Classical Hodgkin rwekenza yelymphoma: nodular kuoma dzimwe nhengo dzomuviri

Nodular kuoma dzimwe nhengo dzomuviri - a histological siyana Hodgkin nechirwere, kunoratidzwa munhu gobvu kuwedzera connective zvinyama, unonyatsoruramisa vazhinji irregularly zvakaumbwa masero uye lobules. Dzine vashoma lymphoid yacho akawandisa Berezovsky-Sternberg masero. The chirwere rinotanga nekukura nodes. zvokurwara Uyu mumwe dzakasiyana ose dzenhoroondo Hodgkin kuti rwekenza yelymphoma.

chirwere Hodgkin iri vaitirei chirwere chakakomba kunokanganisa nhengo dzinobudisa hurongwa. The chirwere anogona kuumba chero mumuviri, kuti une lymphoid munyama (thymus, tonsils, chirwatata uye adenoids said.).

Nodular kuoma dzimwe nhengo dzomuviri Zviratidzo

Hodgkin kuti rwekenza yelymphoma kunogona kuva munhu, kana ane zviratidzo zvakadai:

• uremu;
• Kuzvimba node nodes (kakawanda mapazi kwemitsipa);
• kurasikirwa havi;
• kupfupika mweya;
• usiku sweats kana tembiricha;
• bhokisi marwadzo;
• wakakurisa chiropa (5% wevarwere) kana chirwatata (30% wevarwere);
• kufundumwara kana kurwadziwa mudumbu (muvana);
• itchy ganda (chete 1/3 vanhu kutambura chirwere);
• Kufema zvakaoma;
• kukosora.

zvikonzero

chirwere Hodgkin anogona kubatwa chero zera, asi kazhinji richiwanika munyika vaduku varume nemakore muboka 16 kusvika 30 makore kana vakwegura vanhu makore 50. Vana kusvika 5 makore anenge regai kurwara. Chii chaizvo zvinokonzera chirwere ichi chichiri kuzivikanwa. Zvisinei, pane chinhu kubvuma kuti kunobva - wanda. Zvinofungidzirwa kuti chinokonzera chirwere ichi chinogona kutanga:

• immunodeficiency;
• kutapuriranwa mononucleosis (inovapo pamusana Epstein-Barr utachiona).

Nodular kuoma dzimwe nhengo dzomuviri Hodgkin kuti rwekenza yelymphoma vanogona kuenda pakarepo, last kubva 3 kusvika 6 mwedzi, kana pakupedzisira kwemakore 20.

Chii pavaipfuura ane chirwere?

Dhigirii hodzhinskoy rwekenza yelymphoma vakatsunga kubva Murabhoritari zvidzidzo uye nokuda zvinotevera zviratidzi:

• uwandu sei node nodes, uyewo yavo nzvimbo;
• Kuwanikwa date nodes dzakasiyana nzvimbo diaphragm;
• namamota dzimwe nhengo (semuenzaniso, chiropa kana chirwatata).

Danho rokutanga. Kana ichi sei mumwe chete node raiva pedyo nebundu kana lymphoid nhengo (chirwatata, rin'i Pirogov-Valdera).

Danho rechipiri. Kune kazhinji vanoshamiswa node nodes kumativi maviri mubhokisi, diaphragm, uye lymphoid dzomuviri.

Danho rechitatu. This Hodgkin dhigirii asiri yakasiyana wechipiri pachikuva. Zvisinei, kune mhando mbiri nodular kuoma dzimwe nhengo dzomuviri Danho rechitatu:

• Muchiitiko chokutanga vakawirwawo nhengo iri pazasi diaphragm (celiac node nodes, chirwatata);
• kuwedzera kunzvimbo dziri pakutanga-siyana, achiri vakashamiswa, uye dzimwe nzvimbo node nodes yaiva pedyo diaphragm.

Danho wechina. Zvinokanganisawo kwete chete zvinoriumba, asi vasiri lymphoid zvomukati - mumwongo chiropa, mapfupa, mapapu uye ganda.

Mazita madhigirii Hodgkin kuti rwekenza yelymphoma

Indekisi kunotoda mamiriro ezvinhu uye kwokuomerwa kosi chirwere nedzimwe nzvimbo dzomuviri uye nhengo segwapa netsamba.

A - zvakakomba mukuru zviratidzo chirwere kwete.

B - kuvapo imwe kana kupfuura zviratidzo (kusina rakawedzera tembiricha, usiku sweats, nokukurumidza uremu).

E - foci dzinoshanda nyama uye nhengo iri pedyo njodzi node nodes.

S - Ko splenic lesion.

X - pane chakakomba mumatenhere kukuru saizi.

Mhando Histological zvirwere

Nezveshoko cellular maumbirwo Hodgkin nehosha vari 4 mhando zvirwere.

1. Nodular kuoma dzimwe nhengo dzomuviri Hodgkin kuti rwekenza yelymphoma - vakawanda chimiro chirwere, vanenge 40-50% vose nyaya. Ivo vanorwara kakawanda kupfuura vasikana, vari kazhinji njodzi node nodes yacho mediastinum. The biopsy zvokunyama, kuwedzera Berezovsky-Sternberg masero zvinogarawo guru lacunar masero pamwe foamy cytoplasm uye achirema nuclei. Kufembera mune chirwere ichi Zvinowanzova zvakanaka.
2. Lymphohistiocytic rwekenza yelymphoma iyo vakaumba 15% of mienzaniso. Kakawanda unogona kuwanika majaya pasi pemakore 35 okuberekwa. It ane kwazvo-gore mashanu wokurarama masero uye ane ruzivo limfaitov uye Shtrenberga. mhando iyi chirwere duku nyanyisa uye taped nawo kwokutanga matanho.
3. Aibatanidza marudzi kakawanda chirwere vakwegura uye vana. Siyana mamirire chaiwo kunotoda mufananidzo uye muitiro generalize kuti chiito. Histological ongororo yakaratidza shanduro dzakasiyana-siyana muchitokisi kubatana, kusanganisira Sternberg. Inowanikwa 30% varwere rwekenza yelymphoma. Nodular kuoma dzimwe nhengo dzomuviri pane iyi ine fungidziro hwakanyatsorwisa zvakanaka, uye kana nguva kurapwa iri ushandiswe, kuregererwa makasimba kunoitika pasina matambudziko.
4. Ngozi granuloma kuparadzwa lymphoid zvinyama yakati Kazhinji chete 5% Mienzaniso (kunyanya pakati vakwegura). A maitiro chinhu pano ndechokuti hapana masero uye inotongwa Sternberg masero. chimiro ichi rwekenza yelymphoma inozivikanwa yakadereresa chikamu-gore mashanu tipone.

Diagnostics

The chirwere kuti "rwekenza yelymphoma" rinorondedzerwa bedzi histological kuzviongorora node nodes uye akapikisana chete panyaya apo chaiwo multi-Sternberg masero akawanikwa somugumisiro kudzidza ichi. Muzviitiko kwazvo vanoda immunophenotyping. Cytological Kuongorora node raiva pedyo nebundu kana itsvo kazhinji duku ponji kusimbisa nodular sclerosis, mhando 1. Chii chinofanira kuitwa kuti pave nechirwere chirwere:

• mukuru uye nokukanganisika bvunzo ropa;
• Maekisirei zviri mapapu (fanira parutivi uye frontal fungidziro);
• node raiva pedyo nebundu biopsy;
• ultrasonic rokuongorora yamarudzi ose peripheral uye intraabdominal node nodes, thyroid, chiropa, uye chirwatata;
• CT scan kubvisa imperceptible mediastinal node nodes mu kwakajairika radiography;
• trephine biopsy kuti iliac mapfupa kudzivirira mwongo;
• tarisei uye maekisirei mapfupa.

kurapa

Rine nemwaranzi kurapa, oparesheni uye mishonga. Kusarudza nzira yokuisa padariro chirwere uye kuvapo zvakanaka kana kunaka prognostic zvinhu. The yakanaka zvinhu zvinosanganisira:

• akarova panguva histological kuongororwa nodular sclerosis, uye lymphohistiocytic mhando;
• Zera isingasviki makore 40;
• Mavhoriyamu node nodes kuti haapfuuri 6 masendimita ari dhayamita;
• kushaya zvakafanana zvinoratidza zvipenyu kushanda (Zviitiko indices nokukanganisika ropa);
• kuvapo hapana anopfuura 3 lesion nzvimbo.

Kana usina mumwechete zvikonzero izvi, ipapo murwere aireva boka murombo fungidziro.

nemwaranzi kurapa

Full radiotherapy somunhu nzira nomumwe inoshandiswa varwere pachikuva IA uye IIA, akasimbisa panguva laparotomy, uye kuva akanaka prognostic zvinhu. Zvinonzi masunungurwa kusango yokuwana mhando dzose sei node nodes uye node abudise ndima.

Mugove nhamba muzvinhu metastases lesion ndiyo 40-45 d kwevhiki 4-6 mumunda prophylactic irradiation - 30-40 g pa vhiki 1-4. Uyewo chete widefield nzira vachishandisa multi-munda irradiation vamwe maronda kudzivisa nodular kuoma dzimwe nhengo dzomuviri ns1.

Radiation kunokwanisa kukonzera matambudziko akadai subcutaneous zvinyama fibrosis, nemwaranzi pneumonitis uye pericarditis. Kudzikira kuitika munguva yakasiyana nguva - kubva 3 months kusvika 5 makore kurapwa. Kuoma kwavo kunoenderana nokushandiswa dose.

akavhiyiwa

Kuvhiya kurapwa haawanzopiwi kushandiswa oga onoobychno chikamu kunzwisisa mishonga. Kuita splenectomy, uyewo akavhiyiwa pamusoro trachea, yegurokuro, mudumbu uye nedzimwe nhengo (pamwe pangozi asphyxia, akagumbuka kwemutemo chikafu). Yakawanikwa panguva ichiyerera chlamydia pamuviri kunofanira zvechokwadi kwaizombomiswa.

mishonga

chimiro ichi unoshandiswa somunhu chezvinonhuwira kunzwisisa kurapwa. Kubata nodular sclerosis, vakashandisa gadziriro dzakasiyana:

• alkaloids ( "Vinblastine" kana "rozevin", "Etoposide" kana "Vincristine," Oncovin ");
• Alkire muvhenganiswa ( "Mustargen", "Cyclophosphamide" kana "embihina", "nitrosomethylurea" kana "hlorbutin");
• chakaita zvokugadzirwa yomuchipatara ( "Natulan" kana "procarbazine," "Dacarbazine" kana "Imidazole-carboxamide");
• antitumor mishonga ( "Bleomycin", "adriablastin").

monochemotherapy

Rinoshandiswa chete chinokosha kacho vaine chinangwa kuratidzwa. Yemanyorero zvakawanda medicaments zvinoda kurapa ane zvakasiyana mashandiro chiito (mishonga). In pachikuva chechina pavarwere vane diffuse chiropa chirwere kana mwongo kurapa kwakadaro ndiyo chete nzira - ichi ndicho dzekare Hodgkin rwekenza yelymphoma. Nodular kuoma dzimwe nhengo dzomuviri kubatwa zvirongwa zvakadai:

• ABVD ( "Bleomycin", "Dacarbazine", "adriablastin" "Vinblastine");
• MOTAPMs ( "Oncovin", "prednisolone", "Mustargen", "procarbazine");
• TSVPP ( "Vinblastine", "prednisolone", "Cyclophosphamide", "procarbazine").

Zvipatara zviri zvishoma (2, 7, mazuva 14) makosi pamwe-vhiki mbiri zvikamu. Kuwanda zvinogara zvinosiyana nokuda kwakakura kwokutanga lesion uye susceptibility kurapwa. Kazhinji kuregererwa rose kubudirira chete mushonga 2-6 mapoka. Pashure paizvozvo, Zvinokurudzirwa kuti aite zvimwe 2 Zvinonzi mushonga. Kana zvaiita zvishomanana ruregerero, asi kurapwa zvaiitwa nechakatsinhiwa, uye uwandu mapoka kunowedzera.

Vaungane pressurized mishonga hematopoiesis, alopecia, dyspeptic zviratidzo, iyo siya pakupera kurapwa. Nodular kuoma dzimwe nhengo dzomuviri achiri inoenda mukupera matambudziko akadai mwana, leukaemias nezvimwe malignancies (yechipiri anomera).

mataridzikiro

chirwere Hodgkin kuti anokonzerwa kuerera unhu, chiremba pavaipfuura chirwere, zera murwere, uye dzimwe histological mhando. Unopinza uye subacute weboka chirwere haisi fungidziro yakanaka: varwere kazhinji vanofa munguva 1-3 mwedzi 1 gore. Asi chisingaperi chlamydia for conditionally akanaka. The chirwere anogona kugara kwenguva refu chaizvo nguva, kusvikira makore 15 (dzimwe nguva yakareba).

Muna 40% vose utachiona vanhu, kunyanya 1st uye 2nd pachikuva, uyewo yakanaka prognostic zvikonzero, anopfuura 10 adarika recurrences vaizivikanwa. Kukwanisa kushanda pamusana ya kuregererwa hakusi wakaputsika.

dziviriro

Kazhinji, izvozvo inoendeswa kudzivirira zvazvo. Varwere Hodgkin kuti iongororwe dispensary oncologist. Kudzidza, unova 3 years okutanga kunodiwa kuitwa mwedzi mitanhatu ose, uye ipapo kamwe pagore, unofanira kutarisa kubudirira chaivo zviratidzo kazhinji tiri kutanga zviratidzo dzokororo (yakawedzera padanho fibrinogen uye globulins, zvabuda kuwedzera). Varwere Hodgkin nehosha chinokuvadza chafariz physiotherapy, overheating uye yakananga insolation. Rinogadzwa yakawedzera nhamba zvazvo nokuda pamuviri.

Zvino vanhu zvirokwazvo vakawanda vanoziva kuti Hodgkin kwakaita rwekenza yelymphoma - munhu musiyano wezvinyorwa nodular sclerosis, inova risingafadzi chaizvo uye zvakaoma kurapa zvirwere.