I-Adrenocortical carcinoma

nguJason Wasserman MD PhD FRCPC
Mashi 6, 2023

I-Adrenocortical carcinoma uhlobo lomdlavuza we-adrenal gland. Isimila siqala emangqamuzaneni ngokuvamile atholakala ku-cortex (ungqimba lwangaphandle) lwe-adrenal gland. Nakuba i-adrenocortical carcinoma iyithumba elingavamile kodwa iwuhlobo oluvame kakhulu lomdlavuza we-adrenal gland.

Yiziphi izimpawu ze-adrenocortical carcinoma?

Izimpawu ze-adrenocortical carcinoma zincike ezinhlotsheni zamahomoni akhiqizwa amaseli wesimila. Izimila ezikhiqiza amahomoni ocansi njenge-androgens angabangela abesifazane ukuba bathuthukise izici zesilisa zesibili. Izimila ezikhiqiza i-cortisol zihlotshaniswa nokuvuvukala kobuso nesisu, ubuthakathaka bemisipha, umfutho wegazi ophakeme, nokwanda kwamazinga kashukela egazini. Ezinye izimila azibangeli noma yiziphi izimpawu futhi isimila sitholakala ngokuzenzakalelayo lapho ukuhlolwa kwesithombe kwenziwa ngezinye izizathu.

Kwenziwa kanjani lokhu kuxilongwa?

Inhlanganisela yezithombe zesisu (i-MRI noma i-CT scan), ukuhlolwa kwegazi, nokuhlaziywa kwe-pathologic kuyadingeka ukwenza ukuxilongwa kwe-adrenocortical carcinoma. Ngemva kokuba isimila sesibonakalisiwe, kwenziwa ukuhlolwa kwegazi ukuze kutholwe ukuthi isimila sikhiqiza noma yimaphi amahomoni. Iziguli eziningi zibe sezinikezwa ukuhlinzwa ukuze kukhishwe isimila. Kwezinye iziguli, inqubo yokuhlinzwa ebizwa ngokuthi a i-biopsy kungenziwa ngaphambi kokuba isimila sikhishwe ngokuphelele.

Izici ezincane ze-tumor

Uma sihlolwa ngesibonakhulu isimila sakhiwe amaseli e-adrenocortical abukeka ngendlela engavamile. Amaseli ngokuvamile makhulu futhi icyoplasm (umzimba weseli) ungase ubonakale ucacile noma i-eosinophilic (pink). Izibalo ze-Mitotic (amaseli wesimila ahlukana ukuze akhe amaseli amasha wesimila) avame ukubonakala. Ngaphezu kwalokho, izindawo ze- i-necrosis (amaseli wesimila afile noma afayo) nawo avame ukubonakala.

Isimila singase sizungezwe ungqimba oluncane lwethishu olubizwa ngokuthi a isimila capsule futhi le capsule ingase ihlukanise isimila kunoma iyiphi indlala evamile esele ye-adrenal. I-Adrenocortical carcinoma iyinhlangano -hlaselayo isimila okusho ukuthi sibhebhetheka esicutshini esivamile. Ukuhlasela nge-tumor capsule kubizwa ngokuthi i-capsular invasion. Ezinye izinhlobo zokuhlasela ezivame ukubonakala zihlanganisa ukuhlasela kwe-vascular kanye nokuhlasela kwe-lymphatic. Lezi zinhlobo zokuhlasela zichazwe kabanzi ezigabeni ezingezansi.

Ukuhlasela kwe-tumor capsule

Iningi lama-adrenocortical carcinomas lizungezwe ungqimba oluncane lwezicubu ezibizwa ngokuthi a isimila capsule. Ukuhlasela kwe-tumor capsule kusho ukuthi amangqamuzana omdlavuza abhodloze i-tumor capsule futhi asesakazekele ku-adrenal gland evamile noma izicubu ngaphandle kwe-adrenal gland.

Ukuhlasela kwemithambo

Ukuhlasela kwemithambo kusho ukuthi amangqamuzana omdlavuza atholakala emithanjeni yegazi, ngokuvamile emthanjeni, ngaphandle kwesimila. Uma kutholakala ngokuhambisana ne-adrenocortical carcinoma, ukuhlasela kwe-vascular kubaluleke kakhulu ngenxa yezizathu ezimbili. Okokuqala, isekela ukuxilongwa futhi isiza ukuhlukanisa lesi simila kwesibukeka ngendlela efanayo kodwa engenawo umdlavuza i-adrenal cortical adenoma. Okwesibili, kuhlotshaniswa nokubi kakhulu isibikezelo njengoba ukuhlasela kwemithambo kuvumela amangqamuzana omdlavuza ukuba asakazekele ezingxenyeni ezikude zomzimba njengamaphaphu.

Ukuhlasela kwe-lymphatic

Ukuhlasela kwe-lymphatic kusho ukuthi amangqamuzana omdlavuza atholakala ngaphakathi komkhumbi we-lymphatic. Imikhumbi ye-lymphatic imigudu emincane kakhulu evumela udoti, uketshezi oluthe xaxa, namangqamuzana kuphume esicutshini. Ukuhlasela kwe-lymphatic kubalulekile ngoba kuhlotshaniswa nengozi eyengeziwe ukuthi amangqamuzana omdlavuza azosakazekela kuwo ama-lymph node.

Inkomba yokulebula ye-Ki-67

Ki-67 iphrotheni etholakala kumaseli asendleleni yokuhlukana ukuze akhe amaseli amasha. Ama-pathologists asebenzisa ukuhlolwa okubizwa ngokuthi i-immunohistochemistry ukubona amaseli enza i-Ki-67. I Inkomba yokulebula ye-Ki-67 inani lamaseli omdlavuza enza i-Ki-67 ihlukaniswe ngenani eliphelele lamaseli omdlavuza. Inkomba ngokuvamile yethulwa njengephesenti. Isibonelo, inkomba yelebula ye-Ki-67 engama-25% isho ukuthi u-25% wamangqamuzana omdlavuza endaweni eyodwa yesimila ayenza i-Ki-67 futhi esenqubo yokuhlukana ukuze akhe amaseli omdlavuza amasha. Inkomba yokulebula i-Ki-67 ibaluleke kakhulu ngoba i-adrenocortical carcinomas ngokuvamile inenkomba engaphezu kuka-5% kuyilapho inkomba yokulebula efanayo kodwa engenawo umdlavuza. i-adrenal cortical adenoma ngokuvamile ingaphansi kuka-5%. Inkomba yokulebula ye-Ki-67 iphinde isize odokotela banqume ukuthi bayinikeze nini imithi efana ne-mitotane.

Isikolo se-Weiss

Isikolo se-Weiss wuhlelo olwakhelwe ukusiza odokotela bezifo ukuthi banqume ukuthi isimila se-adrenal siyithumba elinomdlavuza njenge-adrenocortical carcinoma noma uhlobo lwesimila olungenalo umdlavuza olubizwa ngokuthi. i-adrenal cortical adenoma. Isikolo se-Weiss sihlanganisa izici ezingu-9 izazi zezifo ezizibhekayo lapho zihlola isimila ngaphansi kwesibonakhulu. Isici ngasinye se-microscopic sinikezwa iphuzu elingu-1. Inani eliphelele labangu-3 noma ngaphezulu liphakamisa ukuthi isimila kungenzeka siziphathe njengomdlavuza futhi kufanele sibizwe nge-adrenocortical carcinoma. Ngokuphambene, amaphuzu aphelele angaphansi koku-3 noma ngaphezulu aphakamisa ukuthi isimila kungenzeka siziphathe ngendlela engenawo umdlavuza futhi kufanele sibizwe ngokuthi. i-adrenal cortical adenoma.

Nazi izici ezingu-9 ezisetshenziselwa ukunquma isikolo se-Weiss:

• Izinga lenuzi eliphezulu.
• Izibalo ezingaphezu kwe-mitotic (ukuhlukanisa amaseli wesimila) 5 ku-10mm2 ngayinye.
• Izibalo ze-Atypical ze-mitotic.
• I-Necrosis (i-tumor cell death).
• I-diffuse architecture (amaseli esimila akhula ngamaqembu amakhulu).
• Amaseli acacile akha ngaphansi kwama-25% esimila.
• Ukuhlasela kwe-tumor capsule.
• Ukuhlasela kwemithambo.
• Ukuhlasela kwe-lymphatic.