Lub zes qe menyuam, raws li cov kws tshawb fawb, yog qhov chaw nyiam rau cov qog. Granulosa cell qog ntawm zes qe menyuam (GCOT) tsis yog ib qho kab mob, tab sis tag nrho cov pab pawg, lawv yog cov tsis yog epithelial keeb kwm, koom nrog pawg stromal. Tsim los ntawm zes qe menyuam follicle granulosa hlwb uas nyob ib puag ncig oocyte thiab tsim nws cov stroma.
Lub ntsiab ntawm qhov teeb meem
Qhov tshwm sim ntawm kev tsim tshwm sim nrog cov tshuaj hormonal feem ntau lossis hauv zes qe menyuam lawv tus kheej, uas granuloses tsim. Cov pab pawg muaj cov hauv qab no pathological formations:
- vesicle adenoma;
- cylinder;
- granular thiab folliculoid cancer;
- granulosaepithelioma;
- ovarian mesenchymoma.
GKOs suav txog 1-7% ntawm cov kab mob oncological ntawm cov poj niam qhov chaw mos. Lub hnub nyoog ntawm cov neeg mob yog 40-60 xyoo. Feem ntau - 50-55 xyoo. Tab sis nws tuaj yeem txhim kho ntawm lwm lub hnub nyoog.
Pab! Qhov tshwj xeeb ntawm cov qog no yog lawv cov haujlwm hormonal.
Granulosa cell hlavLub zes qe menyuam feem ntau tshwm sim los ntawm kev tsim cov tshuaj estrogen thiab endometrial hyperplasia. Qhov no muab cov tsos mob tsis zoo. Los ntawm nws qhov zoo li, GKO tsis pom qhov phem. Qhov pib ntawm oncogenesis hauv lub cev tuaj yeem ua qhov ua rau mob qog nqaij hlav.
Kev phom sij ntawm malignancy
Malignancy ntawm granulosa cell qog nyob rau hauv lub epididymis tsis yooj yim los kuaj. Tab sis muaj ib txwm muaj kev hloov pauv theem - nruab nrab ntawm cov qog nqaij hlav zoo. Nws chav kawm txiav txim siab txoj hauv kev ua phem.
Ntxim qab kawg: kev txheeb cais qhia tias kev mob hnyav tshwm sim hauv txhua qhov thib tsib. Ua tiav cov qog loj dua 5 cm ua rau qhov kev ntsuas tsis zoo.
qog histology
Tus neeg laus-hom granulosa cell hlav nws tus kheej muaj cov kab mob monoform, piv txwv li. txawv. Tab sis qee zaum cov duab tuaj yeem elongated. Lawv muaj cov xim tsaus nti uas nyob ib puag ncig los ntawm txheej nyias ntawm cytoplasm.
GKO ib txwm muaj lub npe. rosettes - ib tug series ntawm kab noj hniav me me. Lawv muaj xim daj vim yog cov ntsiab lus ntawm lipids, nruab nrab ntawm cov txheej txheem fibrous.
Feem ntau, cov qog nqaij hlav du, tsis tshua muaj - pob. Ib qho micropreparation ntawm malignant granulosa cell qog ntawm zes qe menyuam: nyob rau hauv qhov kev pom nws yog tseeb hais tias cov hlwb twb poob lawv monoformity thiab ua polymorphic. Cov. Cov hlwb txawv txav txawv ntawm qhov loj thiab cov duab.
Nyob rau ntawm cov qog, cov cheeb tsam ntawm softening nrog kab noj hniav ntawm serous los yog hemorrhagic kua yog pom. Granulosa cell hlav ntawm zes qe menyuammuaj cov khoom tsis zoo rau kev cog qoob loo (ntws) rau hauv cov khoom nruab nrog cev - mus rau hauv ob lub zes qe menyuam, tsev menyuam, plab hnyuv, omentum, siab.
Qhov tseem ceeb! Tsis muaj hematogenous thiab lymphogenous kis ntawm cov qog, uas txhais tau hais tias yuav tsis muaj metastases nyob deb ntawm no.
Qhov nyuaj ntawm cov metastases ib txwm yog qhov yuav luag tsis tuaj yeem tawm tsam lawv nrog txoj kev phais. Yog li ntawd, chemotherapy lossis hluav taws xob ua ib qho ntxiv rau kev kho mob.
Relapses tshwm sim lawm. Qhov no piav qhia txog tus nqi ntawm kev kuaj mob ntxov. Granulosa cell carcinoma muaj tsis dhau atypical hlwb - lwm yam ntawm nws cov yam ntxwv. Yog li ntawd, txoj kev pheej hmoo ntawm malignancy tsis yog siab heev. Tsis tas li ntawd, cov qog loj hlob qeeb.
T-b nqi laj thawj
Nws tau sau tseg saum toj no tias nws yog hormonal imbalances uas dhau los ua qhov tseem ceeb. Ntxiv mus, tsab ntawv nqis los "los ntawm saum toj" - ua txhaum ntawm lub caj pas pituitary. Nws yog nws uas yog lub luag haujlwm rau kev tsim cov tshuaj estrogen thiab progesterone hauv appendages.
Qhov tseeb etiology ntawm GKO tseem tsis tau tsim txawm tias niaj hnub no. Tab sis muaj ntau lub sij hawm provocative:
- kev tiv thaiv qis;
- viruses;
- mob khaub thuas appendages;
- ncua sijhawm puberty hauv cov ntxhais;
- kev ua txhaum ntawm MC;
- adnexal dysfunction.
GKO classification
Granulosa cell hlav muaj nyob rau hauv 2 hom thiab 2 hom. Txhua tus ntawm lawv muaj nws tus yam ntxwv ntawm chav kawm, tsos, tshwm sim thiabkev kho mob.
Muaj 2 hom T-nqis raws li hnub nyoog pawg - cov hluas lossis cov hluas thiab cov laus. Cov qub nyob tsuas yog 5%. Lawv tshwm sim hauv cov neeg laus thiab cov poj niam hluas hnub nyoog qis dua 30 xyoo, thaum qhov txhab feem ntau yog ib sab. 95% - tshwm sim tom qab 40 xyoo thiab koom nrog cov neeg laus daim ntawv. Cov tub ntxhais hluas cov qog muaj nyob rau hauv txoj kab uas hla ntawm 9 mus rau 22 cm.
Cov menyuam yaus tsis muaj peev xwm rov tsim dua tshiab, tom qab ua haujlwm cov tsos mob ploj mus thiab cov qog nws tus kheej ploj mus. Tsis tshua muaj, tab sis muaj kev rov qab los, feem ntau hauv thawj 3 xyoos tom qab kev phais. Lub tsev kho mob kuj tau txais txiaj ntsig.
Rau siv: 10% ntawm cov kab mob me me tshwm sim thaum cev xeeb tub, tab sis qhov no tsis hloov qhov kev tshwm sim.
Tus neeg laus GKO tshwm thaum muaj hnub nyoog 45-60 xyoo. Ib tus neeg laus-hom granulosa cell hlav ntawm zes qe menyuam tuaj yeem raug kho nyob rau hauv qhov tshwj xeeb hluas ntawm cov neeg mob, qhov no tau pom nrog endometrial hyperplasia. Lwm cov tsos mob ntawm cov neeg laus hom granulosa cell hlav tsis qab ntxiag thiab lub neej zoo yog phem heev.
Type of T-bills
Lawv kuj yog 2 - macrofollicular thiab luteinized. Macrofollicular - tus yam ntxwv ntawm cov hluas. Cov qog no feem ntau loj, nws cov kab noj hniav loj muaj cov kua dej - serous lossis ntshav.
Luteinized hom - granulosa hlwb sib txawv ntawm qhov loj thiab cov duab thiab yog pawg. Lub cytoplasm yog tsim tau zoo thiab tsis muaj nuclei. Cov hlwb no muaj tee ntawm eosinophilic secretion.
Fact! Ntau cov kev tshawb fawb qhia tias cov menyuam yaus tshwm sim los ntawm cov noob hloov pauv uas tshwm sim txawm tias nyob rau hauv embryogenesis, thiab nws yog thaum lub sij hawm tsim kev sib deev.fetal appendages. Thiab tus neeg laus hom granulosa cell qog ntawm zes qe menyuam yog tshwm sim ntawm pituitary mob.
Symptomatic manifestations
Cov kab mob uas tshwm sim feem ntau ntawm MC thiab uterine los ntshav. Nquag mob nyob rau hauv sab nraub qaum thiab sab plab. Cov hnub nyoog sib txawv muaj lawv tus kheej cov tsos mob. Yog hais tias tus ntxhais muaj ib tug pathology, thaum ntxov puberty yuav raug sau tseg. Uncharacteristically, cov tsos ntawm los ntshav los ntawm lub tsev menyuam thiab thaum cev xeeb tub.
Qhov tseem ceeb! Kev ua haujlwm hormonal ntawm GKO ua rau nws tuaj yeem kuaj pom nws ntxov. Qhov no tau sau tseg hauv 65-75% ntawm cov neeg mob kuaj mob. Tus neeg laus granulosa cell qog ntawm zes qe menyuam tuaj yeem tsim cov tshuaj hormones poj niam txiv neej - estrogens thiab androgens. Cov tsos mob yuav txawv ntawm qhov no.
pom pom tseeb tshaj plaws
feem ntau tshwm sim:
- Pathological fluctuations hauv MC - nyob rau hauv daim ntawv ntawm amenorrhea nyob rau hauv cov me nyuam muaj hnub nyoog, menorrhagia, uterine los ntshav nyob rau hauv menopause, los ntshav nrog mucus ntawm cycles.
- Ntxiv rau, mob hauv qab thiab hauv plab plab.
- Cov menyuam ntxhais muaj kev loj hlob ntawm kev sib deev thaum ntxov ua ke nrog lwm cov cim: kev loj hlob ntawm lub mis thiab cov plaub hau thiab caj dab.
- Prevalence of androgens - yuav muab kev loj hlob ntawm cov clitoris thiab loj ntawm lub tsev menyuam, tsim ib tug txiv neej daim duab, hirsutism, ua kom cov qog sebaceous thiab hirsutism. Nrog hirsutism, ib tug poj niam pib loj hlob ib lub hwj txwv thiab hwj txwv. Kev kuaj mob gynlecological yuav qhia tau dav dav dav dav dav hauv zes qe menyuam. Kev kho mob thaum lub sijhawm kuaj pom ntxov no yeej ib txwm ua tiav.
Tumor Complications
Ntxiv rau qhov metastasis, tej zaum yuav muaj qhov tawg ntawm cov tshuaj ntsiav ntawm qhov tsim, ua raws li qhov chaw kho mob ntawm lub plab mob. Hauv ib lub hlis twg ntawm cov xwm txheej, GCT tuaj yeem ua rau cov kua dej ntau ntxiv hauv lub plab kab noj hniav - ascites. Nws yog qhov zoo tshaj plaws uas tsis muaj cov hlwb atypical hauv cov kua nrog GKO.
ntsuas ntsuas
Nws pib nrog kev kuaj gynecological ntawm tus neeg mob hauv lub rooj zaum - txawm tias nws tuaj yeem txiav txim siab lub foob hauv lub zes qe menyuam. Thaum soj ntsuam cov ntshav rau cov tshuaj hormones, theem ntawm estradiol yog ib txwm nce siab; Nyob rau hauv lub zog ntawm cov txheej txheem, kev nce hauv oncomarker CA-125 tau sau tseg. Cov zis kuj tseem muaj cov tshuaj estrogens.
Smear cytology rau cov kab mob pathological thiab kuaj histological ntawm biopsy, pneumogynecography, kuaj lub tsev menyuam kab noj hniav nrog lub hysteroscope, transvaginal echography, transabdominal ultrasound lossis zes qe menyuam ultrasound yog ua tiav (ob qho tib si tom kawg siv ultrasound, tab sis hom kev siv cov khoom siv sib txawv).
CT - kuaj pom ntau lub chamber cystic tsim, uas qhia txog qhov tsis zoo ntawm cov txheej txheem.
Ultrasound tseem yog ib txoj hauv kev tseem ceeb - nws pom qhov pib ntawm cov qog hauv zes qe menyuam.
Pneumogynecography lossis pneumopelviography yog ib hom kev kuaj X-ray, qhov chaw siv huab cua hloov pauv tus neeg sawv cev: nitrous oxide, oxygen, carbon dioxide. Lawv qhov zoo dua yog nyob rau hauv lub nrawm resorption hauv kab noj hniav - los ntawm ib nrab teev mus rau 2 teev. Oxygen ncua mus txog ib hnub. Tsis tas li ntawd, nws muaj bactericidal thiab analgesic zog. Txoj kev no yog siv rau cov ntxhais thiab cov poj niam uas tsis tau ua neej nyob nrog kev sib deev. Nws muab cov ntaub ntawv hais txog sab nraud contours ntawm lub tsev menyuam thiab cov appendages, cov txheej txheem nplaum ntawm no, cicatricial hloov hauv qhov chaw mos, muaj kev tsim nyob rau hauv zes qe menyuam, thiab hermaphroditism.
txhawm rau txheeb xyuas qhov rov tshwm sim hauv GCOS, lub ntsiab lus ntawm cov cim xws li inhibins yog siv. Nrog menopause, nws xyaum tsis tshwm sim. Tab sis thaum cov qog tshwm sim, nws tseem tsim tawm.
txoj kev kho
Kev kho mob ntawm granulosa cell hlav yog ib txwm nyuaj. Ntawm no peb txhais tau hais tias txoj kev phais (thawj), qog irradiation, hormonal kho thiab chemotherapy. Kev ua haujlwm muaj nyob rau hauv kev tshem tawm tag nrho cov chaw cuam tshuam. Ntau yam txiav txim siab hnub nyoog ntawm tus neeg mob thiab theem ntawm GCT.
Pangisterectomy yog ua rau cov poj niam thaum cev xeeb tub. tshem tawm ntawm uterus thiab appendages, omentum kiag li. Hauv cov poj niam uas muaj hnub nyoog me nyuam uas tab tom npaj cev xeeb tub, cov kws phais ib txwm sim tawm ib lub raj thiab lub tsev menyuam. Tab sis cov omentum feem ntau raug tshem tawm nrog lub zes qe menyuam cuam tshuam, vim tias nws yog nyob rau hauv nws cov qog nyiam germinate.
Metastases tuaj yeem xav tau rov ua haujlwm, tab sis kev pheej hmoo ntawm kev rov tshwm sim tseem nyob hauv txhua kis - qhov no yog qhov tshwj xeeb ntawm GKO. Txhawm rau txo qhov muaj peev xwm ntawm lawv qhov tshwm sim, chemotherapy thiab kev kho hluav taws xob tau ua tiav. Rau kev siv tshuaj khomob, bleocin, platinum derivatives, etoposide, thiab lwm yam yog siv. Feem ntau, tom qab kev phais lawm, lawv txwv rau 3 chav kho mob.
Tsis tas li ntawd, kev kho tshuaj hormone kuj tseem siv tau. Megestrol thiab lwm yam tshuaj hormonesraug xaiv cais rau txhua tus neeg mob, tsis muaj cov qauv ntawm no.
Thiab lwm txoj kev kho mob ntau dua yog kev kho hluav taws xob. Nws yog qhia rau contraindications rau chemotherapy. Xov tooj cua beams rhuav tshem cov qog thiab hauv 80% ntawm cov neeg mob nws regresses.
Txhua txoj hauv kev ntxiv yog siv los tawm tsam tsis yog rov qab los, tab sis kuj yog metastases. Feem ntau, kev kho mob kav li ntawm rau lub hlis mus rau 2 xyoos.
Hauv 12-55% ntawm cov neeg mob, HCT tshwm sim, sib txawv ntawm qhov ntawd txawm tias muaj kev kho mob tag nrho hauv 12-55% ntawm cov neeg mob, nws muab kev rov qab los tom qab ob peb xyoos - los ntawm 9 txog 30 xyoo tos. Qhov no kuj tau qhia los ntawm kev tshuaj xyuas ntawm granulosa cell hlav ntawm zes qe menyuam hauv cov poj niam uas muaj hnub nyoog me nyuam. Nyob rau theem 1 ntawm tus kab mob, 5-xyoo kev ciaj sia yog 95%, nyob rau theem tom qab nws pom tsawg dua. Qee zaum txog li 70%, lossis tsawg dua.
Ceeb toom: Nws tsim nyog ceeb toom koj tsis txhob txhuam ib sab rov qab los ntawm kev kho hluav taws xob thiab tshuaj hormones. Cov no yog cov kev kho mob tiav.
GKO forecasts
Kev kuaj mob ntawm cov qog nqaij hlav hauv lub tsev menyuam yog txiav txim siab los ntawm nws theem, tus neeg mob lub hnub nyoog thiab tus mob. Paradoxically, kev kho mob rau cov neeg laus cov qog nqaij hlav hauv cov neeg mob hnub nyoog 50-60 xyoo yog qhov ua tau zoo dua li cov tub ntxhais hluas. Tsis pub dhau 5 xyoos, qhov rov tshwm sim zoo li no tshwm sim hauv ib feem peb ntawm cov neeg mob.
Cov Hluas - tuaj yeem rov qab los hauv 3 xyoos ntawm kev kho mob. Nws yuav tsum raug sau tseg tias tsis muaj ib tus kws phais neeg yuav muab kev lees paub rau koj tias yuav tsis rov muaj dua. Qhov no ib zaug hais txog qhov tseem ceeb ntawm kev kuaj mob ntxov.
Cov poj niam nug cov kws kho mob dab tsi? Lawv cov lus nug ntau zaus yog seb puas yoggranulosa cell qog rau mob qog noj ntshav? Cov lus teb yog ob npaug - yog thiab tsis yog. Nws yog txiav txim los ntawm theem ntawm tus kab mob.
Raws li lawv hais, nws tsis yog Ameslikas "kev mob qog noj ntshav dawb". Tab sis yog hais tias ib tug poj niam tsis mloog cov tsos mob thiab pib tus txheej txheem, nws yuav mas metastasize thiab ua malignant.
Qhov tsis txaus ntseeg ntawm cov qog nqaij hlav, tsis zoo li lwm yam neoplasms, yog tias txawm tias 30 xyoo tom qab kev tshem tawm tiav, nws tuaj yeem rov qab los ntawm ib nrab ntawm cov neeg mob. Qhov no yog qhov tseeb tshwj xeeb tshaj yog rau cov poj niam uas tshuav ib feem ntawm lub cev xeeb tub thaum lub sijhawm ua haujlwm.
