Kev tsim cov hlwb txawv txav hu ua qog hlwb hauv menyuam yaus. Cov kab mob no cuam tshuam rau thaj chaw uas tswj cov haujlwm tseem ceeb ntawm lub cev thiab cuam tshuam rau cov txheej txheem tseem ceeb ntawm tag nrho lub cev. Nws yog ib hom kab mob kheesxaws uas tshwm sim ntau tshaj plaws hauv cov menyuam yaus.
Kev faib tawm
Tom qab tsim cov yam ntxwv tseem ceeb thiab ua qhov kev kuaj mob, cov neoplasm tuaj yeem raug cais raws li cov yam ntxwv dav dav hauv qab no:
- Ib lub hlwb mob qog nqaij hlav hauv tus menyuam loj hlob qeeb thiab tsis nkag mus rau hauv cov ntaub so ntswg nyob ze. Nyob rau hauv cov ntaub ntawv no, ib tug pathological neoplasm yog txaus ntshai vim hais tias, maj mam nce, nws pib pinch nyob ze thaj chaw ntawm lub paj hlwb, uas provokes qhov tshwm sim ntawm tej yam tsos mob.
- mob qog nqaij hlav ntawm lub hlwb suav nrog kev tsim qis qis (nrog me medegree ntawm aggressiveness) thiab qib siab cov qog uas loj hlob sai thiab kis mus rau lwm cov ntaub so ntswg ntawm lub cev.
- Pib tsim tawm hauv lub hlwb.
- Cov qog nqaij hlav, uas muaj cov hlwb uas metastasize los ntawm lwm qhov hauv lub cev.
Astrocytoma
Cov qog hlwb no thaum yau yog ib qho tseem ceeb hauv cov kab mob hauv lub hlwb neuroepithelial hlav los ntawm astrocytes (stellate cells). Astrocytoma hauv cov menyuam yaus tuaj yeem muaj qhov sib txawv ntawm malignancy. Nws cov tsos mob nyob ntawm qhov chaw thiab muab faib ua feem ntau (tsis qab los noj mov, tsis muaj zog, mob taub hau) thiab focal (hemihypesthesia, hemiparesis, kev sib koom tes, kev hais lus tsis zoo, kev xav tsis zoo, kev hloov pauv tus cwj pwm). Cov neoplasm no tau kuaj pom los ntawm cov ntaub ntawv kho mob, cov txiaj ntsig ntawm MRI, CT thiab histological kev tshawb fawb ntawm cov qog nqaij hlav. Kev kho mob rau astrocytoma hauv cov menyuam yaus feem ntau yog ua ke ntawm ntau txoj hauv kev: kev phais lossis kev phais hluav taws xob, tshuaj khomob thiab hluav taws xob.
Tus me nyuam muaj 10 hli puas tuaj yeem mob qog hlwb? Lub paj hlwb astrocytoma tuaj yeem loj hlob ntawm txhua lub hnub nyoog, tab sis feem ntau pom hauv cov menyuam yaus. Qhov no neoplasm yog tshwm sim los ntawm oncological degeneration ntawm lub hnub qub zoo li astrocytes. Txog thaum tsis ntev los no, nws tau ntseeg tias cov hlwb no ua haujlwm pab txhawb kev sib raug zoo rau cov neurons ntawm lub paj hlwb. Txawm li cas los xij, kev tshawb fawb tsis ntev los no hauv neurophysiology tau qhia tiasuas astrocytes ua haujlwm tiv thaiv, tiv thaiv kev raug mob rau cov neurons thiab inhibiting tshuaj tsim los ntawm lawv cov haujlwm tseem ceeb.
Tsis muaj cov ntaub ntawv tseeb ntawm cov xwm txheej uas ua rau muaj kev hloov pauv pathological ntawm astrocytes tseem. Piv txwv li, hluav taws xob ntau dhau, raug tshuaj lom neeg ntev, thiab cov kab mob ua lub luag haujlwm hauv cov txheej txheem no. Cov kab mob tshwm sim ua lub luag haujlwm tseem ceeb, txij li cov menyuam yaus uas muaj astrocytoma feem ntau muaj cov kab mob caj ces hauv TP53 gene.
Astrocytoma ntawm lub hlwb muab faib ua "ib txwm" lossis "tshwj xeeb". Thawj qeb suav nrog fibrillar, gemistocytic thiab protoplasmic astrocytoma ntawm lub hlwb. Cov qeb "tshwj xeeb" suav nrog pyelocytic, subependymal thiab cerebellar microcystic astrocytoma ntawm lub hlwb hauv cov menyuam yaus.
Astrocytomas kuj raug cais raws li lawv qib ntawm malignancy. Pyelocytic astrocytoma belongs rau qib I, fibrillar astrocytoma rau qib II, anaplastic rau qib III, thiab glioblastoma rau qib IV.
Nyob zoo
Cov qog hlwb no hauv menyuam yaus yog tsim los ntawm cov ntaub so ntswg ependymal ntawm lub ventricular system ntawm lub hlwb. Clinically, nws yog tshwm sim los ntawm cov tsos mob ntawm intracranial siab, ataxia, tsis pom kev thiab hnov lus, qaug dab peg, hais lus tsis zoo, thiab nqos reflexes. Kev kuaj mob yog nqa tawm tsuas yog nrog kev pab ntawm MRI ntawm lub paj hlwb, EEG, txha nraub qaum, kev tshawb fawb histological. Lub hauv paus ntawm kev kho yog radical excision ntawm ependymoma ua raws li hluav taws xob lossis tshuaj khomob.
Ependymoma yog los ntawm ependymocytes,uas yog cov hlwb zoo li epithelial uas tsim ib txheej nyias ntawm lub paj hlwb ventricles thiab tus txha caj qaum. Cov kab mob neoplasms no suav txog txog li 7% ntawm tag nrho cov qog hlwb hauv cov menyuam yaus thiab raug faib ua gliomas. Kwv yees li 60% ntawm cov neeg mob uas muaj cov qog no yog cov menyuam yaus hnub nyoog qis dua tsib xyoos. Nyob rau hauv cov nqe lus ntawm kev nthuav dav, ependymoma nyob rau qib 3 ntawm cov qog hlwb thiab nws cov kab mob malignant feem ntau pom.
Ependymoma ntawm lub hlwb hauv cov menyuam yaus feem ntau yog tsim nyob rau hauv posterior cranial fossa. Cov qog yog tus cwj pwm los ntawm kev nce qeeb, qhov tsis muaj kev loj hlob hauv cov ntaub so ntswg uas nyob sib ze. Txawm li cas los xij, xws li cov qog loj hlob tuaj, nws tuaj yeem ua rau lub hlwb compression. Metastasis ntawm cov txheej txheem tshwm sim feem ntau raws CSF txoj hauv kev thiab tsis mus dhau ntawm lub paj hlwb. Feem ntau pom retrograde metastases nyob rau hauv cov qauv ntawm tus txha caj qaum.
Ntau qhov kev tshawb fawb tshawb fawb tau pom tus kab mob SV40, uas nyob hauv cov qog hlwb hauv lub xeev ua haujlwm. Tab sis txog tam sim no, nws lub luag haujlwm hauv kev loj hlob ntawm neoplasms tsis meej. Nws tau xav tias qhov tsim tshwm sim vim qhov cuam tshuam ntawm cov yam ntxwv ntawm oncogenic: hluav taws xob hluav taws xob, tshuaj lom neeg carcinogens, cov xwm txheej tsis zoo mus ntev (piv txwv li, hyperinsolation), kab mob (tib neeg papillomavirus, kab mob herpes, thiab lwm yam).
Ntxiv rau, kev koom tes ntawm cov yam ntxwv ntawm kev tsim cov ependymoma yuav tsum tsis suav nrog. Muaj kev paub ua ke ntawm cov qog hlwb hauv cov menyuam yaus nrogRecklinghausen neurofibromatosis, familial colon polyposis, endocrine neoplasia syndrome.
Tshav, suav nrog cov ntaub ntawv ntawm kev faib tawm niaj hnub no, muaj 4 hom ependymomas, uas txawv ntawm cov qib ntawm benignness thiab cov txheej txheem ntawm cov qog. Qhov zoo tshaj plaws yog myxopapillary ependymoma. Subependymoma yog tus cwj pwm los ntawm kev loj hlob zuj zus, feem ntau asymptomatic chav kawm thiab tsis tshua muaj tshwm sim. Classical ependymoma yog qhov ntau tshaj plaws. Nws tuaj yeem ua rau txhaws ntawm cov kua cerebrospinal. Nws feem ntau rov tshwm sim, dhau sij hawm nws tuaj yeem degenerate rau hauv anaplastic ependymoma, uas tawm li 1/4 ntawm tag nrho cov ependymomas. Nws yog tus cwj pwm los ntawm kev loj hlob sai thiab metastasis, vim nws tau txais cov npe: ependymoblastoma, undifferentiated ependymoma, malignant ependymoma.
Medulloblastoma
Nov neoplasm ntawm lub hlwb hauv cov menyuam yaus yog cov qog nqaij hlav ntawm medulloblasts, uas yog cov hlwb tsis paub qab hau thiab glia, thiab nyob hauv thaj chaw, raws li txoj cai, nyob rau hauv cov kab mob cerebellar, nyob ib sab ntawm lub ventricle plaub. Tus cwj pwm los ntawm cov cim qhia ntawm kev mob qog noj ntshav hauv tus menyuam yaus, nce intracranial hypertension thiab cerebellar ataxia. Kev kuaj mob yog tsim los ntawm kev ntsuam xyuas daim duab kho mob, cov txiaj ntsig ntawm kev tshawb fawb ntawm cov kua cerebrospinal, CT, PET, biopsy. Kev kho mob suav nrog kev phais tshem tawm cov neoplasm, kho cov leeg txha caj qaum, kho tshuaj kho mob.
Medulloblastoma yog ib qho mob hnyav heev. Cov qog loj hlob nyob rau hauv cerebellar vermis, thiab nyob rau hauv cov me nyuam tom qab rau rauxyoo yog qee zaum nyob rau hauv lub hemispheres ntawm lub hlwb. Feem ntau, nws sai sai metastasizes los ntawm CSF raws, uas txawv nws los ntawm lwm yam mob hlwb thiab nyob rau qib thib ob ntawm malignant hlwb hlav nyob rau hauv cov me nyuam nyob rau hauv cov nqe lus ntawm tshwm sim. Feem ntau tshwm sim hauv cov menyuam yaus.
Lub hnub nyoog uas medulloblastoma feem ntau kuaj pom yog 5-10 xyoo. Txawm li cas los xij, nws tsis yog tsuas yog "thaum me nyuam yaus" pathology; nws tuaj yeem kuaj tau txhua lub hnub nyoog. Feem ntau, cov neeg mob ntawm medulloblastoma yog ib ntus. Txawm li cas los xij, muaj qhov cuam tshuam los ntawm qhov tshwm sim ntawm tus kab mob.
Vim li cas neoplasm ntawm lub paj hlwb tsim nyob rau hauv cov me nyuam tseem tsis tau paub meej nyob rau tam sim no. Tsuas yog cov xwm txheej txaus ntshai rau cov kab mob no tau paub, lawv suav nrog hnub nyoog qis dua 10 xyoo, raug hluav taws xob ionizing, zaub mov carcinogens, xim, kab mob kis (cytomegalovirus, herpes, HPV, kis kab mob mononucleosis), ua rau cov genome ntawm cov hlwb.
Medulloblastoma yog ib qho kev tsim neuroectodermal primitive. Nws yog, raws li txoj cai, nyob rau hauv subtentorially, nyob rau hauv lub cerebellum, loj hlob mus rau hauv nws thiab sau tag nrho plaub cerebral ventricle. Qhov no ua rau muaj kev cuam tshuam ntawm CSF ntws, raws li cov qog pib los thaiv cov kua dej. Intracranial siab nyob rau hauv ib tug me nyuam nce sharply, lub bulbar seem yog puas vim lub germination ntawm ib tug pathological neoplasm nyob rau hauv lub paj hlwb qia. Nws yog ib qho tseem ceeb kom paub txog thawj cov tsos mob ntawm lub hlwb qog nyob rau hauv ib tug me nyuam raws sij hawm.
Daim duab histological yog qhov sib txuam ntawm kev loj hlob, me me, tsis zoo sib txawv, puag ncig, embryonic hlwb nrog hyperchromic nucleus thiab nyias cytoplasm. Los ntawm cov qauv, cov nram qab no ntau yam ntawm xws li ib tug neoplasm yog txawv:
- medullomyoblastoma nrog cov leeg nqaij;
- melanotic medulloblastoma, muaj cov hlwb neuroepithelial uas muaj melanin;
- lipomatous medulloblastoma nrog cov rog rog.
Craniopharyngioma
Cov qog nqaij hlav hauv hlwb hauv tus menyuam no yog cystic-epithelial neoplasm nyob rau hauv thaj tsam ntawm Turkish eeb thiab tsim los ntawm cov epithelium ntawm Rathke lub hnab. Raws li cov neoplasm loj hlob thiab loj hlob, tus me nyuam muaj kev nce qib ntawm intracranial siab, kev loj hlob qeeb, tsis pom kev, hypofunction ntawm adenohypophysis. Txoj kev qhia paub ntau tshaj plaws rau kev kuaj mob pathology yog CT, uas tso cai rau txiav txim siab cov qauv thiab muaj cov calcifications hauv cov qog. Kev kho mob yog phais, tom qab uas tus neeg mob tau txais kev kho hluav taws xob kho mob txhawm rau txhawm rau nres qhov kev loj hlob ntxiv ntawm cov kab mob neoplasm.
Craniopharyngioma nyob, raws li txoj cai, hauv thaj chaw hypothalamic-pituitary. Raws li nws loj hlob tuaj, cysts tuaj yeem tsim nyob rau hauv cov ntaub so ntswg, uas muaj cov kua dej nrog cov protein ntau. Qhov tshwm sim ntawm craniopharyngiomas yog kwv yees li 3% ntawm txhua hom hlwb neoplasms hauv cov menyuam yaus. Qhov tshwm sim feem ntau yog neuroepithelialcraniopharyngiomas (kwv yees li 9% ntawm cov neeg mob), thiab lub ncov ntawm pathology kev loj hlob poob rau lub hnub nyoog ntawm 5 mus rau 13 xyoo. Lwm hom kev tsim no yog papillary.
Cov kws kho mob txiav txim siab txog kev xeeb tub thiab ntau yam kev hloov pauv los ua qhov tseem ceeb ntawm craniopharyngioma. Tsis tas li ntawd, qee qhov lwm yam cuam tshuam rau txoj kev loj hlob ntawm pathological tsim, tshwj xeeb tshaj yog tias lawv cov nyhuv tshwm sim hauv thawj peb lub hlis twg ntawm cev xeeb tub. Cov ua rau craniopharyngiomas hauv cov menyuam yaus muaj xws li cov tshuaj, tshuaj lom, co toxins, hluav taws xob, toxicosis thaum ntxov, cov kab mob ntawm tus poj niam cev xeeb tub (mob ntshav qab zib mellitus, raum tsis ua haujlwm, thiab lwm yam). Craniopharyngioma muab faib ua 2 hom: papillary thiab adamantinomatous.
Cov tsos mob ntawm lub hlwb hlav hauv cov menyuam yaus
Cov cim qhia ntawm lub hlwb neoplasm hauv cov menyuam yaus yog:
- Ntshai ntawm qab los noj mov, ntuav (feem ntau thaum sawv ntxov).
- qaug zog hnyav, tsis muaj zog lossis ua haujlwm tsis zoo, pallor.
- mob, tshwj xeeb tshaj yog tom qab ntuav, ua tsis taus pa ntau dhau.
- chim siab thiab tsis txaus siab rau kev ua ub no (kev ua si, thiab lwm yam).
- Qhov muag tsis pom kev - qhov muag txawv txav, pom ob lub qhov muag, qhov muag tsis pom kev.
- Kev tsis sib haum xeeb, tsis muaj zog ntawm ob txhais ceg, gait cuam tshuam (nquag ntog).
- qaug dab peg yog ib qho tsos mob ntawm cov qog hlwb hauv cov menyuam yaus.
- Head enlargement.
- Ntsuag lub cev.
- Tsis txhob yeemtso zis, cem quav ntau zaus.
- Headache.
- Hyperreflexia thiab cranial paj hlwb palsies.
- Kev txhim kho qeeb.
Yuav mus qhov twg yog tias koj muaj cov tsos mob ntawm lub hlwb hlav hauv menyuam yaus?
Diagnosis
Kev kuaj mob qog nqaij hlav muaj kev ntsuam xyuas dav. Vim qhov xav tau kev kuaj mob ntawm cov cuab yeej siv niaj hnub no, tus menyuam yuav xav tau tshuaj loog. Kev kuaj mob neurological yog ua tiav, uas yog tsom rau kev ntsuas lub luag haujlwm tseem ceeb uas qhia txog kev ua haujlwm raug ntawm lub paj hlwb lossis kev ua txhaum cai. Kev pom, kev hnov lus thiab kev xav ntawm tus menyuam yog raug rau kev tshawb fawb.
Cov kev kuaj mob ua rau nws muaj peev xwm txheeb xyuas qhov chaw hauv cheeb tsam thiab thawj cov cim qhia ntawm lub paj hlwb hauv cov menyuam yaus thaum kawm txog qhov tsis sib xws: kev sib koom tes, kev tsis sib haum xeeb. Lwm txoj kev tshawb fawb yog MRI, uas qhov chaw tsim nyog ntawm lub hlwb pom tau zoo. Hauv qhov no, siv tus neeg sawv cev tshwj xeeb sib txawv.
Cov me nyuam yuav tsum tau tshem cov qog hlwb?
Kev kho mob
Kev kho mob hlwb hauv cov menyuam yaus yuav tsum ua kom zoo li sai tau thiab zam kev cuam tshuam tsis zoo. Kev kho mob yog ua los ntawm peb txoj kev tseem ceeb:
- Kev tshem tawm cov qog.
- tshuaj kho mob.
- Radiation therapy.
Kev kho mob hlwb hauv cov menyuam yausphais aimed ntawm tshem tawm cov pathological tsom xam. Txoj kev no qhia tau hais tias muaj txiaj ntsig zoo tshaj plaws hauv kev ua ke nrog lwm yam kev ntsuas. Kev phais mob rau lub hlwb hauv tus menyuam yuav luag tsis tuaj yeem yog tias lub cev lub cev puas lawm, vim tias cov chaw tseem ceeb nyob hauv cheeb tsam no. Qhov kev cuam tshuam tau ua tiav yog tias tus me nyuam tsim ib qho benign neoplasm. Hauv qhov no, qhov kev cia siab rau kev rov zoo tom qab tshem tawm cov qog hlwb hauv cov menyuam yaus tau zoo dua.
Kev kho hluav taws xob
Radiotherapy yog siv rau contraindications rau kev kho mob phais. Txoj kev tsis pom zoo rau kev kho mob ntawm cov menyuam yaus hnub nyoog qis dua 3 xyoos, vim tias qhov tshwm sim tsis zoo yuav tshwm sim vim yog irradiation - kev txawj ntse thiab lub cev retardation. Cov kev kho no muaj txiaj ntsig zoo rau cov neoplasms ntawm qhov loj hlob sai lossis qhov me me.
Kev siv tshuaj khomob yog qhov tsim nyog yog tias tus neeg mob muaj qib siab ntawm cov qog nqaij hlav. Kev kho mob raug tso cai txawm tias tus menyuam muaj hnub nyoog qis dua peb xyoos. Dab tsi yog qhov tshwm sim rau cov qog ntawm lub paj hlwb hauv cov menyuam yaus, nws yog qhov nthuav rau ntau.
Huab cua
Cov kev kho niaj hnub no ua rau muaj feem yuav rov zoo. Qhov kev tshwm sim rau cov qog hlwb hauv cov menyuam yaus tuaj yeem ua tau zoo, uas feem ntau txiav txim siab seb cov qog puas yog malignant lossis benign.
Qhov txiaj ntsig ntawm kev kho yog nyob ntawm ntau yam:
- ntau yamqog;
- qhov loj thiab qhov chaw ntawm qhov txhab, uas cuam tshuam rau qhov kev cia siab ntawm kev ua tiav ntawm kev kho mob phais;
- degree ntawm qhov hnyav thiab theem ntawm kev loj hlob ntawm pathology;
- hnub nyoog ntawm tus neeg mob;
- presence of concomitant qog.
Nws tau raug pov thawj tias qhov kev mob tshwm sim tom qab tshem tawm cov kab mob pathological hauv menyuam yaus yog qhov zoo dua li cov neeg laus.
