I-non-invasive follicular thyroid neoplasm ene izici zenuzi ezifana ne-papillary (NIFTP)

nguJason Wasserman MD PhD FRCPC
February 21, 2024

I-non-invasive follicular thyroid neoplasm enezici zenuzi ezifana ne-papillary (NIFTP) iyithumba elikhula kancane endlaleni yegilo. Lesi simila ngaphambili sasibhekwa njengohlobo lomdlavuza wegilo kodwa manje sesithathwa njengesemngceleni phakathi benign (engenawo umdlavuza) futhi okubi (umdlavuza) izimila.

Kuze kube ngu-2016, i-NIFTP ibibizwa ngokuthi i-non-invasive encapsulated follicular variant papillary thyroid carcinoma (EFVPTC). Ngaleso sikhathi, kwakubhekwa njengohlobo lomdlavuza wegilo. Isimila sachazwa ngokuthi okungenasidingo ngoba sonke isimila sasizungezwe a i-capsule futhi amangqamuzana e-tumor awazange abonakale esabalala phakathi noma ehlaselayo izicubu ezijwayelekile zegilo. Igama nezigaba kwashintshwa ngemva kocwaningo lwesayensi oluningi olukhulu, oluthole ukuthi iziguli ezitholwe zine-EFVPTC engahlaseli zingelapheka ngokuhlinzwa kuphela.

Ingabe amaseli wesimila ku-non-invasive follicular thyroid neoplasm enezici zenuzi ezifana ne-papillary (NIFTP) angasabalala kuma-lymph nodes nezinye izingxenye zomzimba?

I-NIFTP inamandla abulalayo aphansi kakhulu okusho ukuthi mancane kakhulu amathuba okuthi isabalale kuwo ama-lymph node noma ezinye izitho zomzimba. Ngaphezu kwalokho, iziguli eziningi ezine-non-invasive follicular thyroid neoplasm enezici zenuzi ezifana ne-papillary zelashwa ngokuhlinzwa kuphela.

Kodwa-ke, enanini elincane leziguli ezitholwe ukuthi zine-NIFTP, amaseli wesimila azotholakala kamuva ku-a i-lymph node kumbe esinye isitho somzimba. Amaseli e-tumor asakazekela ku-lymph node noma enye ingxenye yomzimba abizwa i-metastasis. Uma lokhu kwenzeka, cishe, indawo encane ye-tumor capsule sokuhlasela akubonwanga ngesikhathi kuhlolwa isimila. Kulesi simo, ukuxilongwa kokuqala kungase kudingeke kushintshwe.

Yini ebangela i-non-invasive follicular thyroid neoplasm ene-papillary-like nuclear features (NIFTP)?

Izimbangela ezithile ze-NIFTP, njengezimila eziningi ze-thyroid, aziqondi ngokugcwele. Nokho, kunenkolelo yokuthi ukuguqulwa kwezakhi zofuzo kanye nezici zemvelo kungase kube nendima ekuthuthukisweni kwayo. Ukuchayeka emisebeni, ikakhulukazi ebuntwaneni, kuyisici esiyingozi esaziwayo sezimila zegilo ngokujwayelekile.

Yiziphi izimpawu ze-non-invasive follicular thyroid neoplasm enezici ze-nuclear-like papillary (NIFTP)?

I-NIFTP ngokuvamile ayivezi noma yiziphi izimpawu ezithile futhi ivame ukutholwa ngengozi phakathi nezifundo ze-imaging ngezinye izizathu noma njenge-nodule yegilo ezwakalayo ngesikhathi sokuhlolwa ngokomzimba. Uma izimpawu zenzeka, zingase zihlanganise isigaxa esibonakalayo entanyeni, ubunzima bokugwinya noma ukuphefumula, noma ukushintsha kwezwi. Kodwa-ke, lezi zimpawu azifani ne-NIFTP futhi zingahlotshaniswa nezimo ezihlukahlukene ze-thyroid.

Kwenziwa kanjani lokhu kuxilongwa?

Ukuxilongwa kwe-NIFTP kungenziwa kuphela ngemva kokuba sonke isimila sisusiwe futhi sithunyelwe ukuze sihlolwe ngaphansi kwe-microscope yisazi sezifo. Lokhu kuhlolwa kufanele kwenziwe ukuze kuqinisekiswe ukuthi amaseli e-tumor awaweli isimila capsule noma isakazeke esicutshini se-thyroid esizungezile evamile. Ukuxilongwa akukwazi ukwenziwa ngemva kokukhishwa kwesampula yethishu elincane endlaleni yegilo ngenqubo ebizwa ngokuthi i-fine-needle aspiration.

Izici ze-Microscopic

Lapho ehlolwa ngaphansi kwesibonakhulu, amangqamuzana e-tumor ku-NIFTP avame ukuhlukaniswa nendlala yegilo evamile ezungezile ngesithiyo esincane esibizwa ngokuthi isimila capsule. Uma i-capsule ingabonakali, amaseli e-tumor kufanele ahlukaniswe ne-thyroid evamile ngesikhala esincane.

Njengendlala evamile yegilo, i-NIFTP yenziwe ngamangqamuzana e-follicular axhuma enze ama-follicle. Igama elithi "izici zenuzi ezifana ne-papillary" lisho ukuthi amangqamuzana esimila afana namangqamuzana abonwa kolunye uhlobo lomdlavuza wegilo olubizwa ngokuthi. i-papillary thyroid carcinoma. Lezi zici ezibandakanya i-nucleus yengqamuzana (ingxenye yeseli ephethe izakhi zofuzo) zihlanganisa ukuhlanzwa kwe-chromatin (i-nucleus ibukeka icacile noma imhlophe), ukukhuliswa kwe-nucleus (i-nucleus inkulu kunokuvamile), ulwelwesi lwe-nuclear olungajwayelekile (ngaphandle ungqimba lwe-nucleus alubushelelezi), futhi ukuminyana (ama-nuclei aseduze ayadlulana noma ayathintana).

Ukuguqulwa Kwezakhi Zofuzo ku-neoplasm ye-thyroid ye-follicular engahlaseli enezici ze-nuclear ezifana ne-papillary (NIFTP)

Izinguquko eziningana zofuzo zikhonjwe ku-NIFTP, ezisiza ukuyihlukanisa ne-cancer ye-thyroid enamandla kakhulu:

• Izinguquko ze-RAS: Izinguquko ezivamile zofuzo ezitholakala ku-NIFTP ukuguqulwa kofuzo emndenini we-RAS. Lezi zinguquko ziyabonakala nakwezinye izinhlobo ze benign futhi okubi izimila zegilo.
• Izinguquko ze-BRAF V600E: Nakuba ukuguqulwa kwe-BRAF V600E kuvame ukuhlotshaniswa ne-papillary thyroid carcinomas enamandla kakhulu, ukuba khona kwakho ku-NIFTP akuvamile. Ukungabikho kwezinguquko ze-BRAF V600E kungenye yezici ezisiza ekuhlukaniseni i-NIFTP kuzinhlobo ezinonya kakhulu zomdlavuza wegilo.
• Izinguquko ze-PIK3CA kanye nophromotha we-TERT: Lezi zinguquko azijwayele ukuhlotshaniswa ne-NIFTP futhi zivame ukutholakala kumdlavuza wegilo. Ukuba khona kwabo ku-nodule ye-thyroid kungase kuphikisane nokuxilongwa kwe-NIFTP.

Kubalulekile ukuqaphela ukuthi ukuhlonzwa kwe-NIFTP kusekelwe ngokuyinhloko ekuhlolweni kwe-histopathological, okubandakanya ukuhlolwa kwe-microscopic enemininingwane yamaseli wesimila kanye nokwakheka kwawo. Ukuba khona kwezinguquko ezithile zofuzo kungasekela ukuxilongwa kodwa akunqumi kuphela.

Ukuhlasela kwe-lymphatic

Ukuhlasela kwe-lymphatic kusho ukuthi amaseli e-tumor abonwa ngaphakathi komkhumbi we-lymphatic. Imikhumbi ye-lymphatic amashubhu amancane angenalutho avumela ukugeleza koketshezi olubizwa ngokuthi i-lymph lusuka ezicutshini luye ezithweni zomzimba zokuzivikela ezibizwa ama-lymph node. Ukuhlasela kwe-lymphatic akufanele kubonwe ku-NIFTP.

Ukuhlasela kwe-Vascular (i-angioinvasion)

Ukuhlasela kwe-Vascular (okubizwa nangokuthi i-angioinvasion) ukusabalala kwamaseli e-tumor emthanjeni wegazi. Imithambo yegazi ithwala igazi emzimbeni wonke. Ukuhlasela kwe-Vascular akufanele kubonwe ku-NIFTP.

Amanqamu

Ku-pathology, i-margin ibhekisela emaphethelweni ezicubu ezikhishwe ngesikhathi sokuhlinzwa kwesimila. Isimo semajini embikweni we-pathology sibalulekile njengoba sibonisa ukuthi isimila sisusiwe sonke noma uma ezinye zishiywe ngemuva. Lolu lwazi lusiza ekunqumeni isidingo sokwelashwa okwengeziwe.

Ama-pathologists ngokuvamile ahlola ama-margins ngokulandela inqubo yokuhlinzwa njenge- ukuziqhenya or ukukhishwa kabusha, okuhloswe ngayo ukususa sonke isimila. Amajikijolo awavami ukucutshungulwa ngemva kwe-a i-biopsy, esusa ingxenye kuphela yesimila. Inani lamamajini abikiwe kanye nosayizi wawo—ukuthi singakanani izicubu ezivamile phakathi kwesimila nonqenqema olusikiwe—ziyahlukahluka ngokuya ngohlobo lwethishu nendawo yesimila.

Odokotela bezifo bahlola amamajini ukuze bahlole ukuthi amaseli wesimila akhona yini ekugcineni kwethishu. Umkhawulo omuhle, lapho kutholakala khona amangqamuzana e-tumor, uphakamisa ukuthi amanye amaseli wesimila angase asale emzimbeni. Ngokuphambene, imajini engalungile, engenawo amaseli e-tumor emaphethelweni, iphakamisa ukuthi isimila sisuswe ngokuphelele. Eminye imibiko iphinda ilinganise ibanga phakathi kwamaseli wesimila aseduze kanye nemajini, noma ngabe wonke amamajini anegethivu.