I-papillary urothelial carcinoma yezinga eliphansi

nguJason Wasserman MD PhD FRCPC kanye noZuzanna Gorski MD
January 3, 2024

I-Low grade papillary urothelial carcinoma uhlobo lomdlavuza oluqala engxenyeni yomzimba ebizwa ngokuthi ipheshana lomchamo. I-urinary tract ihlanganisa izinso, isinye, i-ureters, ne-urethra. Izimila eziningi zitholakala esinyeni. Izazi ze-pathology zihlukanisa lolu hlobo lomdlavuza lube olungahlaseli futhi luhlasele ngokusekelwe ekubeni khona kwamangqamuzana e-tumor esicutshini esingaphansi kwe-urothelium, ungqimba oluncane lwethishu endaweni engaphakathi yomgudu womchamo. Lo mehluko ubalulekile ngoba izimila ezingahlaseli ngokuvamile zelapheka ngokuhlinzwa kuphela kuyilapho iziguli ezinamathumba ahlaselayo zingadinga ukwelashwa okwengeziwe ngemva kokuhlinzwa.

Lesi sihloko sizokusiza ukuthi uqonde ukuxilongwa kwakho kanye nombiko wakho wokugula we-papillary urothelial carcinoma yebanga eliphansi.

Umgudu womchamo

I-urinary tract iyisistimu eklanyelwe ukusiza ukususa imfucuza kanye namanzi amaningi emzimbeni ngokukhiqizwa komchamo. I-urinary tract ihlanganisa izinso, ureters, isinye, kanye ne-urethra. Umchamo owenziwe ezinso ugelezela esinyeni ngendlela ye-ureters. Isinye sigcina umchamo uze uphume emzimbeni ngendlela ye-urethra. Ingaphakathi lalo lonke i-urinary tract lilayishwe ngokukhethekile amaseli we-urothelial lokho kwakha umgoqo obizwa ngokuthi i-urothelium.

Yiziphi izimpawu ze-papillary urothelial carcinoma yezinga eliphansi?

Izimpawu ze-papillary urothelial carcinoma yezinga eliphansi zihlanganisa umchamo onegazi (hematuria), ubuhlungu lapho uchama (dysuria), nesidingo sokuchama kaningi.

Yini ebangela i-papillary urothelial carcinoma yezinga eliphansi?

Ucwaningo luye lwabonisa ukuthi inhlobonhlobo yobuthi, imithi, kanye nezifo kuhlotshaniswa nengozi eyengeziwe yokuthuthukisa i-papillary urothelial carcinoma. Ubuthi obungadala lolu hlobo lomdlavuza buhlanganisa intuthu kagwayi, i-opium, odayi abasuselwa ku-benzidine, ama-amine anuka kamnandi, i-arsenic, ne-aristolochic acid ekhiqizwa izitshalo ze-Aristolochia (evame ukusetshenziswa emithini yemithi). Okungapheli (isikhathi eside) ukuvuvukala esinyeni esibangelwa izifo ezifana ne-Schistosoma haematobium, i-catheter ehlala isikhathi eside, kanye nezinye izindlela zokwelapha ezihlanganisa imisebe eya esithweni sangasese kanye nokwelashwa ngamakhemikhali nge-chlornaphazine noma i-cyclophosphamide kuhlotshaniswa nengozi eyengeziwe yokuba nalolu hlobo lomdlavuza esinyeni.

I-papillary urothelial carcinoma yezinga eliphansi

I-papillary urothelial carcinoma yezinga eliphansi iqala kusukela amaseli we-urothelial ngokuvamile okutholakala ku-urothelium, ungqimba oluncane lwethishu oluvala ingaphakathi lomgudu womchamo. Nakuba lesi simila sivame ukutholakala esinyeni, singavela noma kuphi ngobude bomzila womchamo. Isimila sichazwa ngokuthi izinga eliphansi ngoba amaseli wesimila abukeka afana kakhulu namaseli e-urothelial anempilo lapho ehlolwa ngesibonakhulu. Njengoba isimila sikhula sakhe amathishu amade afana nomunwe aphuma ngaphakathi kwethishu. Ama-pathologists asebenzisa leli gama i-papillary ukuchaza leli phethini lokukhula.

Izimila ezingavaleli futhi ezihlaselayo

Iningi le-papillary urothelial carcinomas esezingeni eliphansi kakhulu okungenasidingo okusho ukuthi isimila sivaleleke ku-urothelium engaphakathi komgudu womchamo. Izimila ezingahlaseli azikwazi ukusabalala kwezinye izingxenye zomzimba futhi zelapheka ngokuhlinzwa kuphela.

Nokho, ezinye izimila zishintsha zibe izimila ezihlaselayo okusho ukuthi isimila sisabalele esicutshini esingaphansi kwe-urothelium (ngokwesibonelo, i-lamina propria noma i-muscularis propria). Ngokungafani nezimila ezingahlaseli, izimila ezihlaselayo zingasabalala ama-lymph node nezinye izitho zomzimba.

Lapho uhlola i-papillary urothelial carcinoma yebanga eliphansi ehlaselayo, udokotela wakho uzozama ukunquma ukuthi amaseli wesimila asabalele kangakanani ezingqimbeni zezicubu ezingaphansi kwe-urothelium. Lolu lwazi lubaluleke kakhulu ngoba amathumba angena ekujuleni kwezicubu ezizungezile cishe asakazekele kwezinye izingxenye zomzimba. Lolu lwazi luphinde lusetshenziselwe ukunquma isigaba se-pathologic tumor (pT).

Kwenziwa kanjani lokhu kuxilongwa?

Ukuxilongwa kuvame ukwenziwa ngokubheka isampula yomchamo ngaphansi kwesibonakhulu. Ukuxilongwa kungenziwa futhi ngemva kokukhishwa kwesampula encane yezicubu emgudwini womchamo ngesikhathi senqubo ebizwa ngokuthi a i-biopsy. Ngemva kokuxilongwa, sonke isimila ngokuvamile sikhishwa ngenqubo ebizwa ngokuthi i-transurethral resection (TURBT). Kumathumba amakhulu abandakanya esinyeni noma izinso, ingxenye noma sonke isitho somzimba kungase kudingeke ukuthi kukhishwe ngenqubo ebizwa ngokuthi i- ukukhishwa kabusha.

Kungani kubalulekile ukusampula i-muscularis propria?

I-muscularis propria iyingqimba ewugqinsi yomsipha ngaphakathi kodonga lwesinye. Lapho odokotela bekhipha isimila esinyeni, bazama ukukhipha enye ye-muscularis propria ngesikhathi esifanayo. Ukusampula kwe-muscularis propria kubalulekile ngoba izazi ze-pathologists azikwazi ukukhipha isifo esihlasela imisipha kuze kube yilapho imisipha ihlolwe ngaphansi kwe-microscope. Ngenxa yalesi sizathu, ngemva kokwenziwa kwe-TURBT, imibiko eminingi ye-pathology izosho ukuthi i-muscularis propria ibonwe yini noma cha esiculweni esinikeziwe.

Ingabe isimila singakhula futhi ngemva kokususwa?

Yebo. Cishe u-50% we-papillary urothelial carcinomas yezinga eliphansi azokhula futhi ngemva kokususwa. Lokhu kubizwa ngokuthi ukuphindaphinda. Ezinye izimila zingashintsha ngokuhamba kwesikhathi zibe uhlobo lomdlavuza olunolaka olubizwa ngokuthi izinga eliphezulu le-papillary urothelial carcinoma.

Isigaba se-Pathologic

Isigaba se-pathologic salolu hlobo lomdlavuza sisekelwe ohlelweni lwesiteji lwe-TNM, uhlelo olwaziwayo emhlabeni wonke olwakhiwe I-American Joint Committee on Cancer. Ngokwalolu hlelo, wonke ama-papillary urothelial carcinomas angahlaseli ebangeni eliphansi anikezwa isigaba sesimila se-pTa.

Mayelana nalesi sihloko

Lesi sihloko sabhalwa odokotela ukuze bakusize ufunde futhi uqonde umbiko wakho we-pathology. 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-atlas ye-Pathology