-field of lesions qaar ka mid ah si looga hortago in nodular scleros ns1.

daaweynta shucaaca waxay sababi karaan dhibaatooyin sida fibrosis unugyada subcutaneous, pneumonitis shucaaca iyo pericarditis. Daraysa dhacaan xilliyada kala duwan - ka 3 bilood ilaa 5 sano daaweynta ka dib. Ay kakanaanta ku xiran tahay isticmaalka dose.

hawlaha

daaweynta Qalliinka waa dhif ah oo keliya loo isticmaalaa onoobychno waa qayb ka mid ah therapy adag. Qabtaan splenectomy, iyo sidoo kale hawlaha on dhuunta, hunguriga, caloosha iyo xubnaha kale (la halista qabatin, murugoodo marinka cuntada). Helay inta lagu guda jiro dal chlamydia uurka waa in si xaqiiqo ah in la kala gooyey.

chemotherapy

Foomkaan waxaa loo adeegsadaa sidii mid qaybaha kala duwan ee daaweynta adag. Si loo daaweeyo sclerosis nodular, loo isticmaalo diyaarinta kala duwan:

• wada jir ( "Vinblastine" ama "rozevin", "Etoposide" ama "Vincristine," Oncovin ");
• Alkire isku dar ah ( "Mustargen", "Cyclophosphamide" ama "embihina", "nitrosomethylurea" ama "hlorbutin");
• wakiilada dardaro ( "Natulan" ama "procarbazine," "Dacarbazine" ama "isku badalo-carboxamide");
• antibiotics antitumor ( "Bleomycin", "adriablastin").

monochemotherapy

Waxa loo isticmaalaa oo kaliya in xaalado gaar ah oo leh ujeedo ka mid ah muujinta. Sida caadiga ah medicaments dheeraad ah u baahan daaweynta la farsamo kala duwan ee ficil (chemotherapy). Marxaladda afaraad ee bukaanka qaba cudurka beerka waajihi dhuuxa ama daaweynta sida u yahay jidka keliya - taasi waa lymphoma ah Hodgkin classical. sclerosis nodular daaweeyaa qorsheyaasha sida:

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

Therapy waa kooban (2, 7, 14 maalmood) koorsooyin la dura labo isbuuc. Tirada wareegyo kala duwan ay sabab u tahay baaxadda nabar hore oo nuglaato in daaweyn. Sida caadiga ah dembidhaafka oo dhan gaadhi la qoro 2-6 koorsooyinka. Ka dib markii in, waxaa lagu talinayaa inaad qabato dheeraad ah 2 wareegyada ee therapy. Haddii natiijada ahaa dembidhaafka qayb ahaan, halka daawada la bedelo, iyo tirada koorsooyinka kordhay.

Reception waa hematopoiesis daawo xooga leh, alopecia, calaamadaha dyspeptic, taasoo ka tago dhamaadka daaweynta. Nodular weli scleros horseedaa dhibaato ka soo daahay, sida dhalmo la'aan, leukaemias iyo carcinogenic kale (burooyin sare).

Odoroska

cudurka Hodgkin waxaa keena sifooyinka socodka, stage caafimaad ee cudurka, da'da bukaanka, iyo nooca kale histological. Iyada oo dabcan af iyo subacute cudurka ma aha saadaal wanaagsan: bukaanka inta badan ku dhinta muddo 1-3 bilood ilaa 1 sano. Laakiin saadaasha chlamydia chronic keeneysa la wanaagsan. Cudurku wuxuu socon karaa muddo aad u dheer, ilaa 15 sano (xaaladaha qaarkood dheer).

In 40% dhammaan dadka qaba cudurka, gaar ahaan marxaladda 1aad iyo 2aad, iyo sidoo kale sababaha prognostic wanaagsan, muddo ka badan 10 sano oo heer dheeraad ah ayaa xusay. Awoodaada shaqo iyadoo ay sabab u soconayo dembidhaaf ma jabna.

ka hortagga

Sida caadiga ah, waxaa la faray in ay ka hortagga labakaclaynta. Bukaanka qaba Hodgkin in la baadhaa Oncologist dispensary. In daraasadda, taas oo ah 3 sano ee ugu horeysa looga baahan yahay in la fuliyo lix bilood oo kasta, ka dibna sanadkii mar, aad u baahan tahay in ay diiradda saaraan wax ku oolnimada tilmaamayaasha noolaha inta badan waa calaamadaha hore ee ku xoogeystay (kordhay heerka fibrinogen iyo globulins, Minipiller-kordhin). Bukaanka qaba cudurka dabiiciga ah Hodgkin ee waxyeelada leh kaamerada, kululaado oo insolation toos ah. korodhka la aasaasay in tirada soo noqoshada ay sabab u tahay uurka.

Haddaba dadka hubaal badan ogahay in Hodgkin ee lymphoma - a sclerosis nodular duwanaansho, taas oo ah mid aad u xun oo ay adag tahay in la daweeyo cudurka.