Classical Hodgkin lymphoma: ukuqina kwamathishu nodular

Nodular sclerosis - ezihlukahlukene histological yesifo Hodgkin sika, elinesimo ukukhula aminyene ezicutshini, uhlukanisa mass lamaseli ezimise ngendlela engavamile futhi lobules. Ziqukethe yene ndaba lymph ngenombolo enkulu Berezovsky-Sternberg amaseli. Lesi sifo iqala nesanda ISIZINDA. Lokhu zokugula ingenye ezahlukeneyo lymphoma classical Hodgkin sika.

isifo Hodgkin sika kubhekwa lokugula okukhulu okuthinta uhlelo lymph. Lesi sifo bangase bafinyelele kuphi emzimbeni, ukuthi ine kwezicubu lymph (i-thymus, amalaka, ubende kanye adenoids al.).

Nodular sclerosis izimpawu

lymphoma Hodgkin sika kungaba umuntu, uma kunezimpawu ezifana:

• kwesisindo;
• Evuvukele zamanzi (njalo ezonini entanyeni);
• ukungakuthandi ukudla;
• iphika;
• nokujuluka ebusuku noma lokushisa;
• ubuhlungu besifuba;
• isibindi lakhulisiwe (5% weziguli ezine) noma ubende (30% eziguli);
• ukuzimuka noma ubuhlungu esiswini (e izingane);
• isikhumba silume (kuphela 1/3 zabantu ezigulayo);
• ukuphefumula nzima;
• ukukhwehlela.

izizathu

isifo Hodgkin sika kungenziwa izinkontileka ngasiphi yobudala, kodwa ngokuvamile iningi kwenzeka kwabesilisa abasha esigabeni kweminyaka eyi-16 kuya ku-30 ubudala noma abantu abadala engaphezu kwengu-50. Izingane kuze iminyaka 5, cishe aziguli. Yini kahle hle icuphe lesi sifo akwaziwa. Nokho, kukhona kucatshangwa ukuthi umthombo - amagciwane. Kukholakala ukuthi imbangela ngalokhu kugula ungaqala:

• immunodeficiency;
• mononucleosis ezithathelwanayo (ezazivuswa Epstein-Barr igciwane).

Nodular sclerosis lymphoma Hodgkin kungaqhubeka kweso, eledlule 3 kuya ku-6 izinyanga, noma zokugcina iminyaka engu-20.

Yini isigaba isifo?

Degree hodzhinskoy lymphoma kwanqunywa kusukela izifundo laboratory kanye ngesisekelo izinkomba ezilandelayo:

• inani abathintekayo zamanzi, kanye indawo yabo;
• ukutholakala idatha ISIZINDA ezindaweni ezahlukene diaphragm;
• izimila kwezinye izitho (isib isibindi noma ubende).

Isigaba sokuqala. Kulokhu kuthinteka eyodwa kuphela-lymph node noma isitho lymph (ubende, indandatho Pirogov-Valdera).

Eyesibili esiteji. Kujwayele amazed lymph node nhlangothi zombili izitho esifubeni, diaphragm, futhi-lymph.

Isigaba sesithathu. Lokhu Hodgkin degree neze ihluke esigabeni sesibili. Nokho, it has izinhlobo ezimbili nodular sclerosis esigabeni sesithathu:

• ecaleni lokuqala iyathinteka izitho elise ngezansi diaphragm (ISIZINDA celiac lymph-ubende);
• ngaphezu ezindaweni ezisohlwini ezihlukahlukene zokuqala, namanje ngimangaliswe, nakwezinye izindawo ne-lymph etholakala eduze diaphragm.

Isigaba sesine. Kuthinta hhayi kuphela izingxenye, kodwa futhi izitho ze-non-lymph - umnkantsha, isibindi, amathambo, amaphaphu isikhumba.

Amagama degrees lymphoma Hodgkin sika

Inkomba isimo emitholampilo kobukhulu Yiqiniso isifo nezinye izicubu kanye izitho ephawulwe izincwadi.

A - izimpawu ezinamandla jikelele lesi sifo hhayi.

B - khona eyodwa noma ngaphezulu izimpawu (okungenasisekelo lokushisa kakhudlwana, ukujuluka ebusuku, okusheshayo kwesisindo).

E - foci zisebenze izicubu kanye izitho etholakala eduze ethintekile zamanzi.

S - Ingabe lesion splenic.

X - kukhona ukuvuvukala ezibucayi usayizi omkhulu.

izinhlobo histological yesifo

Lapho ikhuluma ngokuhlelwa kwamangqamuzana yesifo Hodgkin sika 4 izinhlobo zokugula.

1. Nodular sclerosis lymphoma Hodgkin sika - ifomu evamile lesi sifo, mayelana 40-50% azo zonke izimo. Begula kakhulu ukudlula abantu besifazane, okuyizona kwathinta kakhulu lymph node we mediastinum. Indaba biopsy, ngaphezu Berezovsky-Sternberg amaseli nazo amaseli ezinkulu lacunar nge foamy cytoplasm kanye nuclei enesisindo. Ukubikezela kule isifo ngokuvamile ezinhle.
2. Lymphohistiocytic lymphoma okuyinto kwakhiwa 15% of the izibonelo. Ngokuvamile-ke ingatholakala amadoda abasha abaneminyaka engaphansi kwengu-35 ubudala. It has an kakhulu oneminyaka emihlanu isilinganiso lokusinda lamaseli futhi limfaitov ovuthiwe futhi Shtrenberga. Lolu hlobo isifo nge abulalayo amancane aqoshiwe ke emabangeni kokuqala.
3. zinhlobo Kuhlanganiswe ngokuvamile kutholakala asebekhulile kanye nezingane. Ezahlukene isici ejwayelekile isithombe emitholampilo ukuthambekela Yenza isenzo. luhlolo histological wembula izinguqulo ezihlukene cell uxhumano, kuhlanganise Sternberg. Found in 30% eziguli lymphoma. ukuqina kwamathishu nodular kulokhu has a Izibikezelo impela okuhle, futhi uma ukwelashwa isikhathi ezinqunyiwe, kube ngukuthethelelwa ngokuqinile kwenzeka ngaphandle kwezinkinga.
4. granuloma Kuyingozi ukubhujiswa lymphoid waphawula kanini, 5% kuphela izibonelo (ikakhulukazi phakathi asebekhulile). Sici sici lapha ukuthi azikho amaseli bese ubuswa Sternberg amaseli. Leli fomu lymphoma libhekene iphesenti eliphansi kakhulu sokusinda oneminyaka emihlanu.

ukuhlola

Sitholakele "lymphoma" kuchazwa kuphela luhlolo histological ka-lymph futhi baphikisana kuphela esimweni lapho ekhethekile multi-Sternberg amaseli eziye zatholakala ngenxa yalolu cwaningo. Ezimweni ezinzima kudingeka immunophenotyping. ukuhlaziywa Cytological we-node lymph noma izinso ngokuvamile wokubhoboza ezincane ukuqinisekisa sclerosis nodular, uhlobo 1. Pho, yini okudingeka yenziwe ukusungula sitholakele isifo:

• jikelele kanye kwamakhemikhali ukuhlolwa igazi;
• X-ray kwamaphaphu (amandla in ecaleni kanye lelivakalako frontal);
• lymph biopsy node;
• Ukuhlolwa ultrasonic zonke izinhlobo neuropathy intraabdominal lymph node, yegilo, isibindi, futhi ubende;
• I-CT scan ukuqeda imperceptible mediastinal izindlala zamanzi esimweni ezivamile;
• biopsy trephine ka iliac ithambo ukuvimbela umnkantsha;
• ukuskena futhi-X ray lamathambo.

Ukwelapha

Iqukethe ukwelashwa ngemisebe, ukuhlinzwa, ngelashwa nangemithi. Ukukhetha indlela kwasusa isifo futhi khona izici prognostic emihle noma emibi. Izinto evumayo zihlanganisa:

• uthephwe at histological luhlolo nodular sclerosis kanye nohlobo lymphohistiocytic;
• ubudala esingaphansi kweminyaka engu-40;
• amavolumu lymph node ukuthi musa idlule 6 cm ububanzi;
• yokuntuleka ukubonakaliswa ezivamile ukusebenza yemvelo (ngentuthuko indices kwamakhemikhali kwegazi);
• khona hhayi ningi than 3 izindawo lesion.

Uma ungaphenduki okungenani eyodwa yalezi zizathu-ke isiguli ubizwa lelicembu Izibikezelo abampofu.

ukwelashwa ngemisebe

Okugcwele radiotherapy njengoba indlela umuntu isetshenziswa iziguli esiteji IA futhi IIA, ukuqinisekisile at laparotomy, nokuba izici ezinhle prognostic. Wenziwe Amasimu khulula nge ukuchayeka zonke izinhlobo abathintekayo lymph node kanye lymph amanzi amavesi.

Ingxenye Imininingwane ugxile metastases lesion kuyinto 40-45 g amasonto 4-6 emkhakheni ngemisebe prophylactic - 30-40 g ngalinye amasonto 1-4. Futhi nge amasu widefield usebenzisa ngemisebe multi-wasensimini wamazwe athile e izilonda ukuvimbela nodular sclerosis ns1.

ukwelashwa ngemisebe kungabangela yezinkinga ezifana ongama izicubu cystic, emisebeni pneumonitis futhi pericarditis. Ukuwohloka zenzeka ngezikhathi ezahlukene - ukusuka ezinyangeni ezingu-3 kuya eminyakeni emi-5 emva kokwelashwa. eyinkimbinkimbi kangakanani kuncike ekutheni ukusetshenziswa umthamo.

imisebenzi

ukwelashwa Steel kuyaqabukela esetshenziswa wedwa onoobychno kuyingxenye yokwelapha eziyinkimbinkimbi. Yenza splenectomy, kanye imisebenzi uqhoqhoqho emphinjeni, esiswini kanye nezinye izitho (nge ingozi asphyxia, uphatheke kabi ukudlula ukudla). Kutholakele ngesikhathi egeleza chlamydia sokukhulelwa kufanele nakanjani uphazamiseka.

ngelashwa nangemithi

Leli fomu lisetshenziswa njengenye ingxenye ukwelashwa eziyinkimbinkimbi. Ukwelapha sclerosis nodular, wasebenzisa amalungiselelo ezahlukene:

• alkaloids ( "Vinblastine" noma "rozevin", "Etoposide" noma "Vincristine," Oncovin ");
• Alkire ingxube ( "Mustargen", "Cyclophosphamide" noma "embihina", "nitrosomethylurea" noma "hlorbutin");
• zokwenziwa ejenti ( "Natulan" noma "procarbazine," "Dacarbazine" noma "Imidazole-carboxamide");
• antitumor ngezilapha magciwane ( "Bleomycin", "adriablastin").

monochemotherapy

Isetshenziselwa kuphela ezimweni ezikhethekile ngenhloso ukwambulwa. Ngokuvamile imithi ngaphezulu zidinga ukwelashwa nge indlela ezahlukene isinyathelo (nokwelashwa ngamakhemikhali). Ngo esigabeni sesine in iziguli ngokukhukhumala kwentamo isifo sesibindi noma umnkantsha ukwelashwa okunjalo kuyindlela kuphela - lena classical Hodgkin lymphoma. ukuqina kwamathishu nodular ziphathwe amaqhinga anjalo:

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

Ukwelashwa kuyinto kafushane (2, 7, izinsuku ezingu-14) izifundo nge wemaviki lamabili ngezikhawu. Isibalo imijikelezo kuyehluka ngenxa ubukhulu bale lesion kokuqala ezifweni ekwelashweni. Ngokuvamile lonke ukuthethelelwa kwafezwa kadokotela 2-6 izifundo. Ngemva kwalokho, kutuswa ukwenza eminye 2 nowe yokwelapha. Uma umphumela kwaba ukuthethelelwa okungaphelele, kuyilapho eziyalezweni ukwelashwa washintsha, futhi inani izifundo iyakhula.

Yokwamukela Umfutho imithi hematopoiesis, Alopecia, izimpawu dyspeptic, okuyinto ushiye ekupheleni ukwelashwa. Nodular sclerosis namanje kuholela yezinkinga ngasekupheleni, ezifana ukungazali, leukaemias nezinye komdlavuza (izimila zesibili).

ukuba nombono ongafani ngeke

isifo Hodgkin sika kubangelwa ukugeleza izici, isigaba zokwelapha lesi sifo, ubudala esiguli, futhi olunye uhlobo histological. Nge inkambo abukhali futhi subacute lesi sifo akusona Izibikezelo ezinhle: iziguli ngokuvamile afele isikhathi esiyizinyanga 1-3 nonyaka 1. Kodwa ngo ezingamahlalakhona chlamydia umhlahlo kunemibandela omuhle. Lesi sifo ingahlala isikhathi eside kakhulu, kuze kube iminyaka engu-15 (kwezinye izimo isikhathi eside).

Ngo-40% wabo bonke abantu onegciwane, ikakhulukazi esigabeni 1 no 2, kanye nezizathu evumayo prognostic, sekuyiminyaka engaphezu kwengu-10 eminyakeni futhi recurrences ngaphezulu beziphawuleka. Amandla ukusebenza ngenxa okuyisikhathi ukuthethelelwa akuyona eziphukile.

zokuvimbela

Njengomthetho, siqondiswe nokuvimbela ngangibuye ngihluleke. Iziguli Hodgkin zihlolwe oncologist Dispensary. Ocwaningweni, okuyinto yokuqala engu 3 okudingeka ukuba kwenziwe njalo ngemva kwezinyanga eziyisithupha, bese kanye ngonyaka, udinga ukugxila ukusebenza izinkomba begazi ngokuvamile kuyizimpawu zokuthi kokuqala Ukuphinda (ukwanda ezingeni fibrinogen globulin, pops ukwandisa). Iziguli isifo elimazayo Physiotherapy Hodgkin sika ezishisayo, okweqile kanye insolation oqondile. ukwanda Umi inani uyahluleka uma elwa nokuphuza ngenxa yokukhulelwa.

Manje abantu ngokuqinisekile abaningi bazi ukuthi lymphoma Hodgkin sika - okuhlukile sclerosis nodular, okuyinto kubuhlungu ngempela futhi kunzima ukuyelapha isifo.