ngu-Bibianna Purgina, MD FRCPC
Mashi 25, 2023
I-liposarcoma ehluke kahle iwuhlobo lomdlavuza olwakhiwe izicubu ze-adipose (amafutha). Kuyisimila esikhula kancane esingaqala cishe noma yikuphi emzimbeni. Elinye igama lalesi simila yi- Isimila se-atypical lipomatous.
I-liposarcoma ehluke kahle futhi I-atypical lipomatous tumor (ALT) amagama amabili aqanjwe ngesimila esisodwa. Odokotela basebenzisa igama elithi ALT lapho bechaza izimila eziqala engxenyeni engaphezulu yomzimba njengengalo noma umlenze nalapho isimila singasuswa ngokugcwele ngokuhlinzwa. Igama elithi liposarcoma elihluke kahle lisetshenziselwa izimila eziqala ezindaweni ezijulile njengangemuva kwesisu nalezo ezingakwazi ukususwa ngokugcwele ngokuhlinzwa kuphela.
Ukuxilongwa kwe-liposarcoma ehluke kahle kuvame ukuvela ngemuva kokukhishwa kwesampula encane yesimila ngenqubo ebizwa ngokuthi i-liposarcoma. i-biopsy. Izicubu ze-biopsy zibe sezithunyelwa kudokotela ohlola izifo ezihlola ngesibonakhulu. Ukuxilongwa kungenziwa futhi ngemva kokuba isimila sonke sisusiwe njenge ukuziqhenya or ukukhishwa kabusha isifanekiso.
Lapho ihlolwa ngaphansi kwesibonakhulu, i-liposarcoma ehluke kahle ingase ibukeke njengamafutha avamile. Nokho, ngokungafani namafutha avamile, i-liposarcoma ehluke kahle iqukethe amaseli amafutha abukeka ngendlela engavamile, aziwa ngokuthi ama-lipoblast.
I-MDM2 iwufuzo olukhuthaza ukuhlukana kwamaseli (ukwakhiwa kwamaseli amasha). Amaseli avamile kanye nalawo asemathumbani angenawo umdlavuza anamakhophi amabili ofuzo lwe-MDM2. Ngokuphambene, ama-liposarcoma ahluke kahle anamakhophi angaphezu kwamabili ofuzo lwe-MDM2.
Kwabizwa ukuhlolwa I-fluorescence in situ hybridization (INHLANZI) ngokuvamile isetshenziselwa ukubala inani lezakhi zofuzo ze-MDM2 kuseli. Inani elikhulayo lezakhi zofuzo (ezingaphezu kwamabili) libizwa ngokuthi i-amplification futhi lisekela ukutholakala kwe-liposarcoma ehluke kahle.
Odokotela bezifo bahlukanisa i-liposarcoma ehluke kahle ibe amamaki amathathu ngokusekelwe ohlelweni oludalwe yi-French Federation of Cancer Centers Sarcoma Group (FNCLCC). Lolu hlelo lusebenzisa izici ezintathu ze-microscopic ukucacisa ibanga lesimila: ukuhlukaniswa, ukubala kwe-mitotic, kanye ne-necrosis. Lezi zici zichazwe kabanzi ngezansi. Ibanga linganqunywa kuphela ngemva kokuhlolwa kwesampula yesimila ngaphansi kwesibonakhulu.
Amaphuzu (kusuka ku-0 kuye ku-3) anikezwa isici ngasinye se-microscopic (0 kuya ku-3) futhi inani eliphelele lamaphuzu linquma ibanga lokugcina lesimila. Ngokwalolu hlelo, ama-liposarcoma ahluke kahle angaba izimila eziphansi noma ezisezingeni eliphezulu. Ibanga lesimila libalulekile ngoba izimila ezisezingeni eliphezulu (amabanga 2 no-3) zinolaka kakhulu futhi zihlotshaniswa nokubi kakhulu. isibikezelo.
Amaphuzu ahlobene nebanga ngalinye:
Izici ezincane ezisetshenziselwa ukunquma ibanga:
Amanye ama-liposarcoma ahluke kahle azoshintsha ngokuhamba kwesikhathi ukuze amanye amangqamuzana angabe esabukeka njengamafutha avamile. Le nqubo ibizwa ngokuthi i-dedifferentiation. Ukuthola i-dedifferentiation ku-liposarcoma ehluke kahle kushintsha ukuxilongwa i-liposarcoma ehlukile. Lolu shintsho lubalulekile ngoba i-dedifferentiated liposarcoma iwumdlavuza ohlasela kakhulu okungenzeka ukuthi ubuye ubuye ngemva kokuhlinzwa bese usakazekela kwezinye izingxenye zomzimba.
Ubukhulu be-tumor bubalulekile ngoba amathumba angaphansi kuka-5 cm mancane amathuba okuthi asakazekele kwezinye izingxenye zomzimba futhi ahlotshaniswa nengcono kakhulu. isibikezelo. Usayizi we-tumor usetshenziselwa ukunquma isigaba se-pathologic tumor (pT).
A wekhasi yinoma yisiphi isicubu esasikwa udokotela ohlinzayo ukuze akhiphe isimila emzimbeni wakho. Kuye ngohlobo lokuhlinzwa oye wahlinzwa, izinhlangothi zingahlanganisa amathambo, imisipha, imithambo yegazi, nezinzwa ezisikwe ukuze kukhishwe isimila emzimbeni wakho. Amamajini azochazwa kuphela embikweni wakho ngemva kokuba isimila sesisusiwe.
Umkhawulo ongemuhle usho ukuthi awekho amaseli wesimila abonwe kunoma imaphi amaphethelo asikiwe esithishu. Imajini ibizwa ngokuthi iphozithivu uma kunamaseli e-tumor emaphethelweni ezicubu ezisikiwe. Umkhawulo omuhle uhlotshaniswa nengozi enkulu yokuthi isimila siphinde sivele endaweni efanayo ngemva kokwelashwa.
Isigaba se-pathologic se-liposarcoma ehluke kahle sisekelwe ohlelweni lwesiteji lwe-TNM, uhlelo olwaziwayo emhlabeni wonke olwakhiwe ekuqaleni 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.
Isigaba sesimila se-liposarcoma ehluke kahle siyahlukahluka kuye ngengxenye yomzimba ehilelekile. Isibonelo, isimila esingamasentimitha angu-5 esiqala entanyeni sizonikezwa isigaba sesimila esihlukile kunesimila esiqala sijule ngemuva kwesisu (i-retroperitoneum). Kodwa-ke, ezindaweni eziningi zomzimba, isigaba sesimila sihlanganisa usayizi wesimila kanye nokuthi isimila sesikhule saba yizitho zomzimba ezizungezile.
I-liposarcoma ehluke kahle inikezwa isigaba se-nodal sika-0 noma 1 ngokususelwa ebukhoneni bamaseli wesimila endaweni. i-lymph node. Uma engekho amaseli wesimila abonwa kunoma yimaphi ama-lymph nodes ahloliwe, isigaba se-nodal ngu-N0. Uma amaseli wesimila ebonakala kunoma iyiphi i-lymph nodes ehloliwe, isigaba se-nodal siba ngu-N1.
I-liposarcoma ehluke kahle inikezwa isigaba se-metastatic esingu-0 noma esingu-1 ngokusekelwe ebukhoneni bamaseli wesimila endaweni ekude emzimbeni (ngokwesibonelo amaphaphu). Isigaba se-metastatic singanikezwa kuphela uma izicubu ezivela endaweni ekude zihanjiswa ukuze zihlolwe ukugula. Ngenxa yokuthi lesi sicubu asivamile ukuba khona, isigaba se-metastatic asikwazi ukunqunywa futhi sibhalwe njenge-MX.