Lub tswv yim kho mob thiab anatomical ntawm "cov ntaub so ntswg" raws li txhais los ntawm WHO xyoo 1969 suav nrog tag nrho cov ntaub so ntswg uas tsis yog epithelial extraskeletal: cov nqaij du thiab striated, cov ntaub so ntswg synovial, tendons thiab ligaments, nqaij rog, subcutaneous rog los yog hypodermis, connective. cov ntaub so ntswg (fibrous), paj hlwb thiab cov ntaub so ntswg vascular. Neoplasms hauv lawv yog cov qog nqaij mos. Ntawm lawv yog cov qog nqaij hlav ntawm cov ntaub so ntswg saum toj no thiab cov qog ntawm qhov tsis meej ntawm qhov embryogenesis.
Ua rau cov nqaij mos mos
Lawv yog vim li cas tsis to taub tag nrho txawm niaj hnub no. Qee qhov ua rau muaj kev cuam tshuam rau kev loj hlob ntawm cov qog nqaij mos yog paub. Nws tuaj yeem yog:
- yam tsis zoo los ntawm kev xeeb tub (piv txwv li, tuberous sclerosis ua rau sarcoma);
- tshuaj lom neeg carcinogens ntawm txhua lub hauv paus chiv keeb;
- kab mob caj ces tsis suav nrog;
- muaj kab mob herpes thiab kab mob HIV hauv lub cev;
- ionizing hluav taws xob, txo kev tiv thaiv;
- mob raug mobcov ntaub so ntswg (lawv ua rau oncology ntau tshaj li ib nrab ntawm cov neeg mob);
- muaj caws pliav;
- pob txha pathologies tuaj yeem ua ntej cov qog;
- qee yam kab mob, xws li Recklinghausen's disease.
Ntau zaus, benign qog tuaj yeem ua malignant. Raws li kev txheeb cais, cov qog nqaij hlav malignant ntawm cov ntaub so ntswg nyob rau hauv dav oncopathology nyob li ntawm 1%. Tsis muaj kev sib deev thiab hnub nyoog degradation, tab sis feem ntau cov neoplasms tshwm sim tom qab 25 xyoo. Thiab tom qab 80 xyoo, daim duab no twb dhau 8%. Kev nyiam hauv zos - qis qis, caj dab, plab, thiab lwm yam.
Kev faib tawm
Systematization ntawm cov qog nqaij mos yog qhov nyuaj heev, suav nrog ntau yam ntsuas. Nyob rau hauv tsab xov xwm, nws yog sawv cev los ntawm qhov yooj yim faib. Hom qog nqaij mos tuaj yeem muab faib ua mesenchymal (cov qog ntawm cov kabmob hauv nruab nrog cev - sarcomas, leiomyomas) thiab cov qog PNS. Hom nyob ntawm qhov etiology ntawm neoplasm.
Nyob rau hauv WHO kev xyaum, kev faib tawm yog siv - cov qog nqaij mos muag tau muab faib los ntawm hom ntaub so ntswg:
- ntawm cov ntaub so ntswg;
- fatty;
- muscular;
- vascular;
- ntawm synovial thiab serous membranes, hlwb ntawm peripheral paj hlwb (PNS);
- pob txha mos.
Txhua cov qog tau muab tso ua ke rau hauv 4 qhov loj: benign, malignant, lossis ciam teb, hauv zos aggressive thiab tsis tshua muaj metastasizing. Cov nqaij mos moscov ntaub so ntswg tsis muaj cellular atypism, tsis muab metastases thiab tsis tshua muaj tshwm sim. Cov kab mob phem muaj cov khoom sib txawv kiag li, ua rau tus neeg mob tuag. Cov kab mob ciam teb (hauv zos txhoj puab heev) rov tshwm sim yam tsis muaj metastases; tsis tshua muaj metastasizing tshwm sim lawv tus kheej ntawm sab no tsawg dua 2% ntawm cov neeg mob.
qog nqaij hlav metastases yog qhov ntsuas:
- 1 point - 0-9 metastases;
- 2 points - 10-19;
- 3 ntsiab lus - ntau dua 20 metastases.
Nyob zoo cov nqaij mos
Type of qog:
- Lipoma - raws li cov ntaub so ntswg adipose, nyob hauv thaj chaw ntawm lub cev nrog cov ntaub so ntswg lipid. Nws yog palpated raws li qhov tsis mob o ntawm qhov muag-elastic sib xws, nws tuaj yeem loj hlob tau ntau xyoo.
- Angiolipoma - tsim ntawm cov hlab ntsha, feem ntau kuaj pom hauv cov menyuam yaus. Localized nyob rau hauv qhov tob ntawm cov leeg. Yog tsis muaj kev txhawj xeeb, tsuas yog kev soj ntsuam xwb.
- Hemangioma yog ib hom kab mob vascular heev. Feem ntau tshwm sim hauv cov menyuam yaus. Yog tias tsis muaj tsos mob, tsis tas yuav kho.
- Fibroma thiab fibromatosis - muaj cov ntaub so ntswg fibrous. Fibromas thiab fibroblastomas yog cov neeg sawv cev tseem ceeb. Fibroids muaj cov cell ntawm cov ntaub so ntswg paub tab; fibroblastomas yog raws li collagen fibers. Lawv tsim lub thiaj li hu. fibromatosis, ntawm cov qog nqaij hlav ntawm cov nqaij mos ntawm lub caj dab li fibromatosis ntawm caj dab yog ntau dua li lwm tus. Cov qog no tshwm sim hauv cov menyuam yug tshiab ntawm cov leeg sternocleidomastoid nyob rau hauv daim ntawv ntawm cov nplej tuab txog li 20 hli. Fibromatosis yog nruj heev thiab muaj peev xwmloj hlob mus rau hauv cov leeg uas nyob ib sab. Yog li ntawd, yuav tsum tau tshem tawm.
- Neurofibroma thiab neurofibromatosis - yog tsim los ntawm cov hlwb ntawm cov hlab ntsha hauv cov hlab ntsha los yog ib ncig ntawm nws. Cov kab mob pathology yog keeb kwm, nrog rau kev loj hlob tuaj yeem ua rau tus txha caj qaum, tom qab ntawd cov tsos mob tshwm sim. Ntxim yug dua tshiab.
- Pigmented nodular synovitis yog ib qho qog ntawm cov ntaub so ntswg synovial (kab sab hauv ntawm cov pob qij txha). Nws feem ntau mus dhau qhov sib koom ua ke thiab ua rau degeneration ntawm cov ntaub so ntswg ib puag ncig, uas yuav tsum tau kho phais. Ntau zaus localization - lub hauv caug thiab lub duav sib koom. Kev loj hlob tom qab hnub nyoog 40.
Nyob zoo nqaij hlav
Cov qog hauv qab no yog qhov zoo:
- Leiomyoma yog ib qho qog ntawm cov leeg du. Nws tsis muaj hnub nyoog txwv thiab yog ntau tshaj plaws hauv qhov xwm txheej. Muaj kev xav rov yug dua tshiab.
- Rhabdomyoma - ib qho qog ntawm cov leeg nqaij striated ntawm ob txhais ceg, nraub qaum, caj dab. Raws li cov qauv hauv daim ntawv ntawm nodule lossis infiltrate.
Feem ntau, cov tsos mob ntawm cov kab mob benign tsis zoo heev, kev tshwm sim tuaj yeem tshwm sim tsuas yog nrog kev loj hlob ntawm cov qog nrog compression ntawm lub paj hlwb lossis lub nkoj.
Malignant soft tissue tumor
Yuav luag tag nrho lawv yog sarcomas, uas suav txog 1% ntawm tag nrho cov oncologies. Lub hnub nyoog tshaj plaws ntawm qhov pib yog 20-50 xyoo. Sarcoma tsim los ntawm cov ntaub so ntswg sib txuas uas tseem nyob rau theem kev loj hlob thiab tseem tsis paub qab hau. Nws tuaj yeem yog pob txha mos, nqaij, rog,cov ntaub so ntswg, thiab lwm yam. Hauv lwm lo lus, sarcoma tuaj yeem tshwm sim nyob txhua qhov chaw thiab tsis muaj kev sib txuas nruj rau ib lub cev. Ntawm kev txiav, lub sarcoma zoo li pinkish-dawb nqaij ntses. Nws mob hnyav dua li mob qog noj ntshav thiab muaj:
- infiltrating loj hlob mus rau hauv cov ntaub so ntswg uas nyob ib sab;
- tom qab tshem tawm ib nrab ntawm cov neeg mob nws rov zoo;
- metastasizes ntxov (mus rau lub ntsws feem ntau), tsuas yog nrog plab sarcoma - rau daim siab;
- muaj kev loj hlob tawg, hais txog cov neeg tuag nyob hauv qhov chaw thib 2.
Hom ntawm cov nqaij mos sarcomas thiab lawv qhov tshwm sim
Liposarcoma - tshwm sim nyob qhov twg muaj cov ntaub so ntswg nrog cov roj ntau, feem ntau ntawm tus ncej puab. Nws tsis muaj ciam teb meej, nws yooj yim palpable. Kev loj hlob qeeb, tsis tshua muaj metastasizes.
Rhabdomyosarcoma, lossis RMS, yog cov qog uas cuam tshuam rau cov leeg nqaij striated. Nws feem ntau cuam tshuam rau cov txiv neej hnub nyoog tshaj 40 xyoo. Cov qog nyob rau hauv daim ntawv ntawm ib tug ntom ruaj knot yog nyob rau hauv nruab nrab ntawm cov leeg, tsis ua mob, yog palpable. Qhov chaw nyiam yog caj dab, taub hau, pelvis thiab ob txhais ceg.
Leiomyosarcoma yog cov qog uas cuam tshuam rau cov leeg nqaij. Tsis tshua muaj tshwm sim, feem ntau nyob rau hauv lub tsev menyuam. Nws yog suav hais tias yog ib tug uas ntsiag to qog thiab manifests nws tus kheej nyob rau hauv lub tom ntej theem. Nrhiav tau los ntawm lub caij nyoog hauv lwm qhov kev tshawb fawb.
Hemangiosarcoma yog ib qho qog ntawm cov hlab ntsha. Localized nyob rau hauv qhov tob ntawm cov leeg, mos hauv cov qauv, tsis mob. Cov no suav nrog Kaposi's sarcoma, hemangiopericytoma, thiab hemangioendothelioma. Qhov zoo tshaj plaws paub yog Kaposi's sarcoma (tsim los ntawm cov hlwb tsis paub qab hau thaum raug tus kab mob herpes 8).hom; Tus yam ntxwv ntawm AIDS).
Lymphangiosarcoma - tsim los ntawm cov hlab ntsha lymphatic.
Fibrosarcoma - tshwm sim los ntawm cov ntaub so ntswg sib txuas, feem ntau nyob hauv cov leeg ntawm ob txhais ceg thiab pob tw. Ntawm palpation, nws yog ib qho mobile, muaj cov tsos ntawm tubercle ntawm ib puag ncig lossis oval duab. Muaj peev xwm loj hlob mus rau qhov loj me. Feem ntau tshwm sim hauv cov poj niam.
Synovial sarcoma - tuaj yeem kuaj tau txhua lub hnub nyoog. Mob ntawm palpation, vim kev nqus tsis zoo ntawm daim nyias nyias ntawm cov pob qij txha, cov kua paug los yog cov ntshav yooj yim accumulates. Yog tias muaj cyst hauv cov qog, nws yog elastic thaum palpated. Yog tias nws muaj calcium ntsev, nws nyuaj.
Nervous tissue sarcomas - neurogenic sarcomas, neurinomas, sympathoblastomas, thiab lwm yam. Txij li thaum peb tab tom tham txog paj hlwb, hauv ib nrab ntawm cov neeg mob, kev tsim cov qog yog nrog los ntawm qhov mob thiab cov tsos mob ntawm lub paj hlwb. Kev loj hlob ntawm cov qog yog qeeb, qhov nyiam qhov chaw ntawm qhov tsos yog sab ceg thiab ncej puab. Cov qog no tsis tshua muaj thiab tshwm sim hauv cov txiv neej hnub nyoog nruab nrab. Cov qog feem ntau yog loj-tuberous, nyob rau hauv ib ntsiav tshuaj; Qee lub sij hawm nws yuav muaj ob peb cov nodes nyob rau ntawm lub paj hlwb. Ntawm palpation, nws txhais tau tias "mos-elastic sib xws", tab sis nrog cov ciam teb ntshiab, tej zaum yuav muaj calcareous inclusions thiab tom qab ntawd ua nyuaj. Mob thiab lwm yam tsos mob tsis tshua muaj. Nyob ze ntawm daim tawv nqaij, nws tuaj yeem loj hlob mus rau hauv nws, nrog rau cov pob txha nws tuaj yeem loj hlob nyob ntawd thiab. Metastases tsis tshua muaj, feem ntau rau lub ntsws. Relapses yog nquag. Ua kom tiav qhov tau hais, nws yuav tsum nco ntsoov tias feem ntau cov qog muajelastic los yog tawv sib xws. Yog tias thaj chaw ntawm softening pom, lawv qhia qhov tawg ntawm cov qog.
kab mob kis kab mob
Los ntawm lawv tus cwj pwm, lawv zoo li cov qauv zoo, tab sis tam sim ntawd, vim tsis paub meej, lawv pib metastasize:
- Protruding dermatofibrosarcoma - ib lub qog nyob rau hauv daim ntawv ntawm ib qho loj ntawm daim tawv nqaij. Loj hlob qeeb heev. Thaum nws raug tshem tawm, ib nrab ntawm cov neeg mob rov qab los, tsis muaj metastases.
- Atypical fibroxanthoma - tuaj yeem tshwm sim nrog ntau dhau ntawm ultraviolet hluav taws xob hauv cov neeg laus. Localized nyob rau hauv qhib qhov chaw ntawm lub cev. Nws zoo li lub pob txha zoo, uas tuaj yeem npog nrog cov kab mob. Tej zaum yuav metastasize.
daim duab kho mob
Cov qog nqaij hlav ntawm cov nqaij mos ntawm thawj theem loj hlob imperceptibly, tsis qhia lawv tus kheej. Hauv 70% ntawm cov neeg mob, lawv tau pom los ntawm caij nyoog hauv lwm cov kev tshawb fawb thiab dhau los ua cov tsos mob nkaus xwb. Yog tias qhov tsim nyob ib sab ntawm cov hlab ntsha loj, tsim los ntawm cov hlab ntsha ntawm cov hlab ntsha, los yog loj hlob mus rau hauv cov pob txha, cov tsos mob ntawm qhov mob yog yam ntxwv. Feem ntau, cov qog muaj kev txwv tsis pub txav mus los hauv kev hloov pauv, zoo li ib leeg. Nws tsis loj hlob mus rau hauv lub paj hlwb, tab sis hloov lawv mus rau sab. Thaum sprouts mus rau hauv cov pob txha, nws yuav immobile.
Cov tawv nqaij ntawm cov nqaij mos mos uas twb dhau los lawm tom qab theem dhau los ua ntshav-cyanotic, edematous, loj hlob mus rau hauv cov ntaub so ntswg. Qhov saum npoo yuav ulcerate. Cov hlab ntsha saphenous nthuav dav hauv daim ntawv ntawm subcutaneous mesh. Muaj lub zos hyperthermia. Tsis tas li ntawd, tus kab mob no tsis txwv rau lub chaw kho mob hauv zos,Cov tsos mob ntawm intoxication koom nyob rau hauv daim ntawv ntawm cachexia, kub taub hau, tsis muaj zog ntawm tag nrho cov kab mob.
Metastasis los ntawm cov hlab ntsha - hematogenous, hauv 80% ntawm cov neeg mob tshwm sim hauv lub ntsws. Ntawm cov nqaij mos mos ntawm qhov tsis paub meej histogenesis, ib tus tuaj yeem hu ua myxoma, uas yog tus cwj pwm los ntawm cov duab tsis zoo, muaj cov khoom zoo li jelly thiab feem ntau nyob hauv lub plawv chamber. Yog li ntawd, nws tseem hu ua kab noj hniav. Hauv 80% ntawm cov neeg mob, nws tshwm sim nyob rau sab laug atrium. Xws li cov qog yog invasive, uas yog, lawv sai sai loj hlob mus rau hauv cov ntaub so ntswg nyob sib ze. Nws feem ntau yuav tsum tau tshem tawm thiab, yog tias tsim nyog, phais yas.
Diagnosis
Kev kuaj mob ntawm cov nqaij mos mos yog qhov nyuaj heev vim qhov tsis txaus ntawm kev kho mob tshwm sim. Yog tias xav tias sarcoma, kev kuaj xyuas yuav tsum pib nrog kev kuaj ntshav. Qhov no yog ib qho tseem ceeb ntawm txoj kev tshawb no, txij li yav tom ntej ib tug biopsy yuav muab tag nrho cov ntaub ntawv hais txog lub pathology.
X-ray muaj txiaj ntsig thiab qhia tsuas yog rau cov qog nqaij hlav. Nws tuaj yeem pom qhov kev vam khom ntawm cov qog ntawm cov pob txha nyob sib ze ntawm cov pob txha.
Yog tias muaj qhov chaw ntawm kev tsim ntawm ob txhais ceg, lub plab kab noj hniav - arterial angiography ua qhov tseem ceeb. Nws ua rau nws muaj peev xwm txiav txim siab qhov chaw ntawm cov qog, qhia txog lub network ntawm neovessels nyob random. Angiography kuj tseem xav tau los xaiv hom kev ua haujlwm.
MRI thiab CT yuav qhia txog qhov tshwm sim ntawm pathology, uas txiav txim siab txog kev kho mob. Ultrasound ntawm cov nqaij mos mos yog siv los ua ib qho kev kuaj mob thawj zaug lossiskom paub meej qhov kev kuaj mob ua ntej. Ultrasound ntawm cov ntaub so ntswg yog siv dav thiab indispensable rau kev kuaj mob sib txawv.
kho mob qog
Kev kho cov qog nqaij mos yog ua raws li 3 txoj hauv kev tseem ceeb - kev ua haujlwm radical, xov tooj cua- thiab tshuaj kho mob ua ke. Tom qab ntawd cov kev kho mob zoo li no yuav ua ke thiab ua haujlwm zoo dua. Tab sis kev ua haujlwm tseem yog qhov tseem ceeb.
Niaj hnub nimno txoj kev tshem tawm cov qog benign
Hnub no, 3 txoj hauv kev yog siv los tshem tawm cov qog nqaij hlav benign:
- nrog scalpel;
- CO2 laser;
- radio wave method.
Lub scalpel tsuas yog siv rau cov qog nqaij hlav sib txawv uas muaj qhov pom zoo ntawm kev rov zoo.
CO2-laser - thaum tshem cov qog nqaij hlav benign, nws ua rau nws tuaj yeem tshem tawm tau zoo thiab niaj hnub. Kev kho mob laser muaj ntau yam zoo dua lwm txoj hauv kev thiab muab cov txiaj ntsig zoo nkauj zoo dua. Tsis tas li ntawd, nws muaj qhov ua kom pom tseeb, uas tsis ua rau cov ntaub so ntswg nyob ib puag ncig. Txoj kev no tsis muaj ntshav, lub sij hawm rov kho dua yog luv, tsis muaj teeb meem. Kev tshem tawm cov qog nqaij hlav nyuaj tuaj yeem ua tau.
Nrog rau txoj kev xov tooj cua yoj (ntawm lub cuab yeej "Surgetron") qhov kev txiav ntawm cov ntaub so ntswg yog ua los ntawm kev raug nthwv dej ntau zaus. Txoj kev no tsis muab qhov mob. "Surgitron" tuaj yeem tshem tawm fibromas thiab lwm yam qog nqaij hlav ntawm lub hauv siab, caj npab, caj dab.
BasicKev phais yog kev kho mob rau tag nrho cov qog malignant. Kev tshem tawm ntawm cov nqaij mos mos yog ua los ntawm 2 txoj kev: dav excision los yog amputation ntawm ceg. Kev txiav tawm yog siv rau cov qog nruab nrab thiab me me uas tau khaws cia thiab nyob ntawm qhov tob tob. Tsis tas li ntawd, yuav tsum tsis muaj germination ntawm lawv nyob rau hauv cov hlab ntsha, pob txha thiab paj hlwb. Kev rov ua dua tom qab txiav tawm tsawg kawg yog 30%, lawv ob npaug qhov kev pheej hmoo ntawm kev tuag ntawm tus neeg mob.
Indications for amputation:
- tsis muaj qhov kev txiav tawm dav;
- kev txiav tawm tuaj yeem ua tau, tab sis lub caj dab khaws cia yuav tsis ua haujlwm vim yog qhov tsis zoo ntawm lub cev thiab kev ncig;
- lwm cov haujlwm ua tsis tiav;
- yav dhau los ua palliative amputations coj mus rau qhov mob unbearable, stench vim cov ntaub so ntswg tawg.
Kev txiav caj dab yog ua tiav siab dua qib ntawm cov qog.
Kev kho hluav taws xob raws li kev kho mob monotherapy rau sarcoma tsis muaj txiaj ntsig. Yog li ntawd, nws yog siv los ua ib qho ntxiv ua ntej thiab tom qab phais. Ua ntej kev phais, nws cuam tshuam rau kev tsim nyob rau hauv xws li ib txoj kev uas nws txo qhov loj me thiab yooj yim rau kev khiav lag luam. Nws tseem tuaj yeem pab ua kom lub qog ua haujlwm tsis zoo (70% ntawm cov neeg mob muab qhov txiaj ntsig zoo nrog rau txoj hauv kev no). Nws siv tom qab kev phais kom txo tau qhov rov tshwm sim dua. Tib yam tuaj yeem hais txog kev siv tshuaj khomob - kev siv cov txheej txheem sib xyaw ua haujlwm tau zoo tshaj plaws.
Kev Ntsuas rau 5-xyoo txoj sia nyob hauv sarcomas muaj feem tsawg heev vim lawvnce aggressiveness. Ntau yam nyob ntawm theem, hom qog, hnub nyoog ntawm tus neeg mob thiab cov xwm txheej ntawm lub cev.
Synovial sarcoma muaj qhov tshwm sim phem tshaj plaws, qhov ciaj sia ntawm tus kab mob no tsis ntau tshaj 35%. Lwm cov qog nqaij hlav, nrog rau kev kuaj mob ntxov, kev phais kom zoo thiab lub sijhawm rov zoo txaus, muaj feem ntau dua 5-xyoo txoj sia.
