I-Adenocarcinoma yamaphaphu

nguJason Wasserman MD PhD FRCPC kanye noZuzanna Gorski MD
Mashi 27, 2024

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I-Adenocarcinoma iwuhlobo lomdlavuza wamaphaphu ongewona omncane (NSCLC) kanye nohlobo oluvame kakhulu lomdlavuza wamaphaphu olubalelwa ku-40% wazo zonke izimo eNyakatho Melika. Iqala kumangqamuzana akhethekile abizwa ngokuthi ama-pneumocyte angena ngaphakathi kwezikhala zomoya ezincane ezibizwa ngokuthi i-alveoli emaphashini.

 

Yini ebangela i-adenocarcinoma emaphashini?

Imbangela ehamba phambili ye-adenocarcinoma ukubhema ugwayi. Ezinye izimbangela ezingavamile zihlanganisa ukuchayeka kwe-radon, ama-occupational agents, nokungcoliswa komoya ngaphandle.

Yiziphi izimpawu ze-adenocarcinoma emaphashini?

Izimpawu ze-adenocarcinoma yamaphaphu zihlanganisa ukukhwehlela okuqhubekayo noma okubi kakhulu, ukukhwehlela igazi, ubuhlungu besifuba, nokuphefumula. Amathumba asabalele kwezinye izingxenye zomzimba angase abangele izimpawu ezengeziwe kuye ngendawo emzimbeni. Ngokwesibonelo, izimila ezisakazekela emathanjeni zingabangela ubuhlungu bamathambo futhi zibangele ukuba ithambo liphuke. Odokotela bachaza lokhu njenge-pathologic ukwa.

Yiziphi izimo ezihlotshaniswa ne-adenocarcinoma yamaphaphu?

Ezimweni eziningi, i-adenocarcinoma iqala esifweni sangaphambi komdlavuza esibizwa ngokuthi i-atypical adenomatous hyperplasia (AAH). Amaseli aku-atypical adenomatous hyperplasia abukeka engajwayelekile kodwa angakabi amaseli omdlavuza. Ngokuhamba kwesikhathi, i-AAH ingaphenduka ibe yisimo esibi kakhulu esibizwa ngokuthi i-adenocarcinoma in situ (AIS). Lesi simo sithathwa njengohlobo olungahlaseli lomdlavuza wamaphaphu ngoba amaseli angavamile abonakala kuphela endaweni engaphakathi yezikhala zomoya futhi ukukhula kungaphansi kwamasentimitha amathathu ngosayizi. I-Adenocarcinoma in situ iba yi-adenocarcinoma ehlaselayo uma amangqamuzana omdlavuza esakazeka phakathi i-stroma ngaphansi kwendawo yomoya noma uma isimila sikhula sibe sikhulu kuno-3 amasentimitha ngosayizi.

Kwenziwa kanjani lokhu kuxilongwa?

Ukuxilongwa kokuqala kwe-adenocarcinoma emaphashini ngokuvamile kwenziwa ngemva kokukhishwa kwesampula encane yezicubu ngenqubo ebizwa ngokuthi i-biopsy noma i-fine needle aspiration (FNA). Khona-ke kungase kwenziwe ukuhlinzwa ukuze kukhishwe sonke isimila. Uhlobo lokuhlinzwa olwenziwa ukuze kukhishwe isimila kuzoncika kusayizi wesimila nendawo esikuyo ephashini lakho. Ukukhishwa kwe-wedge ngokuvamile kwenziwa ukuze kukhishwe izimila ezincane kanye nalezo eziseduze nangaphandle kwamaphaphu. Ama-lobectomies kanye nama-pneumonectomies enziwa amathumba amakhulu noma lawo aseduze nendawo yamaphaphu.

Umbiko wakho we-pathology we-adenocarcinoma yamaphaphu

Ulwazi olutholakala embikweni wakho we-pathology we-adenocarcinoma yamaphaphu luncike ohlotsheni lwenqubo eyenziwe. Umbiko wakho we-pathology ngemuva kwenqubo encane efana ne- i-fine needle aspiration biopsy (FNAB) ingase inikeze kuphela ukuxilongwa kanye nemiphumela yokuhlolwa okusetshenziselwa ukuqinisekisa ukuxilongwa okufana i-immunohistochemistry (IHC). Ngemuva kwenqubo yokuhlinzwa enkulu ukuze kukhishwe isimila, umbiko wakho we-pathology ungase uhlanganise ulwazi olwengeziwe njengohlobo lwe-histological, ibanga lesimila, usayizi wesimila, ukusabalala kwezikhala zomoya, ukuhlasela kwe-pleural, kanye imishado. Uma ikhona ama-lymph node zisusiwe, zizochazwa futhi. Ukuhlolwa kwamangqamuzana kungase kwenziwe ukuze kubhekwe izinguquko zofuzo kusimila futhi leyo miphumela ingase ifakwe embikweni we-biopsy noma ngemva kokukhishwa kwesimila. Zonke lezi zihloko kuxoxwa ngazo ngokuningiliziwe ezigabeni ezingezansi.

Izinhlobo ze-Histological ze-adenocarcinoma yamaphaphu

I-Adenocarcinoma yamaphaphu ihlukaniswa yaba izinhlobo ze-histological ngokuya ngephethini yokukhula noma indlela amangqamuzana omdlavuza anamathelana ngayo kanye nezakhiwo ezakhayo. Izinhlobo ezivame kakhulu ze-histologic ze-adenocarcinoma yi-lepidic, solid, acinar, papillary, ne-micropapillary.

Isimila singase sibonise iphethini eyodwa yokukhula noma amaphethini amaningi okukhula angase abonakale esimila esifanayo. Uma amaphethini amaningi okukhula ebonakala, iningi lama-pathologists lizochaza iphesenti lesimila esakhiwe iphethini ngayinye. Uhlobo lwe-histological olwakha ingxenye enkulu yesimila lubizwa ngokuthi iphethini evelele.

Iphethini ye-Lepidic

I-Lepidic-type adenocarcinoma yamaphaphu isho ukuthi amangqamuzana omdlavuza abonakala ekhula eduze kolwelwesi lwangaphakathi lwezikhala zomoya ezibizwa ngokuthi i-alveoli. Amaseli omdlavuza athatha indawo yama-pneumocyte avamile njengoba ekhula. Lolu uhlobo oluvame kakhulu lwe-histological lwe-adenocarcinoma. Uma isimila singaphansi kuka-3 cm ngosayizi futhi sibonisa iphethini yokukhula ngokuphelele ye-lepidic kubizwa i-adenocarcinoma endaweni.

Iphethini ye-Acinar

I-acinar-type adenocarcinoma yamaphaphu isho ukuthi amangqamuzana omdlavuza akha amaqoqo amancane ayindilinga amaseli anendawo evulekile phakathi. Indawo evulekile ibizwa ngokuthi i-lumen. Lolu uhlobo lwesibili oluvame kakhulu lwe-histology lwe-adenocarcinoma.

Iphethini eqinile

I-solid-type adenocarcinoma yamaphaphu isho ukuthi amangqamuzana omdlavuza akha amaqembu amakhulu amaseli anendawo encane phakathi kwamaseli. Uhlobo oluqinile lwe-adenocarcinoma lunolaka kunezinhlobo ze-lepidic kanye ne-acinar futhi kungenzeka kakhulu i-metastasis (sakaza) ku ama-lymph node.

Iphethini ye-papillary

I-papillary-type adenocarcinoma yamaphaphu isho ukuthi amangqamuzana omdlavuza anamathelana ukuze akhe amathishu amade afana nomunwe okuthiwa i-papilla. Uhlobo lwe-papillary lwe-adenocarcinoma luvame ukuba nolaka kakhulu kunezimila ezine-lepidic predominant kodwa alunalaka kunezinhlobo eziqinile noma ze-micropapillary.

Iphethini ye-Micropapillary

I-Micropapillary-type adenocarcinoma yamaphaphu isho ukuthi amangqamuzana omdlavuza anamathelana ukuze akhe amaqembu amancane amaseli ahlala ngaphakathi kwesikhala. Uhlobo lwe-micropapillary lwe-adenocarcinoma wuhlobo olunolaka lomdlavuza oluvame kakhulu i-metastases (isabalalisa) ku ama-lymph node nezinye izingxenye zamaphaphu.

Ibanga lesimila

I-Adenocarcinoma yamaphaphu ihlukaniswe yaba amamaki amathathu (ihlukaniswe kahle ihlukaniswe ngokusesilinganisweni, futhi ihlukaniswe kabi) ngokusekelwe enhlanganisela yohlobo lwe-histologic oluvelele (oluvame kakhulu) (iphethini yokukhula) kanye nohlobo olubi kakhulu (noma olunolaka) lwe-histologic. Ibanga le-tumor libalulekile ngoba liyisibikezelo esihle sokuthi isisu sizosabela kanjani ekwelashweni. Lolu hlelo lokugreda lusetshenziswa kuphela ku-nonmucinous adenocarcinoma yamaphaphu (izimila ezingakhiqizi inani elikhulu le-mucin).

Uhlelo lokulinganisa lwe-adenocarcinoma yamaphaphu:

• Ihlukaniswe kahle: Isimila sohlobo lwe-lepidic oluningi noma ngokuphelele olunokukhula okuqinile okungaphansi kuka-20% noma i-micropapillary.
• Ihlukaniswe ngokumaphakathi: Isimila esivame kakhulu noma ngokuphelele sohlobo lwe-acinar noma uhlobo lwe-papillary esinokukhula okuqinile okungaphansi kuka-20% noma kwe-micropapillary.
• Uhlukaniswe kabi: Isimila esinokukhula okuqinile okungaphezu kuka-20% noma i-micropapillary noma enezindawo ezakhiwe ngezindlala eziyinkimbinkimbi noma iseli elilodwa.

Immunohistochemistry

I-Immunohistochemistry (IHC) ukuhlola okuvumela izazi zezifo ukuthi zibone izinhlobo ezithile zamaseli ngokusekelwe kumakhemikhali, ngokuvamile amaprotheni, lawo maseli enziwayo. Ngenxa yokuthi izinhlobo ezahlukene zamaseli ziveza omaka be-IHC abahlukene, izazi zezifo zingasebenzisa lokhu kuhlola ukuhlukanisa phakathi kwezinhlobo ezahlukene zomdlavuza.

Lapho kwenziwa i-IHC, i-adenocarcinoma yamaphaphu ngokuvamile ibonisa imiphumela elandelayo:

• I-TTF-1 - Positive kuma-80% wamathumba.
• p40 – Negative.
• CK5 – Negative.
• I-Chromogranin – Negative.
• I-Synaptophysin – Negative.

Izinguquko zofuzo ezitholakala ku-adenocarcinoma carcinoma yamaphaphu

Izinguquko zofuzo ezivame ukutholakala ku-adenocarcinoma yamaphaphu zihlanganisa ukuguquka kwezakhi zofuzo ezifana ne-EGFR, IKRAS, kanye ne-ALK. Izazi zezifo zihlola lezi nezinye izinguquko zofuzo zisebenzisa amasu afana nala ukulandelana kwesizukulwane esilandelayo (NGS), i-immunohistochemistry (IHC), Futhi I-fluorescence in situ hybridization (INHLANZI). Ukukhomba ukuguqulwa kwezakhi zofuzo ezithile kubalulekile ekukhetheni izindlela zokwelapha ezihlosiwe.

Sabalalisa ezindaweni zomoya

Ukusabalala ezindaweni zomoya (STAS) kuchaza iphethini yokuhlasela ebonakala kumdlavuza wamaphaphu, lapho amangqamuzana omdlavuza abonwa esabalala ezindaweni zomoya esicutshini samaphaphu ngaphandle kwesimila. Ukuba khona kwe-STAS kuye kwahlotshaniswa nengozi ephezulu yokuphindeka kanye nokuphila okubi kakhulu kukonke ezigulini ezine-adenocarcinoma yamaphaphu, ikakhulukazi kulezo ezinesifo esisanda kuqala. Ngakho-ke ukuqaphela i-STAS kunganikeza ulwazi lokubikezela olubalulekile nosizo ekuhlukaniseni ingozi.

Izazi zezifo zihlonza i-STAS ngokuhlola ngokucophelela izicubu zamaphaphu ezizungeze isimila ngesibonakhulu. Babheka amaseli wesimila noma amaqoqo amaseli ngaphakathi kwezikhala zomoya ahlukene nesimila esikhulu futhi angaxhunywanga onqenqemeni lwesimila, evame ukutholakala ebangeni lesisimila ngokwaso. Lawa maseli angantanta mahhala noma anamathiselwe ezindongeni ze-alveolar kodwa ahlukaniseke kusimila esiyinhloko futhi angachazwa ezinye izinqubo ezifana ne-artefact noma ukuhlasela kwe-lymphovascular.

Amathumba amaningi

Akuvamile ukuthi kutholakale isimila esingaphezu kwesisodwa ephashini elifanayo. Uma lokhu kwenzeka, isimila ngasinye sizochazwa ngokwehlukana embikweni wakho.

Kunezincazelo ezimbili ezingaba khona zokuthola isimila esingaphezu kwesisodwa:

1. Amaseli wesimila asuka kwesinye isimila asesabalele kwenye ingxenye yephaphu. Le ncazelo kungenzeka kakhulu uma zonke izimila ziwuhlobo olufanayo lwe-histological. Isibonelo, uma zonke izimila ziyi-acinar-type adenocarcinoma. Uma izimila zisohlangothini olulodwa nomzimba, izimila ezincane zibizwa ngokuthi amaqhuqhuva. Uma izimila zisemaceleni ahlukene omzimba (iphaphu lesokudla nesobunxele), isimila esincane sibizwa i-metastasis.
2. Amathumba athuthukile ngokwehlukana. Lena incazelo engenzeka kakhulu lapho izimila ziyizinhlobo ezahlukene ze-histological. Isibonelo, isimila esisodwa siyi-adenocarcinoma kanti esinye siyi-a i-squamous cell carcinoma. Kulesi simo, izimila zibhekwa njengezifo ezihlukene hhayi isifo se-metastatic

Ukuhlasela kwe-Pleural

Ukuhlasela kwe-Pleural kubhekisela ekusabalaleni kwamangqamuzana omdlavuza ku-pleura, okuwungqimba oluncane lwezicubu ezizungeze amaphaphu futhi lulandele ingaphakathi lesifuba. Kunezingqimba ezimbili ze-pleura: i-visceral pleura, enamathela emaphashini, kanye ne-parietal pleura, ehlanganisa udonga lwesifuba kanye ne-diaphragm. Ukuhlasela kwe-pleural ngomdlavuza wamaphaphu kusho ukuthi isimila sesikhule ngaphezu kwezicubu zamaphaphu ngokwaso futhi sangena ezingqimbeni ezizungezile ze-pleural.

Ukuhlasela kwe-Pleural kubalulekile kokubili ekunqumeni isigaba se-pathologic kanye nokubikezela:

• Isiteji sesimila: Ukuba khona kwe-pleural invasion kuyisici esibalulekile ekunqumeni isigaba somdlavuza wamaphaphu. Izimila ezihlasela i-pleura zibhekwa njengezithuthuke kakhulu kunalezo ezivalelwe ku-parenchyma yamaphaphu (izicubu ezisebenzayo zamaphaphu). Ngokohlelo lokuhlukaniswa kwe-TNM olusetshenziselwa ukwelapha umdlavuza wamaphaphu, ukuhlasela kwe-pleural kungase kwenyuse isigaba se-T sesimila, okubonisa ubukhulu nesimila. Isibonelo, isimila esihlasela i-visceral pleura singase sichazwe njenge-T2, kuyilapho ukuhlasela ku-pleura ye-parietal noma ukubandakanyeka kwe-pleural effusion (ukuqoqwa koketshezi) kungaholela ekuhlukaniseni okuphezulu.
• Isibikezelo: Iziguli ezinomdlavuza wamaphaphu ohlasele i-pleura ngokuvamile zinesimo esibi kakhulu kunalezo ezingenakho ukubandakanyeka kwe-pleural. Lokhu kungenxa yokuthi ukuhlasela kwe-pleural kukhombisa isimila esinamandla kakhulu okungenzeka sisabalele futhi sibangele izinkinga, njengokuphuma kwe-pleural, okungaphazamisa ukusebenza kwamaphaphu futhi kuholele ezimpawini ezifana nobuhlungu besifuba, ukukhwehlela, nokuphelelwa umoya.

Ukuhlasela kwe-lymphovascular

Ukuhlasela kwe-lymphovascular kubhekisela ekusakazekeni kwamangqamuzana omdlavuza emthanjeni wegazi noma kumzila we-lymphatic. Imithambo yegazi amashubhu amade azacile athwala igazi emzimbeni wonke. Imigudu ye-lymphatic ifana nemithambo yegazi emincane ngaphandle kokuthi ithwala uketshezi olubizwa ngokuthi i-lymph esikhundleni segazi. Amashaneli e-lymphatic axhuma nezitho zokuzivikela ezincane ezibizwa ngokuthi ama-lymph node ezitholakala kuwo wonke umzimba. Ukuhlasela kwe-lymphovascular kubalulekile ngoba uma ungaphakathi emkhunjini wegazi noma indawo ye-lymphatic, amangqamuzana omdlavuza angasakazekela kuma-lymph nodes noma kwezinye izingxenye zomzimba ezifana nesibindi noma amathambo.

Amanqamu

Ku-pathology, umkhawulo uwunqenqema lwesicubu esisikwa lapho kususwa isimila emzimbeni. Amamajini achazwe embikweni we-pathology abaluleke kakhulu ngoba akutshela ukuthi isimila sisusiwe sonke noma ukuthi esinye isimila sishiywe ngemuva. Isimo semajini sizonquma ukuthi yikuphi (uma kukhona) ukwelashwa okwengeziwe ongakudinga.

Izazi ze-pathologists zihlola ngokucophelela ama-margin ukuze zibheke amaseli wesimila emaphethelweni asikiwe ezicubu. Uma amaseli wesimila ebonakala emaphethelweni asikiwe ezicubu, umkhawulo uzochazwa njengephozithivu. Uma engekho amaseli wesimila abonwa emaphethelweni asikiwe ezicubu, umkhawulo uzochazwa njengenegethivu. Ngisho noma wonke amamajini engemihle, eminye imibiko ye-pathology izohlinzeka ngesilinganiso samaseli wesimila aseduze onqenqemeni lwethishu.

Imajini ephozithivu (noma esondele kakhulu) ibalulekile ngoba kusho ukuthi amaseli e-tumor kungenzeka ukuthi ayeshiywe ngemuva emzimbeni wakho lapho isimila sikhishwa ngokuhlinzwa. Ngenxa yalesi sizathu, iziguli ezinomkhawulo omuhle zingase zinikezwe okunye ukuhlinzwa ukuze kususwe sonke isimila noma ukwelashwa ngemisebe endaweni yomzimba enemajini eqondile.

Izindawo ezinama-lymph

Izindawo ezinama-lymph amasosha omzimba amancane atholakala kuwo wonke umzimba. Amangqamuzana omdlavuza angasakazeka ngemikhumbi emincane ye-lymphatic esuka eqhumeni iye kuma-lymph nodes. Ngenxa yalesi sizathu, ama-lymph nodes avame ukususwa futhi ahlolwe ngesibonakhulu ukuze kubhekwe amangqamuzana omdlavuza. Ukuhamba kwamangqamuzana omdlavuza ukusuka esimila ukuya kwenye ingxenye yomzimba njenge-lymph node kubizwa i-metastasis.

Ama-lymph nodes entanyeni, esifubeni, nasemaphashini angase akhishwe ngesikhathi esifanayo nesimila. Lawa ma-lymph nodes ahlukaniswe abe izindawo ezibizwa ngokuthi iziteshi. Kuneziteshi eziyi-14 ezahlukene entanyeni, esifubeni, nasemaphashini (bheka isithombe ngezansi).

Uma noma imaphi ama-lymph node akhishiwe emzimbeni wakho, azohlolwa ngesibonakhulu udokotela wezifo futhi imiphumela yalokhu kuhlolwa izochazwa embikweni wakho. Imibiko eminingi izobandakanya inani eliphelele lama-lymph nodes ahloliwe, lapho emzimbeni kutholwe khona ama-lymph nodes, kanye nenombolo (uma ikhona) equkethe amaseli omdlavuza. Uma amangqamuzana omdlavuza abonwa ku-lymph node, usayizi weqembu elikhulu kunawo wonke lamaseli omdlavuza (okuvame ukuchazwa ngokuthi “ukugxila” noma “idiphozithi”) nawo uzofakwa.

Ukuhlolwa kwama-lymph nodes kubalulekile ngenxa yezizathu ezimbili. Okokuqala, lolu lwazi lusetshenziselwa ukunquma isigaba se-pathologic nodal (pN). Okwesibili, ukuthola amangqamuzana omdlavuza 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-chemotherapy, i-radiation therapy, noma i-immunotherapy.

Isigaba se-Pathologic (pTNM)

Isigaba se-pathologic se-adenocarcinoma yamaphaphu 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-Adenocarcinoma yamaphaphu inikezwa isiteji sesimila esiphakathi koku-1 no-4 ngokusekelwe kusayizi wesimila, inani lezimila ezitholakala esicutshini esihloliwe, kanye nokuthi ingabe isimila sibhodloze i-pleural noma sesisabalele ezithweni ezizungeze amaphaphu.

Isiteji seNodal (pN)

I-Adenocarcinoma yamaphaphu inikezwa isigaba se-nodal phakathi kuka-0 no-3 ngokusekelwe ebukhoneni noma ekungabi bikho kwamangqamuzana omdlavuza endaweni. i-lymph node kanye nendawo yama-lymph nodes aqukethe amangqamuzana omdlavuza.

• NX - Awekho ama-lymph node athunyelwe ukuhlolwa kwe-pathologic.
• N0 – Awekho amaseli omdlavuza atholakele kunoma yimaphi ama-lymph nodes ahloliwe.
• N1 - Amangqamuzana omdlavuza atholakala okungenani ku-lymph node eyodwa ngaphakathi kwephaphu noma eduze kwemigudu yomoya emikhulu eya emaphashini. Lesi sigaba sihlanganisa iziteshi 10 kuya ku-14.
• N2 -Amangqamuzana omdlavuza atholakale okungenani ku-lymph node eyodwa kusuka esicubungwini esiphakathi kwesifuba naseduze nemigudu yomoya emikhulu. Lesi sigaba sihlanganisa iziteshi 7 kuya ku-9.
• N3 - Amangqamuzana omdlavuza atholakala entanyeni noma kunoma yimaphi ama-lymph nodes ohlangothini lomzimba obhekene (contralateral) ne-tumor. Lesi sigaba sihlanganisa iziteshi 1 kuya ku-6.

Umphumela wokwelashwa

Umphumela wokwelashwa uchazwa embikweni wakho kuphela uma uthole ukwelashwa ngamakhemikhali noma ngemisebe ngaphambi kokuhlinzwa ukuze kukhishwe isimila. Ukuze unqume umphumela wokwelapha, udokotela wakho wezifo uzokala inani lesimila esiphilayo (esisebenzayo) futhi aveze leyo nombolo njengephesenti lesimila sokuqala. Isibonelo, uma udokotela wakho wezifo ethola u-1 cm wesimila esisebenzayo futhi isimila sokuqala sasingu-10 cm, iphesenti lesimila esiphilayo singu-10%.

Funda kabanzi nge-pathology

I-atlas ye-pathology