Classical Hodgkin nqaij hlav: nodular sclerosis

Nodular sclerosis - ib tug histological ntau yam ntawm Hodgkin tus kab mob, yog yus muaj los ntawm ib tug tuab loj hlob ntawm connective ntaub so ntswg, faib lub loj ntawm irregularly zoo li tus hlwb thiab lobules. Lawv muaj overgrown lymphoid teeb meem nrog ib tug lossis loj tus naj npawb ntawm Berezovsky-Sternberg hlwb. Tus kab mob yuav pib nrog qhov kev nce rau cov ntshav. Qhov no pathology yog ib tug ntawm cov variants ntawm classical Hodgkin lymphomas.

Hodgkin tus kab mob no yog pom tau hais tias ib tug loj kev mob nkees uas muaj feem xyuam rau cov lymphatic system. Tus kab mob tej zaum yuav tsim nyob qhov twg nyob rau hauv lub cev, uas muaj lymphoid ntaub so ntswg (thymus, tonsils, tus po thiab adenoids al.).

Nodular sclerosis cov tsos mob

Hodgkin lymphomas yuav ua tau ib tug neeg, yog hais tias nws muaj xws tsos mob li:

• poob;
• O cov qog ntshav hauv (nquag nyob rau hauv lub cheeb tsam ntawm lub caj dab);
• tsis qab los noj mov;
• ua tsis taus pa;
• tawm hws hmo ntuj los yog kub;
• mob hauv siab;
• mob siab (5% ntawm cov neeg mob) los yog tus po (30% ntawm cov neeg mob);
• heaviness los yog mob nyob rau hauv lub plab (nyob rau hauv cov me nyuam);
• khaus khaus tawv nqaij (tsuas 1/3 ntawm cov neeg kev txom nyem mob);
• ua pa nyuab;
• hnoos.

yog vim li cas

Hodgkin tus kab mob no yuav tsum muaj ntawv cog lus ntawm cov muaj hnub nyoog, tab sis feem ntau nws tshwm sim nyob rau hauv cov tub ntxhais caug nyob rau hauv lub hnub nyoog qeb ntawm 16 mus rau 30 xyoo ntawm lub hnub nyoog los yog nyob rau hauv cov neeg laus dua 50 xyoo. Cov me nyuam mus txog rau 5 xyoos, yuav luag tsis tau muaj mob. Yuav ua li cas raws nraim ua kab mob no yog tseem tsis paub hais tias. Txawm li cas los, muaj ib tug assumption tias yog qhov - kab mob. Nws yog ntseeg hais tias qhov ua rau ntawm no kev mob nkees yuav pib:

• immunodeficiency;
• kab mononucleosis (zoo siab heev los ntawm Epstein-Barr virus).

Nodular sclerosis Hodgkin lymphomas yuav mus instantly, kawg ntawm 3 mus rau 6 lub hlis, los yog lub xeem rau 20 xyoo.

Yuav ua li cas theem muaj tus kab mob no?

Degree hodzhinskoy nqaij hlav txiav txim los ntawm laboratory kev tshawb fawb thiab nyob rau lub hauv paus ntawm cov hauv qab no qhia:

• lub xov tooj ntawm cuam tshuam cov qog o, raws li zoo raws li lawv qhov chaw nyob;
• nyob rau ntawm cov ntaub ntawv ntshav nyob rau hauv cheeb tsam sib txawv ntawm cov diaphragm;
• hlav nyob rau hauv lwm yam kabmob (e.g., daim siab los yog tus po).

Tus thawj theem. Nyob rau hauv cov ntaub ntawv no cuam tshuam tsuas yog ib qho mob qog los yog lymphoid hloov khoom nruab nrog (po, ntiv nplhaib Pirogov-Valdera).

Qhov thib ob theem. Muaj feem ntau yog amazed cov qog ntshav hauv ob qho tib si nyob rau hauv sab ntawm lub hauv siab, diaphragm, thiab lymphoid kabmob.

Qhov thib peb theem. Qhov no degree Hodgkin tsis yog raws ntawm lub thib ob theem. Txawm li cas los, nws muaj ob hom ntawm nodular sclerosis thib peb theem:

• nyob rau hauv thawj cov ntaub ntawv uas cuam tshuam nrog cev nyob rau hauv qab lub diaphragm (celiac cov qog ntshav hauv, tus po);
• nyob rau hauv tas li ntawd mus rau lub chaw uas muaj npe nyob rau hauv thawj ntau yam, tseem xav tsis thoob vim, thiab lwm qhov chaw uas muaj cov qog ntshav nyob ze ntawm lub diaphragm.

Qhov thib plaub theem. Nws muaj feem xyuam tsis yog tsuas yog lub Cheebtsam, tab sis kuj tsis yog-lymphoid kabmob - hloov hlwb pob txha, daim siab, cov pob txha, lub ntsws thiab cov tawv nqaij.

Designations degrees Hodgkin lymphomas

Index tus soj ntsuam qhov teeb meem thiab cov heev ntawm tus kab mob chav kawm ntawm lwm yam ntaub so ntswg thiab kabmob yog cim nrog cov tsiaj ntawv.

A - mob loj heev general cov tsos mob ntawm tus kab mob tsis tau.

B - cov xub ntiag ntawm ib los yog ntau tshaj cov tsos mob (unfounded nce kub, tawm hws hmo ntuj, sai poob).

E - foci thov rau ntaub so ntswg thiab kabmob nyob ze ntawm lub cov lymph node.

S - Muaj splenic lesion.

X - yog ib tug loj o ntawm loj me me.

Histological hom ntawm tus kab mob

Hais txog cov cellular qauv ntawm Hodgkin tus kab mob yog 4 ntaub ntawv ntawm cov ailments.

1. Nodular sclerosis Hodgkin lymphomas - lub feem ntau ntau daim ntawv ntawm tus kab mob, hais txog 40-50% ntawm txhua tus neeg mob. Lawv muaj mob ntau dua cov ntxhais hluas, uas yog tsuas yog cov qog ntshav ntawm lub mediastinum. Cov me khoom, nyob rau hauv tas li ntawd mus Berezovsky-Sternberg hlwb yog tseem loj lacunar hlwb nrog foamy cytoplasm thiab weighing nuclei. Twv ua ntej nyob rau hauv kab mob no yog feem ntau zoo.
2. Lymphohistiocytic nqaij hlav uas tsim 15% ntawm cov piv txwv. Feem ntau cov feem ntau nws muaj peev xwm yuav nrhiav tau nyob rau hauv cov tub hluas nyob rau hauv 35 xyoo. Nws muaj ib tug zoo tsib-xyoo ciaj sia taus tus nqi ntawm lub hlwb thiab muaj ib tug paub tab limfaitov thiab Shtrenberga. Qhov no zoo ntawm tus kab mob nrog ib tug me me phem thiab kev sib tw nyob rau hauv thawj zaug rau theem.
3. Ua ke hom no feem ntau yog kuaj nyob rau hauv cov neeg laus thiab cov me nyuam. Txawv yam ntxwv raug soj ntsuam daim duab thiab tej kev xav generalize qhov kev txiav txim. Histological xeem qhia sib txawv versions ntawm cell kev sib txuas, xws li Sternberg. Pom nyob rau hauv 30% ntawm cov neeg mob nrog nqaij hlav. Nodular sclerosis nyob rau hauv cov ntaub ntawv no muaj ib tug kuj zoo raug, thiab yog hais tias lub sij hawm kev kho mob yog cov tshuaj, lub ruaj zam txim tshwm sim tsis muaj teeb meem.
4. Tej granuloma kev puas tsuaj ntawm lymphoid cov ntaub so ntswg sau tseg ncaw, tsuas 5% ntawm cov piv txwv (feem ntau yog cov neeg laus). Ib tug yam ntxwv feature ntawm no yog tias muaj cov tsis muaj hlwb thiab yog yeej los ntawm Sternberg hlwb. Qhov no daim ntawv ntawm nqaij hlav tsiag ntawv los ntawm qis tshaj feem pua ntawm tsib-xyoo ciaj sia taus.

diagnostics

Tus kab mob ntawm "nqaij hlav" yog txhais los ntawm histological kev soj ntsuam ntawm lub qog thiab yuav contested xwb nyob rau hauv lub rooj plaub uas tshwj xeeb multi-Sternberg hlwb tau pom raws li ib tug tshwm sim ntawm txoj kev tshawb no. Rau hauv loj heev zaus yuav immunophenotyping. Cytological tsom xam ntawm lub qog los yog ob lub raum feem ntau me me tej kom paub meej tias nodular sclerosis, hom 1. Yuav ua li cas yuav tsum tau ua kom txhim tsa lub mob ntawm tus kab mob:

• dav dav thiab biochemical ntshav kuaj;
• X-rays ntawm lub ntsws (yuav tsum tau nyob rau hauv lub sab thiab frontal projection);
• Lymph node me;
• ultrasonic soj ntsuam ntawm tag nrho cov hom ntawm peripheral thiab intraabdominal cov qog ntshav hauv, thyroid, daim siab, thiab tus po;
• CT scan los mus tshem tawm imperceptible mediastinal cov qog ntshav hauv nyob rau hauv cov pa radiography;
• trephine me ntawm iliac pob txha los mus tiv thaiv hlwb pob txha;
• luam theej duab thiab X-rays ntawm cov pob txha.

txoj kev kho

Nws muaj tawg txoj kev kho, kev phais thiab cov kws khomob. Xaiv txoj kev mus rau teem rau theem ntawm kev mob nkees thiab muaj cov zoo los yog tsis zoo prognostic yam. Lub paaj yam muaj xws li:

• tapped ntawm histological xeem nodular sclerosis, thiab lymphohistiocytic hom;
• hnub nyoog tsawg tshaj 40 xyoo;
• tagnrho cov qog ntshav hauv uas tsis pub tshaj 6 cm nyob rau hauv txoj kab uas hla;
• tsis muaj ntau ces lom hauj lwm zoo (uas biochemical indices ntawm cov ntshav);
• lub xub ntiag ntawm tsis muaj ntau tshaj li 3 lesion qhov chaw.

Yog hais tias koj ua tsis tau tsawg kawg yog ib tug ntawm cov yog vim li cas, ces tus neeg mob yog raug xa mus rau cov pab pawg neeg nrog ib tug neeg txom nyem raug.

tawg txoj kev kho

Tag nrho cov radiotherapy li ib tug neeg txoj kev yog siv rau cov neeg mob uas ntev IA thiab IIA, paub tseeb hais tias ntawm laparotomy, thiab muaj ib tug zoo prognostic yam. Nws yog tsim free teb nrog raug rau tag nrho cov hom ntawm cuam tshuam cov qog ntshav hauv thiab cov qog kua nqe vaj lug kub.

Ib feem ntawm tag nrho cov absorbed nyob rau hauv metastases lesion yog 40-45 g rau 4-6 lub lis piam nyob rau hauv lub teb ntawm prophylactic irradiation - 30-40 g ib 1-4 lub lis piam. Tsis tas li ntawd nrog widefield kev siv multi-teb irradiation ntawm ib co txhab los mus tiv thaiv nodular sclerosis ns1.

Tawg kho mob yuav ua rau mob xws li subcutaneous cov ntaub so ntswg fibrosis, tawg pneumonitis thiab pericarditis. Deterioration tshwm sim nyob rau hauv sij hawm sib txawv - los ntawm 3 lub hlis mus rau 5 xyoo tom qab kev kho mob. Lawv complexity nyob rau kev siv cov tshuaj.

ua hauj lwm

Phais kho mob yog tsis tshua muaj siv nyob ib leeg onoobychno yog ib feem ntawm ib tug complex txoj kev kho. Ua splenectomy, raws li zoo raws li kev ua hauj lwm nyob rau hauv lub raj cua, cov hlab pas, lub plab thiab lwm yam kabmob (nrog rau cov kev pheej hmoo ntawm asphyxia, chim siab rau cov zaj uas cov zaub mov). Sab thaum lub sij hawm ntws chlamydia cev xeeb tub yuav tsum mas nws yeej yuav tu ncua.

cov kws khomob

Qhov no daim ntawv yog siv raws li ib feem ntawm txoj kev kho mob. Yuav kom kho nodular sclerosis, siv txawv kev npaj:

• alkaloids ( "Vinblastine" los yog "rozevin", "Etoposide" los yog "Vincristine," Oncovin ");
• Alkire sib tov ( "Mustargen", "Cyclophosphamide" los yog "embihina", "nitrosomethylurea" los yog "hlorbutin");
• hluavtaws agents ( "Natulan" los yog "procarbazine," "Dacarbazine" los yog "Imidazole-carboxamide");
• antitumor tshuaj tua kab mob ( "Bleomycin", "adriablastin").

monochemotherapy

Nws yog tsuas yog siv nyob rau hauv tshwj xeeb no nrog lub hom phiaj ntawm revealing. Feem ntau ntau medicaments yuav tsum tau kho nrog ib tug txawv mechanism ntawm qhov kev txiav txim (cov kws khomob). Nyob rau hauv lub plaub theem nyob rau hauv cov neeg mob uas diffuse daim siab mob los yog hloov hlwb pob txha xws kev kho mob yog tib txoj kev - qhov no yog qhov classical Hodgkin nqaij hlav. Nodular sclerosis kho nrog xws li schemes:

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

Therapy yog luv luv (2, 7, 14 hnub) cov hoob kawm nrog ob-lub lim tiam Team sib. Cov nab npawb ntawm cov mus txawv vim lub qhov ntau ntawm cov thawj lesion thiab nyhav rau kev kho mob. Feem ntau yog cov tag nrho cov kev so ib pliag tiav nrog tshuaj 2-6 kawm. Tom qab hais tias, nws yog pom zoo kom ua tau ib tug ntxiv 2 mus ntawm txoj kev kho. Yog hais tias qhov tshwm sim yog ib nrab zam txim, whereas cov kev kho mob regimen yog hloov, thiab tus naj npawb ntawm cov kev kawm nce.

Txais tos yog Pa tshuaj hematopoiesis, alopecia, dyspeptic cov tsos mob, uas tawm nyob rau thaum xaus ntawm kev kho mob. Nodular sclerosis tseem ua rau yus lub caij teeb meem, xws li ntxiv lawm tshob, leukaemias thiab lwm yam malignancies (theem nrab hlav).

outlook

Hodgkin tus kab mob no yog tshwm sim los ntawm cov khiav yam ntxwv, kev soj ntsuam theem ntawm tus kab mob, uas muaj hnub nyoog ntawm tus neeg mob, thiab lwm yam histological hom. Nrog ib tug ntse thiab subacute chav kawm ntawm tus kab mob no yog tsis yog ib tug zoo raug: cov neeg mob feem ntau yog tuag nyob rau hauv ib lub sij hawm ntawm 1-3 lub hlis mus rau 1 xyoo. Tab sis nyob rau hauv mob chlamydia forecast conditionally zoo. Tus kab mob muaj peev xwm kav rau ib tug ntev heev lub sij hawm, mus txog rau 15 xyoo (nyob rau hauv tej rooj plaub ntev npaum li cas).

Nyob rau hauv 40% ntawm tag nrho cov uas raug tus mob, tshwj xeeb tshaj yog nyob rau hauv lub 1st thiab 2nd theem, raws li zoo raws li ib tug dej siab prognostic yog vim li cas, rau ntau tshaj 10 xyoo thiab ntau recurrences tau sau tseg. Muaj peev xwm mus ua hauj lwm raws li ib tug tshwm sim ntawm qhov ntev ntawm txoj kev zam txim yog tsis tawg.

kev tiv thaiv

Raws li ib tug txoj cai, nws yog raws kev coj kom lub kev tiv thaiv ntawm rov. Cov neeg mob uas Hodgkin yuav ntsuam xyuas dispensary oncologist. Nyob rau hauv txoj kev tshawb no, uas yog tus thawj 3 xyoo yuav tsum tau yuav tsum tau nqa tawm txhua txhua rau lub hlis, thiab ces ib xyoos ib zaug, koj yuav tsum ua kom pom tseeb rau cov hauj lwm zoo ntawm lom ntsuas feem ntau yog pib tej yam tshwm sim ntawm kev rov muaj dua (nce nyob rau hauv cov theem ntawm fibrinogen thiab globulins, Pops kom). Cov neeg mob uas Hodgkin tus kab mob teeb meem thermal physiotherapy, overheating thiab ncaj qha insolation. Tsim nce nyob rau hauv lub xov tooj ntawm rov vim cev xeeb tub.

Tam sim no muaj tseeb muaj coob tus neeg paub hais tias Hodgkin lymphomas - ib tug variant nodular sclerosis, uas yog ib tug heev tsis kaj siab thiab nyuaj los kho tus kab mob.