Carcinoid yog ib qho mob qog nqaij hlav maj mam loj tuaj uas muaj peev xwm tso tawm cov ntsiab lus hormonally. Qhov tshwm sim no belongs rau qeb ntawm neuroendocrine neoplasms. Cov qog yog tsim los ntawm cov hlwb ntawm lub diffuse system, uas muaj nyob rau hauv tag nrho cov nruab nrog cev. Lub bronchopulmonary apparatus nyob rau qib thib ob ntawm tus naj npawb ntawm cov qauv no, yielding primacy rau lub plab zom mov.
Carcinoid ntawm lub ntsws yog cov qog nqaij hlav tsis mob hnyav, uas, thaum kuaj pom raws sijhawm thiab muaj cov txheej txheem kho mob muaj peev xwm, muaj qhov pom zoo.
Mechanism ntawm qhov tshwm sim
Neuroendocrine hlwb, nyob rau hauv lub hauv paus ntawm pathological neoplasms tsim, tshwm sim txawm nyob rau hauv lub sij hawm ntawm intrauterine kev loj hlob nyob rau hauv lub neural crest cheeb tsam, tom qab uas lawv tsiv mus rau lub ntsws. Cov qog muaj cov granules neurosecretory uas tsim cov amines biogenic - histamine, norepinephrine, prostaglandins, adrenaline, serotonin - thiab cov tshuaj hormones.
ntsws carcinoid yog hom mob qog noj ntshav. Nyob rau hauv hom kab mob no, kev tso tawm ntawm biologically activecov ntsiab lus tsawg heev los yog tsis muaj kiag li, kuj tseem tsis muaj cov duab qhia meej thiab ntxaws ntxaws ntawm tus kab mob.
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Raws li cov qauv ntawm tes, cov qog nqaij hlav no tau muab faib ua ob pawg.
Tswj mob ntsws carcinoid yog qhov sib txawv ntawm cov neuroendocrine anomaly. Lub neoplasm yog tsim los ntawm cov hlwb me tshaj plaws nrog cov nuclei loj thiab cov granules uas tsim ib qho zais cia. Cov qauv no, dhau los, kuj tseem faib cov kab mob mus rau hauv cov chav kawm:
- trabecular - atypical hlwb demarcated los ntawm cov txheej tshwj xeeb fibrous;
- adnocarcinoma - ib qho neoplasm nyob rau hauv lub mucous daim nyias nyias, nws nto yog npog nrog prismatic txheej ntawm lub epithelium, thiab nws cov qauv yog feem ntau glandular;
- tsis muaj qhov sib txawv - tsim nyob rau hauv txheej txheej epithelial, kis tau sai heev thiab provokes qhov pib ntawm metastasis;
- mixed.
Atypical ntsws carcinoid tshwm sim hauv tsuas yog 10-30% ntawm txhua kis. Cov qog no muaj tus cwj pwm txhoj puab heev, kis tau sai, muaj zog ua haujlwm hormonal, thiab metastasizes thoob plaws hauv lub cev. Xws li mob qog noj ntshav zoo ib yam li infiltrate nrog cov qauv tsis sib xws, uas muaj cov ntsiab lus loj pleomorphic. Hauv lub ntsws nrog hom kab mob no, necrotic foci tuaj yeem tshwm sim.
Yog vim li cas
Raws li koj paub, txhim khu kev qha ua rau mob qog noj ntshav ntawm ntau hom tseem tsis tau paub, thiab mob ntsws carcinoid hauv qhov notxoj kev npaj yog tsis muaj kev zam. Tab sis cov kws tshaj lij tau pom ntau yam kev mob tshwm sim uas tuaj yeem ua rau muaj qhov tshwm sim ntawm qog nqaij hlav hauv lub ntsws. Cov no yuav tsum raug ntaus nqi rau:
- genetic predisposition;
- theem mob hnyav ntawm tus kab mob;
- mob ntev ntawm lub cev nrog cawv thiab luam yeeb.
daim duab kho mob
Mob ntsws carcinoid yog sib npaug ntawm cov txiv neej thiab poj niam. Cov neeg muaj hnub nyoog 10 mus rau 80 yog raug tus kab mob. Cov qog nqaij hlav qog nqaij hlav feem ntau nyob hauv thaj chaw nruab nrab ntawm lub cev, tsis deb ntawm lub bronchi loj, thiab me ntsis tsawg dua hauv parenchyma.
Cov tsos mob hnyav feem ntau pib nrog kev rov ua mob ntsws. Cov neeg raug tsim txom muaj bouts ntawm qhuav qhuav unproductive hnoos, hnoos qeev excretion yog tsawg, nrog txhaws los yog streaks ntawm cov ntshav. Cov tsos mob ntawm pathology zoo ib yam li bronchial obstruction thiab bronchial hawb pob, uas yog tus cwj pwm los ntawm kev hnov tsw. Ua ke nrog cov kab mob carcinoid, lub ntsws puas ntawm lub ntsws tsim.
Nyob rau hauv txhua tus neeg mob thib peb, qhov tsis xws luag yog asymptomatic kiag li. Feem ntau, ib qho neoplasm tau pom los ntawm lub caij nyoog thaum kuaj kev tiv thaiv ntawm lub cev.
Kev sib tw
Ib txhij nrog mob qog noj ntshav nce ectopic syndrome, uas yog tshwm sim los ntawm kev tsim cov tshuaj hormones uas tsim los ntawm cov qog hlwb. Cov tsos mob ntawm tus kab mob no yog:
- moon face;
- poob ob txhais ceg thiab caj npab tiv thaiv keeb kwm ntawm kev poob ntawm cov leeg nqaij;
- pob txuv;
- scarlet blush on ob sab plhu me ntsis tinge;
- cov roj ntau ntau hauv thaj tsam ntawm lub hauv siab, caj dab, plab thiab ntsej muag;
- stretch marks hauv pob tw, plab thiab ncej puab.
Nws yog ib qho tseem ceeb uas nrog rau cov kab mob no, kev raug mob ntawm daim tawv nqaij kho tau qeeb heev. Hauv cov neeg sawv cev ntawm kev sib deev tsis muaj zog, cov plaub hau ntawm lub ntsej muag tshwm raws li txiv neej hom. Cov pob txha ua dhau lawm. Sij hawm dhau mus, kev nyeem ntshav siab nce ntxiv.
Qee zaum, cov neeg mob muaj kev ua haujlwm tsis zoo hauv kev ua haujlwm ntawm lub plab zom mov hauv daim ntawv raws plab thiab mob paroxysmal hauv plab kab noj hniav. Kub flashes tshwm sim, carcinoid mob plawv yug.
Dav metastases feem ntau pom muaj nyob rau hauv daim siab nqaij.
Diagnosis
Thaum xav tias mob ntsws cancer, tus neeg mob raug tshuaj xyuas siv cov cuab yeej thiab cov txheej txheem kuaj. Ua ntej tshaj plaws, kev tshuaj xyuas cov zis thiab ntshav yog ua. Tom qab ntawd lub cev ntawm lub hauv siab kab noj hniav yog ua tib zoo tshuaj xyuas.
Carcinoid ntawm lub ntsws yog thawj zaug kuaj pom ntawm x-ray. Yuav kom tau txais cov ntaub ntawv ntau ntxiv, tus neeg mob raug xa mus rau kev suav tomography, uas qhia meej txog kev hloov pauv ntawm cov ntaub so ntswg ntawm lub cev hauv ntau qhov kev kwv yees. Tsis tas li ntawd, cov lymphatic thiab skeletal systems ntawm lub cev raug kuaj.
Nyob rau hauv cov ntaub ntawv tshawb pombronchoscopy yog ua los coj cov khoom siv lom neeg rau histology. Ib qho tshwj xeeb smear yog tsim los ntawm cov qauv ntaub so ntswg, uas tau tshuaj xyuas nyob rau hauv lub tshuab kuaj kab mob - qhov no yog qhov xwm txheej ntawm cov qog txiav txim.
txhawm rau kuaj tus kab mob, nws tseem ceeb heev kom kuaj pom muaj cov tshuaj hormones thiab cov khoom siv roj ntsha uas tsim los ntawm cov qog nqaij hlav cancer. Ua li no, me me ntawm cov tshuaj zoo li histamine tau nkag rau hauv tus neeg mob lub cev. Yog hais tias tus neeg mob muaj cov tshuaj tiv thaiv ntawm ib hom vegetative - arrhythmia, kub flashes nyob rau hauv lub taub hau thiab caj dab cheeb tsam, colic nyob rau hauv lub plab mog, kev kuaj mob ntawm "functioning carcinoid" yuav ua tau.
Ntxiv thiab, lwm txoj kev kuaj mob tuaj yeem siv tau:
- magnetic resonance imaging;
- scintigraphy;
- positron emission tomography.
Kev kho mob ntsws carcinoid
Qhov kev ntsuas tseem ceeb siv rau kev sib raug zoo rau cov neeg mob nrog qhov kev kuaj mob no yog kev phais tshem tawm cov ntaub so ntswg puas. Rau qhov no, anatomical resection yog ua - ib ntu lossis lobe ntawm lub ntsws raug tshem tawm, thiab parenchyma tseem nyob twj ywm. Nyob rau hauv cov ntaub ntawv ntawm kev phais, relapses ntawm pathology yog tsis tshua muaj heev. Cov kev kho mob zoo li no ua rau muaj txiaj ntsig zoo.
Yog hais tias cov carcinoid tau nkag mus rau hauv lub bronchus, qhov chaw puas ntawm tsob ntoo yog resected thiab sutured nrog tshwj xeeb threads. Qhov no yog qhov tsim nyog los ua kom cov pob txha mos ntawm lub cev.
Yog tias mob qog noj ntshav ncaj qha rau hauv lub ntsws, cov qog ntshav qab zib yuav raug tshem tawm thiabfiber ntau hauv cheeb tsam mediastinal.
Ua ke nrog kev phais, tus neeg mob tau pom zoo siv tshuaj kho mob, xov tooj cua yoj irradiation, siv cov tshuaj tiv thaiv kab mob. Nrog kev pab ntawm cov tshuaj, hormonal keeb kwm yav dhau ntawm tus neeg mob raug kho.
Ntau ntxiv rau mob ntsws carcinoid
Tus kab mob no tsis suav tias yog qhov txaus ntshai. Lub neej nyob rau tsib xyoos rau lub ntsws carcinoid ntawm daim ntawv raug yog kwv yees li 90-100%. Tab sis nrog rau kev kawm atypical ntawm pathology, qhov xwm txheej yog qhov phem dua. Hauv qhov no, tsis tshua muaj 50-60% ntawm cov neeg mob tuaj yeem hais txog qhov muaj sia nyob tsib xyoos. Tsuas yog 30% ncav cuag lub neej expectancy ntawm kaum xyoo.
Tom qab kev phais, txawm tias nyob rau hauv cov ntaub ntawv thaum cov qog nqaij hlav cancer nyob ntawm txoj kab resection, cov neoplasm tsis tshua muaj tshwm sim. Ib ntawm plaub tus neeg mob tuaj yeem ua neej nyob ntev txog 25 xyoos.
Kev ntsuas rau atypical ntsws carcinoid, raws li twb tau hais lawm, tsis yog rosy. Nyob rau hauv cov ntaub ntawv ntawm lymph node metastases, tsib-xyoo ciaj sia taus nce mus txog 20%. Yog li ntawd, thaum kuaj pom atypical ntsws carcinoid, kev kho uas cuam tshuam nrog kev khaws cia ntawm lub cev puas tsuaj yog qhov tsis tsim nyog.
