I-angioinvasive oncocytic carcinoma ehlanganisiwe wendlala yegilo

nguJason Wasserman MD PhD FRCPC
Mashi 26, 2024

I-angioinvasive oncocytic carcinoma ehlanganisiwe iwuhlobo lomdlavuza wegilo. Isimila sibizwa ngokuthi “encapsulated” ngoba sihlukanisiwe kokujwayelekile yegilo ndlala ngebhande elincane lethishu elibizwa ngokuthi a isimila capsule. “Angioinvasive” kusho ukuthi amangqamuzana omdlavuza atholakala ngaphakathi okungenani komthambo owodwa wegazi ngaphandle kwesimila. Elinye igama lalolu hlobo lomdlavuza lithi I-angioinvasive Hurthle cell carcinoma ehlanganisiwe.

Lesi sihloko sizokusiza ukuthi uqonde ukuxilongwa kwakho kanye nombiko we-pathology we-encapsulated angioinvasion oncocytic carcinoma.

Yiziphi izimpawu ze-encapsulated angioinvasion oncocytic carcinoma?

Izimpawu ze-encapsulated angioinvasive oncocytic carcinoma zingabandakanya:

• Isigaxa noma ukuvuvukala entanyeni yakho okwazi ukukubona noma ukukuzwa.
• Izwi liyashintsha, njengokuhosha.
• Inkinga yokugwinya noma ukuphefumula.

Yini ebangela i-encapsulated angioinvasion oncocytic carcinoma?

Ukuthi yini ebangela i-angioinvasion encapsulated oncocytic carcinoma ayiqondakali ngokugcwele. Kodwa-ke, kubonakala kuhlanganisa inhlanganisela yakho kokubili izinguquko zofuzo kanye nezici zengozi yemvelo njengokuchayeka emisebeni ye-ionizing kanye namathonya okudla. Lolu hlobo lomdlavuza luvame kakhulu kwabesifazane abasebasha.

Kungani lolu hlobo lomdlavuza lubizwa ngokuthi i-encapsulated?

I-Oncocytic carcinoma ye-thyroid ibizwa ngokuthi "i-encapsulated" lapho isimila sihlukaniswa ne-thyroid evamile ngebhande elincane lezicubu ezibizwa ngokuthi isimila capsule. Ukuba khona kwe-tumor capsule kubalulekile ngoba kusiza ukuhlukanisa lolu hlobo lomdlavuza nento ehlobene nayo ebizwa i-oncocytic carcinoma ehlasela kakhulu ene-tumor capsule encane kakhulu noma engenawo futhi iningi lamangqamuzana omdlavuza asesabalele endlaleni yegilo evamile ezungezile.

Kungani lolu hlobo lomdlavuza lubizwa ngokuthi i-angioinvasive?

I-Oncocytic carcinoma ye-thyroid ibizwa ngokuthi "i-angioinvasive" lapho amangqamuzana omdlavuza ebonakala ngaphakathi kwemithambo yegazi. I-Angioinvasion kubalulekile ngoba kwandisa ingozi yokuthi amangqamuzana omdlavuza asakazekele kwezinye izingxenye zomzimba njengamaphaphu noma amathambo.

Uma i-angioinvasion ibonakala, udokotela wakho wezifo uzohlola ngokucophelela isimila ukuze anqume inani lemithambo yegazi equkethe amangqamuzana omdlavuza.

• Okugxile: Amaseli e-tumor abonwe emithanjeni yegazi NGAPHANSI kwemi-4.
• Kuyandiswa: Amaseli e-tumor abonwe emithanjeni yegazi emi-4 noma OKUNINGI.

Inombolo yemithambo yegazi ehilelekile ibalulekile ngoba ingozi yokuthuthukiswa i-metastatic Isifo siphezulu uma i-angioinvasion ibanzi.

Kwenziwa kanjani lokhu kuxilongwa?

Ukuxilongwa kwe-angioinvasive oncocytic carcinoma ehlanganisiwe kungenziwa kuphela ngemva kokuba isimila sisusiwe futhi sithunyelwe kudokotela wezifo ukuze ahlolwe. Lokhu ngokuvamile kuhilela ukukhipha ngokuhlinzwa i-lobe eyodwa yegland yegilo nakuba ngezinye izikhathi yonke indlala yegilo ikhishwa. Lokhu kuhlonza akukwazi ukwenziwa ngemuva kwenqubo ehlasela kancane ebizwa ngokuthi a i-fine needle aspiration biopsy (FNAB).

Umbiko wakho we-pathology we-encapsulated angioinvasive oncocytic carcinoma

Umbiko wakho we-pathology we-encapsulated angioinvasion oncocytic carcinoma uzokwaziswa njengosayizi wesimila, inani lemithambo yegazi ehilelekile ngenxa yesimila, ukuba khona noma ukungabikho kwe-extrathyroidal extension, kanye nokuhlolwa imishado. Imiphumela yanoma iyiphi ama-lymph node okuhloliwe kufanele kufakwe embikweni. Lezi zihloko zichazwe kabanzi ezigabeni ezingezansi.

Izici ze-Microscopic

Uma ihlolwa ngaphansi kwesibonakhulu i-oncocytic thyroid carcinoma yenziwa ngepinki enkulu amaseli we-oncocytic. Kuze kube muva nje, la maseli ayebizwa Hurthle amaseli. Amaseli e-Oncocytic avela e-pink ngoba icyoplasm (umzimba weseli) ugcwele ingxenye yeselula ebizwa ngokuthi i-mitochondria. Amaseli e-Oncocytic nawo anomjikelezo omkhulu nucleus (ingxenye yeseli ephethe izakhi zofuzo) kanye nendawo emaphakathi evelele i-nucleolus (inqwaba yezinto zofuzo phakathi nenucleus). Amaseli e-oncocytic angaxhumeka akhe izakhiwo eziyindilinga ezincane ezibizwa ngokuthi ama-follicle noma angase abe ngamaqembu amakhulu izazi zezifo eziwachaza ngokuthi 'iphethini eqinile'.

Usayizi wesimila

Ngemuva kokuthi isimila sikhishiwe sonke, sizokalwa futhi nosayizi wesimila uzofakwa embikweni wakho we-pathology. Ubukhulu besimila bubalulekile ngoba sisetshenziselwa ukunquma isigaba se-pathologic tumor (pT) futhi ngenxa yokuthi izimila ezinkulu kungenzeka zisabalele kwezinye izingxenye zomzimba.

Ukuhlasela kwe-lymphatic

Ukuhlasela kwe-lymphatic ukusabalala kwamangqamuzana e-tumor ku-lymphatic channel (amashubhu amancane ahambisa uketshezi kanye namangqamuzana omzimba omzimba emzimbeni). Uma amaseli e-tumor engaphakathi kwesiteshi se-lymphatic, angasakazekela ezithweni ezincane zokuzivikela ezifweni ezibizwa ama-lymph node. Ngenxa yalesi sizathu, ukuhlasela kwe-lymphatic kwandisa ingozi yokuthuthukisa i-lymph node i-metastasis. Kodwa-ke, ukuhlasela kwe-lymphatic akubonakali ngokuvamile ku-angioinvasive oncocytic carcinoma ehlanganisiwe.

Ukunwetshwa kwe-Extrathyroidal

Isandiso se-Extrathyroidal ukusabalala kwamaseli e-tumor aphuma endlaleni yegilo aye ezicutshini ezizungezile. Amangqamuzana esimila asabalele ngokwanele ngaphandle kwendlala yegilo angase ahlangane nezinye izitho ezinjengemisipha, umminzo, noma uqhoqhoqho.

Kunezinhlobo ezimbili ze-extrathyroidal extension:

• I-Microscopic - Amaseli e-tumor angaphandle kwegland yegilo atholakala kuphela ngemva kokuhlolwa kwesimila ngaphansi kwe-microscope.
• I-Macroscopic (gross) – Isimila sibonakala sikhula sibe yizicubu ezisizungezile ngaphandle kokusebenzisa isibonakhulu. Lolu hlobo lwesandiso se-extrathyroidal lungabonwa udokotela wakho ohlinzayo ngesikhathi sokuhlinzwa noma umsizi we-pathologist owenza ukuhlola okujulile kwezicubu ezithunyelwe ku-pathology.

I-Macroscopic (gross) extrathyroidal extension ibalulekile ngoba yandisa i-pathologic tumor stage (pT) futhi ihlotshaniswa nokubi kakhulu. isibikezelo. Ngokuphambene nalokho, isandiso se-microscopic extrathyroidal asishintshi isigaba sesimila.

Amanqamu

A wekhasi izicubu okufanele zisikwe udokotela ohlinzayo ukuze akhiphe indlala yegilo emzimbeni wakho. Imajini ibhekwa njengenhle lapho kunamaseli wesimila emaphethelweni ezicubu ezisikiwe. Umkhawulo ongemuhle usho ukuthi awekho amaseli wesimila abonwe emaphethelweni asikiwe esicubu.

Izindawo ezinama-lymph

Izindawo ezinama-lymph amasosha omzimba amancane atholakala kuwo wonke umzimba. Amangqamuzana e-tumor angasakazeka esuka esimila esiyinhloko aye kuma-lymph nodes ngokusebenzisa imikhumbi emincane ye-lymphatic. Ngenxa yalesi sizathu, ama-lymph nodes avame ukususwa futhi ahlolwe ngesibonakhulu ukuze kubhekwe amangqamuzana omdlavuza. Ukuhamba kwamangqamuzana e-tumor kusuka esimila kuya kwenye ingxenye yomzimba njenge-lymph node kubizwa ngokuthi a i-metastasis.

Amaseli e-tumor ngokuvamile asakazeka kuqala kuma-lymph nodes eduze kwesimila nakuba ama-lymph nodes akude nesimila nawo angabandakanyeka. Ngenxa yalesi sizathu, ama-lymph nodes okuqala asusiwe ngokuvamile aseduze nesimila. Ama-lymph nodes aqhelelene kakhulu nesimila avame ukususwa kuphela uma ekhulisiwe futhi kukhona izinsolo eziphakeme zomtholampilo zokuthi kungase kube namaseli omdlavuza ku-lymph node.

I-neck dissection iyinqubo yokuhlinzwa eyenziwa ukususa ama-lymph node kusukela entanyeni. Ama-lymph nodes asusiwe ngokuvamile avela ezindaweni ezahlukene zentamo futhi indawo ngayinye ibizwa ngokuthi izinga. Amazinga entanyeni ahlanganisa u-1, 2, 3, 4, kanye no-5. Umbiko wakho we-pathology uzovame ukuchaza ukuthi mangaki ama-lymph nodes abonwe ezingeni ngalinye elithunyelwe ukuze lihlolwe.

Uma noma imaphi ama-lymph node akhishiwe emzimbeni wakho, azohlolwa ngesibonakhulu udokotela wezifo futhi imiphumela yalokhu kuhlolwa izochazwa embikweni wakho. "Positive" kusho ukuthi ama-tumor cells atholakala ku-lymph node. “Okubi” kusho ukuthi awekho amaseli wesimila atholakele. Uma amaseli wesimila etholakala ku-lymph node, usayizi weqembu elikhulu lamaseli wesimila (ngokuvamile okuchazwa ngokuthi “ukugxila” noma “idiphozithi”) nawo angase afakwe embikweni wakho. Isandiso se-Extranodal kusho ukuthi amangqamuzana e-tumor abhodloze i-capsule engaphandle kwe-lymph node futhi asakazeke esicutshini esizungezile.

Ukuhlolwa kwama-lymph nodes kubalulekile ngenxa yezizathu ezimbili. Okokuqala, lolu lwazi lusetshenziselwa ukunquma isigaba se-pathologic nodal (pN). Okwesibili, ukuthola amaseli e-tumor ku-lymph node kwandisa ingozi yokuthi amangqamuzana omdlavuza azotholakala kwezinye izingxenye zomzimba esikhathini esizayo. Ngenxa yalokho, udokotela wakho uzosebenzisa lolu lwazi lapho enquma ukuthi kuyadingeka yini ukwelashwa okwengeziwe okufana ne-radioactive iodine, i-chemotherapy, i-radiation therapy, noma i-immunotherapy.

Isigaba se-Pathologic (pTNM)

Isigaba se-pathologic se-encapsulated angioinvasive oncocytic carcinoma sisekelwe ohlelweni lwesiteji lwe-TNM, uhlelo olwaziwayo emhlabeni wonke olwakhiwe I-American Joint Committee on Cancer. Lolu hlelo lusebenzisa ulwazi mayelana nesimila esiyinhloko (T), ama-lymph node (N), futhi kude i-metastatic isifo (M) ukucacisa isigaba esiphelele se-pathologic (pTNM). I-pathologist yakho izohlola izicubu ezithunyelwe bese inika ingxenye ngayinye inombolo. Ngokuvamile, inani eliphakeme lisho isifo esithuthuke kakhulu futhi esibi kakhulu isibikezelo.

Isiteji se-Tumor (pT)

I-angioinvasive oncocytic carcinoma ehlanganisiwe inikezwa isigaba sesimila phakathi koku-1 no-4 ngokusekelwe kubukhulu besimila kanye nokuba khona kwamangqamuzana omdlavuza ngaphandle kwegilo.

• T1 – Isimila singaphansi noma silingana no-2 cm futhi amangqamuzana omdlavuza awadluleli ngale kwendlala yegilo.
• T2 – Isimila sikhulu kuno-2 cm kodwa singaphansi noma silingana no-4 cm futhi amangqamuzana omdlavuza awadluleli ngale kwendlala yegilo.
• T3 - Isimila sikhulu kuno-4 cm OR amangqamuzana omdlavuza adlulela emisipha engaphandle kwegland yegilo.
• T4 - Amangqamuzana omdlavuza adlulela ezakhiweni noma ezithweni ezingaphandle kwegland yegilo okuhlanganisa uqhoqhoqho, umphimbo, noma umminzo.

Isiteji seNodal (pN)

I-angioinvasive oncocytic carcinoma ehlanganisiwe inikezwa isigaba se-nodal esingu-0 noma 1 ngokusekelwe ebukhoneni noma ukungabikho kwamaseli omdlavuza endaweni. i-lymph node kanye nendawo yama-lymph nodes ahilelekile.

• N0 – Awekho amaseli omdlavuza atholakele kunoma yimaphi ama-lymph nodes ahloliwe.
• N1a - Amangqamuzana omdlavuza atholakala ku-lymph nodes eyodwa noma ngaphezulu kusukela kumazinga 6 noma 7.
• N1b - Amangqamuzana omdlavuza atholakala ku-lymph nodes eyodwa noma ngaphezulu ukusuka ku-level 1 kuya ku-5.
• NX - Awekho ama-lymph node athunyelwe ku-pathology ukuze ahlolwe.

Mayelana nalesi sihloko

Lesi sihloko sabhalwa odokotela ukuze sikusize ufunde futhi uqonde umbiko wakho we-pathology we-angioinvasive oncocytic carcinoma ehlanganisiwe. Izigaba ezingenhla zichaza imiphumela etholakala emibikweni eminingi ye-pathology, nokho, yonke imibiko ihlukile futhi imiphumela ingahluka. Okubalulekile, okunye kwalokhu kwaziswa kuzochazwa kuphela embikweni wakho ngemva kokuba isimila sikhishiwe ngokuhlinzwa futhi sahlolwa udokotela wezifo. Xhumana nathi uma unemibuzo mayelana nalesi sihloko noma umbiko wakho we-pathology. Funda lesi sihloko ukuze uthole isingeniso esijwayelekile ezingxenyeni zombiko we-pathology ojwayelekile.

Ezinye izinsiza eziwusizo

I-American Thyroid Association (ATA)

I-American Cancer Society

Funda kabanzi nge-pathology

I-atlas ye-Pathology