Ukwehluka kwe-follicular evalekile kancane i-papillary thyroid carcinoma

nguJason Wasserman MD PhD FRCPC
Mashi 26, 2024

I-follicular variant papillary thyroid carcinoma (FVPTC) iyinhlobo yomdlavuza wegilo. Lolu hlobo lomdlavuza luvame kakhulu kubantu abadala nakuba lubonakala ezinganeni. Yakhiwe ngamaseli e-follicular ngokuvamile atholakala ku-thyroid gland.

I-athikili izokusiza ukuthi ufunde futhi uqonde umbiko wakho we-pathology we-follicular invasive encapsulated variant papillary thyroid carcinoma.

Kungani lolu hlobo lomdlavuza lubizwa ngokuthi i-encapsulated futhi luhlasela kancane?

I-follicular variant papillary thyroid carcinoma ichazwa ngokuthi "i-encapsulated" lapho isimila sizungezwe ungqimba oluncane lwezicubu ezibizwa ngokuthi isimila capsule. Igama elithi "i-invasive kancane" lisho ukuthi ukuhlolwa okungabonakali kwesimila kuhlonze amaqembu amancane amangqamuzana e-tumor egqekeza i-capsule futhi asakazekele endlaleni yegilo ezungezile. La magama abalulekile ngoba asiza ukuhlukanisa lolu hlobo lomdlavuza kumathumba amabili ahlobene: I-nonvasive follicular thyroid neoplasm enezici ze-nuclear ezifana ne-papillary (NIFTP) futhi infiltrative follicular variant papillary thyroid carcinoma. Ngokungafani, i-NIFTP, i-follicular invasive kancane i-papillary thyroid carcinoma i-a okubi (umdlavuza) isimila esingasakazeka ngale kwendlala yegilo. Kodwa-ke, amathumba angavaleli kancane mancane amathuba okuthi enze njalo i-metastasis (sakaza) ku ama-lymph node kuka infiltrative follicular variant papillary thyroid carcinoma.

Yini ebangela umdlavuza wegilo wegilo wegciwane le-follicular kancane ohlaselayo?

Kubantu abaningi abahlakulela i-follicular invasive encapsulated kancane i-papillary thyroid carcinoma, imbangela ayaziwa. Kodwa-ke, ingozi yokuthola lolu hlobo lomdlavuza iphezulu kubantu abanesimila esithile sofuzo ama-syndromes kufaka phakathi i-PTEN hamartoma syndrome, i-DICER1 syndrome, ne-Carney complex.

Yiziphi izimpawu ze-follicular invasive encapsulated papillary thyroid carcinoma?

Izimpawu ze-ecapsulated follicular variant papillary thyroid carcinoma zingabandakanya:

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

Kwenziwa kanjani lokhu kuxilongwa?

Ukuxilongwa kwe-follicular encapsulated encapsulated variant papillary thyroid carcinoma kungenziwa kuphela ngemva kokuba isimila sisusiwe futhi sithunyelwe kudokotela wezifo ukuze ahlolwe. Lokhu ngokuvamile kuhilela ukukhipha ngokuhlinzwa ingxenye yegilo 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-follicular encapsulated encapsulated kancane i-papillary thyroid carcinoma

Umbiko wakho we-pathology we-follicular encapsulated encapsulated kancane i-papillary thyroid carcinoma izoba nolwazi olufana nosayizi wesimila, ukuba khona noma ukungabikho i-angioinvasion, ukuhlasela kwe-lymphatic, kanye nokwandiswa kwe-extrathyroidal, kanye nokuhlolwa kwe imishado. Imiphumela yanoma iyiphi ama-lymph node okuhloliwe kufanele kufakwe embikweni. Lezi zihloko zichazwe kabanzi ezigabeni ezingezansi.

Usayizi wesimila

Ngemuva kokuthi isimila sikhishwe ngokuphelele sizolinganiswa. Isimila ngokuvamile sikalwa ngezinhlangothi ezintathu kodwa ubukhulu obukhulu kuphela obuchazwa embikweni wakho. Isibonelo, uma isimila sikala u-4.0 cm ngo-2.0 cm ngo-1.5 cm, umbiko wakho uzochaza isimila njengo-4.0 cm. Usayizi wesimila ubalulekile ku-follicular encapsulated encapsulated kancane ehlukahlukene i-papillary thyroid carcinoma ngoba isetshenziselwa ukunquma isigaba se-pathologic (pT) futhi ngenxa yokuthi izimila ezikhudlwana zinamathuba amaningi okuba nazo. i-metastasis (sabalala) kwezinye izingxenye zomzimba.

Ukuhlasela kwe-Vascular (i-angioinvasion)

I-Vascular invasion, eyaziwa nangokuthi i-angioinvasion, ukusabalala kwamaseli e-tumor emthanjeni wegazi. Lapho ama-tumor cell ehlasela imithambo yegazi, anamandla okuhamba emgudwini wegazi aye kwezinye izingxenye zomzimba, inqubo eyaziwa ngokuthi i-metastasis. Ngenxa yalesi sizathu, ukuhlasela kwemithambo kubalulekile ngoba kubonisa uhlobo lomdlavuza olunolaka. Imibiko eminingi izochaza ukuhlasela kwemithambo njengento engeyinhle uma kungekho maseli e-tumor abonwayo ngaphakathi kwemithambo yegazi noma evumayo uma amaseli e-tumor ebonakala ngaphakathi kwemithambo yegazi okungenani eyodwa.

Ukuhlasela kwe-lymphatic

Ukuhlasela kwe-lymphatic kusho ukuthi amangqamuzana e-tumor abonakala ngaphakathi kwemigudu ye-lymphatic, amashubhu amancane angenalutho avumela ukugeleza koketshezi olubizwa ngokuthi i-lymph lusuka ezicutshini luye ezithweni zokuzivikela ezibizwa ngokuthi. ama-lymph node. Ukuhlasela kwe-lymphatic kubalulekile ngoba kwandisa ingozi yokuthi amangqamuzana e-tumor azosakazeka ngohlelo lwe-lymphatic ama-lymph node. Uma ukuhlasela kwe-lymphatic kubonakala, kuzobizwa ngokuthi i-positive. Uma kungabonakali ukuhlasela kwe-lymphatic, kuzobizwa ngokuthi i-negative.

Ukunwetshwa kwe-Extrathyroidal

Ukunwetshwa kwe-Extrathyroidal kusho ukuthi amangqamuzana e-tumor asabalale ngaphandle kwendlala yegilo nasezicutshini ezizungezile. Ama-pathologists ahlukanisa i-extrathyroidal extension ngezinhlobo ezimbili:

• I-Microscopic extrathyroidal extension – Amaseli wesimila angaphandle kwendlala yegilo angabonakala kuphela ngemva kokuhlolwa kwesimila ngesibonakhulu. Lolu hlobo lwesandiso se-extrathyroidal aluhlotshaniswa nokubi kakhulu isibikezelo futhi ayisishintshi isigaba se-pathologic tumor (pT).
• I-Gross (macroscopic) isandiso se-extrathyroidal - Isimila sasibonakala sisakazekela ezicutshini ezizungezile ngaphandle kokusebenzisa isibonakhulu. Lolu hlobo lwesandiso se-extrathyroidal lungabonwa udokotela wakho ngesikhathi sokuhlinzwa noma umsizi we-pathologist owenza ukuhlolwa okuphelele kwezicubu ezithunyelwa ku-pathology. Lolu hlobo lokunwetshwa kwe-extrathyroidal lubalulekile ngoba lezi zimila kungenzeka zisabalele kwezinye izingxenye zomzimba. I-gross extrathyroidal extension iphinde inyuse isigaba se-pathologic tumor (pT) sibe yi-pT3b.

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.

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.

Izindawo ezinama-lymph

Izindawo ezinama-lymph amasosha omzimba amancane atholakala kuwo wonke umzimba. Amangqamuzana omdlavuza angasakazeka esuka eqhumeni 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 omdlavuza ukusuka esimila ukuya kwenye ingxenye yomzimba njenge-lymph node kubizwa ngokuthi a i-metastasis.

Amaseli omdlavuza 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 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. Ama-lymph nodes ohlangothini olufanayo nesimila abizwa ngokuthi i-ipsilateral kanti lawo aphesheya kwesimila abizwa ngokuthi i-contralateral.

Uma noma imaphi ama-lymph node akhishiwe emzimbeni wakho, azohlolwa ngesibonakhulu udokotela wezifo futhi imiphumela yalokhu kuhlolwa izochazwa embikweni wakho. "Positive" kusho ukuthi amaseli omdlavuza atholakala ku-lymph node. “Okubi” kusho ukuthi awekho amaseli omdlavuza atholakele. Uma amangqamuzana omdlavuza etholakala ku-lymph node, usayizi weqembu elikhulu kunawo wonke lamangqamuzana omdlavuza (okuvame ukuchazwa 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 lunquma 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-radioactive iodine, i-chemotherapy, i-radiation therapy, noma i-immunotherapy.

Izinguquko zofuzo ku-follicular encapsulated encapsulated kancane i-papillary thyroid carcinoma

I-follicular invasive encapsulated invant papillary thyroid carcinoma, njengezinhlobo eziningi zomdlavuza, ngokuvamile ihilela izinguquko ku-DNA yamangqamuzana egilo. Lezi zinguquko zivumela amaseli ukuthi akhule ngokushesha futhi ngaphansi kokulawulwa okuncane kunamaseli avamile.

Ezinye zezinguquko ezijwayelekile zofuzo ezihambisana nalolu hlobo lomdlavuza zihlanganisa:

1. Ukushintsha kwe-BRAF: Ngenkathi ukuguqulwa kwe-BRAF, ikakhulukazi ukuguqulwa kwe-BRAF V600E, kwande kakhulu uhlobo oluhlukile lwe-papillary thyroid carcinoma, imvamisa yabo ingahluka ekuhlukeni okuncane kwe-follicular encapsulated papillary thyroid carcinoma. Lokhu kuguqulwa kuholela ekusebenziseni indlela yokusayina ye-MAPK, ikhuthaze ukukhula nokuqhubeka kwesimila.
2. Izinguquko ze-RAS: Ukuguqulwa kwezakhi zofuzo ze-RAS (i-NRAS, i-HRAS, i-KRAS) kuvame ukuhlotshaniswa nomdlavuza wegilo wegilo onephethini ye-follicular, okuhlanganisa ne-follicular encapsulated encapsulated variant papillary thyroid carcinoma. Lezi zinguquko ziphinde zenze kusebenze indlela ye-MAPK, nakuba kusetshenziswa indlela ehlukile eqhathaniswa nokuguqulwa kwe-BRAF, futhi ixhunywe ekwandeni kwesimila nokuhlukaniswa.
3. Izinguquko zomgqugquzeli we-TERT: Ukuguqulwa kwezakhi zofuzo endaweni yomgqugquzeli wofuzo lwe-TERT kungatholakala ku-follicular encapsulated encapsulated kancane okuhlukile kwe-papillary thyroid carcinoma. Lezi zinguquko zihlotshaniswa nokwanda komsebenzi we-telomerase, okuvumela amangqamuzana omdlavuza ukuthi agcine ubude bawo be-telomere futhi aqhubeke nokuhlukana unomphela.
4. Ukuguqulwa kwe-PIK3CA nokulahlekelwa kwe-PTEN: Izinguquko ezithinta indlela ye-PI3K/AKT, okuhlanganisa ukuguqulwa kwe-PIK3CA kanye nokulahlekelwa kwenkulumo ye-PTEN, kungenzeka nge-follicular encapsulated encapsulated variant papillary thyroid carcinoma. Lezi zinguquko ziholela ekusindeni kwamangqamuzana, ukukhula, kanye nemetabolism.
5. Ukuhlelwa kabusha kwe-RET/PTC: Nakuba kungavamile kakhulu ekuhlaselweni okuncane kwe-follicular variant papillary thyroid carcinoma uma kuqhathaniswa uhlobo oluhlukile lwe-papillary thyroid carcinoma, ukuhlelwa kabusha kwe-RET/PTC kungenzeka. Lezi zinguquko zofuzo ziphumela ekuhlanganisweni kwe-RET tyrosine kinase nezakhi zofuzo zozakwethu ezihlukene, okuqhuba ukubonakaliswa kwe-oncogenic.

Ukuba khona kwalezi zinguquko zofuzo kuba nomthelela ekuziphatheni kwethumba, ukuphendula ekwelashweni, kanye nokubikezelwa kwesifo. Isibonelo, izimila ezinokuguqulwa kwe-BRAF V600E noma ukuguqulwa komgqugquzeli we-TERT kuvame ukuba nokuziphatha okunolaka futhi kube mpofu kakhulu. isibikezelo. Ukuqonda izinguquko zofuzo ku-follicular variant papillary thyroid carcinoma kubalulekile ekuqondiseni izinqumo zokwelashwa, okuhlanganisa ukusetshenziswa okungenzeka kwezindlela zokwelapha ezihlosiwe, kanye nokuhlola ubungozi bokuqhubekela phambili kwesifo nokuphindaphinda.

Isigaba se-Pathologic (pTNM)

Isigaba se-pathologic se-follicular encapsulated encapsulated minimally encapsulated variant papillary thyroid carcinoma sisekelwe ohlelweni lwesiteji lwe-TNM, uhlelo olwaziwayo emhlabeni wonke olwakhiwe I-American Joint Committee on Cancer. Lolu hlelo lusebenzisa ulwazi mayelana nesisekelo isisu (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-follicular encapsulated encapsulated kancane i-papillary thyroid carcinoma inikezwa isigaba sesimila esiphakathi koku-1 no-4 ngokusekelwe kubukhulu besimila kanye nokuba khona kwamaseli wesimila ngaphandle kwendlala yegilo.

• 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 e-tumor adlulela emisipha engaphandle kwegland yegilo.
• T4 - Amaseli e-tumor atholakala ezakhiweni noma ezithweni ezingaphandle kwegland yegilo kuhlanganise ne-trachea, i-larynx, noma i-esophagus.

Isiteji seNodal (pN)

I-follicular invasive encapsulated invant papillary thyroid carcinoma inikezwa isigaba se-nodal sika-0 noma 1 ngokusekelwe ekubeni khona noma ukungabikho kwamaseli wesimila endaweni i-lymph node kanye nendawo yama-lymph nodes ahilelekile.

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

Ezinye izinsiza eziwusizo

I-American Thyroid Association (ATA)

I-American Cancer Society

Funda kabanzi nge-pathology

I-atlas ye-Pathology