Nodular sclerosis yog ib hom kab mob qog nqaij hlav lymphogranulomatosis, uas yog tus cwj pwm los ntawm kev loj hlob ntawm cov ntaub so ntswg sib txuas, faib rau hauv ib pawg ntawm cov hlwb tsis sib xws thiab lobules. Lawv muaj overgrown lymphoid teeb meem nrog ib tug loj tus naj npawb ntawm Berezovsky-Sternberg hlwb. Tus kab mob pib nrog kev nce hauv cov nodes. Qhov no pathology yog ib qho ntawm cov kev hloov pauv ntawm classical Hodgkin's lymphoma.
Hodgkin's disease yog suav tias yog ib qho mob hnyav uas cuam tshuam rau cov kab mob lymphatic. Tus kab mob tuaj yeem tsim hauv txhua lub cev uas muaj cov ntaub so ntswg lymphoid (thymus caj pas, tonsils, spleen, adenoids, thiab lwm yam).
Nodular sclerosis: Cov tsos mob
Hodgkin's lymphoma tuaj yeem nyob hauv ib tus neeg yog tias nws muaj cov tsos mob xws li:
- poob phaus;
- cov qog ntshav o (feem ntau hauv lub caj dab);
- poob qab los;
- ua tsis taus pa;
- hmo ntuj tawm hws lossis kub taub hau;
- mob plab;
- daim siab loj (5% ntawm cov neeg mob) lossis tus po (30% ntawm cov neeg mob);
- hnyav lossis mob hauv plab (hauv menyuam yaus);
- daim tawv nqaij khaus (tsuas yog 1/3cov neeg mob);
- ua pa nyuaj;
- ncaws.
Yog vim li cas
Lymphogranulomatosis tuaj yeem kis tau rau txhua lub hnub nyoog, tab sis nws muaj ntau dua rau cov txiv neej hluas hnub nyoog 16 txog 30 lossis cov laus dua 50 xyoo. Cov menyuam yaus hnub nyoog qis dua 5 xyoos xyaum tsis muaj mob. Dab tsi yog provokes tus kab mob no tseem tsis tau paub. Txawm li cas los xij, muaj kev xav tias lub hauv paus yog kab mob. Nws ntseeg tias qhov pib ntawm tus kab mob no tuaj yeem yog:
- immunodeficiency xeev;
- kis kab mob mononucleosis (ua los ntawm tus kab mob Epstein-Barr).
Nodular sclerosis ntawm Hodgkin's lymphoma tuaj yeem daws tau sai, kav ntev li 3 txog 6 lub hlis, lossis ncab rau 20 xyoo.
Tus kab mob yog dab tsi?
Hodgkin's lymphoma qib yog txiav txim siab los ntawm kev kuaj pom thiab ua raws cov ntsuas hauv qab no:
- tus naj npawb ntawm cov qog ntshav qab zib cuam tshuam thiab lawv qhov chaw nyob;
- muaj cov nodes nyob rau hauv ntau qhov chaw ntawm lub diaphragm;
- qog nqaij hlav hauv lwm lub cev (piv txwv li, hauv daim siab lossis tus po).
thawj theem. Hauv qhov no, tsuas yog ib qho qog nqaij hlav lossis cov qog ntshav qog ntshav (spleen, Pirogov-Walder nplhaib) raug cuam tshuam.
theem thib ob. Lymph nodes ntawm ob sab ntawm lub hauv siab, diaphragm thiab lymphoid organ feem ntau cuam tshuam ntawm no.
Thib peb. Qhov degree ntawm Hodgkin's lymphoma yuav luag zoo ib yam li theem ob. Txawm li cas los xij, nws muaj ob hom nodular sclerosisThib peb:
- thawj kis, cov kabmob uas nyob hauv qab ntawm lub diaphragm (lub plab lymph nodes, spleen) raug cuam tshuam;
- Ntxiv rau thaj chaw uas tau teev tseg hauv thawj ntau yam, lwm qhov chaw uas muaj cov qog ntshav qog nyob ze ntawm lub diaphragm kuj raug cuam tshuam.
theem plaub. Tsis tsuas yog cov nodes raug cuam tshuam, tab sis kuj cov kab mob uas tsis yog-lymphoid - pob txha pob txha, siab, pob txha, ntsws thiab tawv nqaij.
Designations of degrees ntawm Hodgkin's lymphoma
Qhov qhia txog qhov mob hnyav ntawm qhov chaw kho mob thiab qhov mob ntawm lwm cov ntaub so ntswg thiab lub cev yog cim nrog cov ntawv.
A - tsis muaj qhov tshwm sim dav dav ntawm tus kabmob.
B - ib lossis ntau cov tsos mob tshwm sim (ua npaws tsis tau piav qhia, tawm hws hmo ntuj, poob ceeb thawj).
E - qhov txhab kis mus rau cov ntaub so ntswg thiab cov kabmob uas nyob ze ntawm cov qog nqaij hlav cuam tshuam.
S - muaj qhov txhab ntawm tus po.
X - muaj qog nqaij hlav loj loj.
Histological hom kab mob
Hais txog cov qauv cellular ntawm lymphogranulomatosis, muaj 4 hom malaise.
- Nodular sclerosis ntawm Hodgkin's lymphoma yog hom kab mob ntau tshaj plaws, suav txog kwv yees li 40-50% ntawm tag nrho cov mob. Lawv feem ntau cuam tshuam los ntawm cov poj niam hluas, uas feem ntau cuam tshuam los ntawm cov qog nqaij hlav ntawm mediastinum. Nyob rau hauv cov khoom siv biopsy, ntxiv rau Berezovsky-Sternberg hlwb, kuj tseem muaj cov hlwb loj lacunar nrog foamy cytoplasm thiab cov nuclei loj. Kev kwv yees nrog qhov noKev mob nkeeg feem ntau yog qhov zoo.
- Lymphohistiocytic lymphoma, uas tshwm sim hauv 15% ntawm cov neeg mob. Feem ntau nws tuaj yeem pom hauv cov txiv neej hluas hnub nyoog qis dua 35 xyoos. Nws muaj qhov zoo tshaj plaws nyob rau tsib xyoos thiab muaj cov kab mob lymphaitis paub tab, nrog rau Strenberg hlwb. Hom kab mob no nrog me me malignancy thiab kuaj pom nyob rau hauv thawj theem.
- Qhov sib xyaw ua ke feem ntau yog kuaj pom hauv cov neeg laus thiab menyuam yaus. Nws yog qhov txawv los ntawm tus yam ntxwv ntawm daim duab kho mob thiab ib qho kev nyiam rau kev ua kom dav dav. Kev ntsuam xyuas histological qhia txog qhov sib txawv ntawm kev sib txuas ntawm tes, suav nrog Sternberg. Nws pom nyob rau hauv 30% ntawm cov neeg mob uas muaj lymphoma. Nodular sclerosis nyob rau hauv cov ntaub ntawv no muaj ib tug kuj zoo prognosis, thiab yog hais tias kho raws sij hawm, ib tug ruaj khov remission tshwm sim yam tsis muaj teeb meem.
- Kev phom sij granuloma nrog kev puas tsuaj ntawm cov ntaub so ntswg lymphoid tau pom ntau zaus, tsuas yog hauv 5% ntawm cov neeg mob (feem ntau ntawm cov neeg laus). Ib tug yam ntxwv feature ntawm no yog hais tias tsis muaj lymphocytes thiab Sternberg hlwb predominate. Daim ntawv ntawm lymphoma no muaj tsawg tshaj plaws nyob rau tsib xyoos.
Diagnosis
Kev kuaj mob ntawm "lymphoma" tsuas yog txiav txim siab los ntawm kev soj ntsuam histological ntawm cov qog ntshav qab zib thiab suav tias yog qhov pov thawj nkaus xwb yog tias, raws li kev tshawb fawb no, cov hlwb tshwj xeeb multinucleated Sternberg tau pom. Hauv qhov xwm txheej hnyav, yuav tsum tau siv tshuaj tiv thaiv kab mob. Kev tsom xam cytological ntawm cov qog nqaij hlav los yog puncture ntawm ob lub raum feem ntau tsis txaus kom paub meejnodular sclerosis hom 1. Yuav tsum tau ua dab tsi los tsim kev kuaj mob:
- kuaj ntshav dav dav thiab biochemical;
- xov tooj cua ntawm lub ntsws (yuav tsum tau nyob rau sab nraud thiab ncaj qha qhov projection);
- lymph node biopsy;
- kuaj ultrasound ntawm txhua hom peripheral thiab intra-abdominal lymph nodes, thyroid caj pas, daim siab thiab spleen;
- mediastinal xam tomography txhawm rau tshem tawm cov qog ntshav tsis pom ntawm cov pa hluav taws xob zoo;
- trepan-biopsy ntawm ilium kom txiav txim siab cov pob txha pob txha puas;
- Scans thiab radiographs ntawm cov pob txha.
Kev kho mob
Muaj kev kho hluav taws xob, kev phais thiab tshuaj khomob. Qhov kev xaiv ntawm txoj kev yog txiav txim los ntawm theem ntawm malaise thiab muaj qhov zoo los yog tsis zoo prognostic yam. Cov yam tseem ceeb muaj xws li:
- nodular sclerosis thiab lymphohistiocytic yam kuaj pom los ntawm kev kuaj histological;
- under 40;
- ntim cov qog ntshav uas tsis pub tshaj 6 cm inch;
- tsis muaj qhov tshwm sim dav dav ntawm kev ua haujlwm lom neeg (kev loj hlob ntawm cov ntshav biochemical tsis muaj ntshav);
- tsis ntau tshaj 3 qhov chaw ntaus.
Yog tias tsawg kawg yog ib qho ntawm cov laj thawj no ploj lawm, tus neeg mob raug cais tias muaj qhov tsis zoo.
Radiotherapy
Tag nrho cov xov tooj cua kho raws li tus kheej txoj kev yog siv rau cov neeg mobIA thiab IIA theem, paub tseeb tias ntawm laparotomy, thiab muaj cov txiaj ntsig zoo. Nws yog ua dawb teb nrog irradiation ntawm txhua yam cuam tshuam cov qog nqaij hlav, nrog rau cov kab mob ntawm cov qog ntshav tawm.
Tag nrho qhov nqus tau nyob rau hauv cov metastases ntawm qhov txhab yog 40-45 g hauv 4-6 lub lis piam, nyob rau hauv qhov chaw ntawm prophylactic irradiation - 30-40 g hauv 1-4 lub lis piam. Tsis tas li, nrog rau qhov dav dav, txoj hauv kev ntawm ntau qhov chaw irradiation ntawm qee qhov foci yog siv los tiv thaiv nodular sclerosis ns1.
Kev kho hluav taws xob tuaj yeem ua rau muaj teeb meem xws li subcutaneous fibrosis, hluav taws xob pulmonitis thiab pericarditis. Deteriorations tshwm sim nyob rau hauv ib lub sij hawm sib txawv - los ntawm 3 lub hlis mus rau 5 xyoo tom qab kho. Lawv qhov nyuaj yog nyob ntawm cov tshuaj noj.
Kev ua haujlwm
Kev kho phais tsis tshua siv cais, feem ntau nws yog ib feem tseem ceeb ntawm kev kho mob hauv qhov nyuaj. Splenectomy tau ua, nrog rau kev ua haujlwm ntawm cov hlab pas, txoj hlab pas, plab thiab lwm yam kabmob (yog tias muaj kev pheej hmoo ntawm asphyxia, kev tsis sib haum xeeb hauv cov zaub mov). Lub cev xeeb tub uas kuaj pom muaj tus kab mob Hodgkin txuas ntxiv yuav tsum raug txiav.
Tshuaj khomob
Hom no yog siv los ua ib qho ntawm cov khoom siv kho mob nyuaj. Txhawm rau kho tus kab mob nodular sclerosis, siv cov tshuaj sib txawv:
- alkaloids ("Vinblastine" lossis "Rozevin", "Etoposide" lossis "Vincristine," Onkovin");
- alkaline sib tov ("Mustargen", "Cyclophosphan" lossis "Embikhin", "Nitrosomethylurea" lossis "Chlorbutin");
- khoom siv hluavtaws ("Natulan" lossis"Procarbazine", "Dacarbazine" lossis "Imidazole-Carboxamide");
- tshuaj tua kab mob Antineoplastic (Bleomycin, Adriablastin).
Monochemotherapy
Siv tsuas yog hauv cov xwm txheej tshwj xeeb nrog lub hom phiaj qhia. Raws li txoj cai, kev kho mob nrog ntau yam tshuaj nrog ntau lub tswv yim ntawm kev ua (polychemotherapy) tau sau tseg. Nyob rau theem plaub hauv cov neeg mob uas muaj qhov txhab ntawm daim siab lossis pob txha pob txha, hom kev kho mob no yog tib txoj kev - qhov no yog classic Hodgkin's lymphoma. Nodular sclerosis raug kho raws li cov qauv hauv qab no:
- ABVD ("Bleomycin", "Dacarbazine", "Adriablastin", "Vinblastine");
- MOPP (Onkovin, Prednisolone, Mustargen, Procarbazine);
- CVPP (Vinblastine, Prednisolone, Cyclophosphamide, Procarbazine).
Kev kho mob yog ua los ntawm cov kev kawm luv luv (2, 7, 14 hnub) nrog kev so ob lub lis piam. Tus naj npawb ntawm cov voj voog sib txawv nrog qhov loj ntawm qhov pib qhov txhab thiab qhov cuam tshuam rau kev kho mob. Feem ntau qhov kev tso cai ua tiav tiav nrog cov tshuaj ntawm 2-6 chav kawm. Tom qab ntawd, nws raug nquahu kom ua 2 lub voj voog ntxiv ntawm kev kho. Yog tias qhov tshwm sim yog qhov kev tso cai ib nrab, ces qhov kev kho mob hloov pauv, thiab cov chav kawm tau nce ntxiv.
Tshuaj yog nrog los ntawm hematopoietic siab, alopecia, dyspeptic tshwm sim uas ploj thaum kawg ntawm kev kho mob. Nodular sclerosis kuj ua rau muaj teeb meem lig xws li kev xeeb tsis muaj menyuam, leukemia thiab lwm yam qog nqaij hlav (mob theem nrab).
Huab cua
Kev txiav txim siabnta ntawm chav kawm ntawm lymphogranulomatosis, qhov chaw kho mob theem ntawm tus kab mob, tus neeg mob lub hnub nyoog, histological tsos, thiab lwm yam. Nrog rau cov txheej txheem ntse thiab subacute ntawm tus kab mob, qhov kev kwv yees tsis zoo: cov neeg mob feem ntau tuag hauv lub sijhawm ntawm 1-3 lub hlis mus rau 1 xyoos. Tab sis nrog mob lymphogranulomatosis, qhov kev mob tshwm sim yog qhov zoo. Tus kab mob tuaj yeem nyob ntev heev, mus txog 15 xyoo (qee zaum ntev dua).
Hauv 40% ntawm tag nrho cov kab mob, tshwj xeeb tshaj yog nyob rau theem 1 thiab theem 2, nrog rau cov laj thawj pom zoo, rau 10 xyoo lossis ntau dua, kev rov ua dua tsis raug pom. Kev muaj peev xwm ua haujlwm vim qhov kev tso tawm ntev ntev tsis cuam tshuam.
Kev Tiv Thaiv
Feem ntau yog tsom rau kev tiv thaiv rov qab. Cov neeg mob uas muaj lymphogranulomatosis yuav raug kuaj xyuas los ntawm oncologist. Hauv txoj kev tshawb no, uas thawj 3 xyoos yuav tsum tau ua txhua rau lub hlis, thiab tom qab ntawd ib xyoos ib zaug, nws yog ib qho tsim nyog yuav tsum tau tsom mus rau cov cim qhia txog kev ua tau zoo, uas feem ntau yog thawj cov tsos mob ntawm kev rov qab los (nce qib ntawm qib. ntawm fibrinogen thiab globulins, nce POPs). Cov neeg mob lymphogranulomatosis muaj teeb meem rau thermal physiotherapy, overheating thiab ncaj qha insolation. Kev nce ntxiv ntawm tus lej rov qab vim yog cev xeeb tub tau tsim.
Tam sim no, kom paub meej, ntau tus neeg paub tias Hodgkin's lymphoma yog ib qho txawv ntawm nodular sclerosis, uas yog ib yam kab mob uas tsis txaus siab thiab cuam tshuam.
