I-Mantle cell lymphoma

nguRosemarie Tremblay-LeMay MD MSc FRCPC
Mashi 2, 2022

Iyini i-mantle cell lymphoma?

I-Mantle cell lymphoma wuhlobo lomdlavuza oluvela kumaseli omzimba abizwa ngokuthi ama-B-lymphocytes. Ezimweni eziningi, amangqamuzana omdlavuza anenguquko yofuzo ebizwa ngokuthi i-translocation efaka isakhi sofuzo i-CCND1.

Itholakala kuphi emzimbeni i-mantle cell lymphoma?

Izindawo ezivame kakhulu ezithintekayo yi-mantle cell lymphoma ziyi ama-lymph node, kulandele ingquza kanye nomnkantsha. Amangqamuzana omdlavuza avame ukutholakala egazini. Ezinye izingosi, njengepheshana lesisu, zingathinteka.

Izazi ze-pathologists zenza kanjani ukuxilongwa kwe-mantle cell lymphoma?

Ukuxilongwa kwe-Mantle cell lymphoma ngokuvamile kwenziwa ngemva kokususwa kwesiqephu esincane sethishu ngendlela ebizwa ngokuthi a i-biopsy. Isampula yezicubu ngokuvamile ikhishwa ku-lymph node ekhulisiwe nakuba ezinye izingxenye zomzimba zingase zibandakanyeke. Isampula lethishu libe selithunyelwa kudokotela wakho wezifo osihlola ngesibonakhulu.

Yiziphi ezinye izivivinyo ezenziwa i-mantle cell lymphoma?

Immunohistochemistry

I-pathologist yakho izokwenza ukuhlolwa okubizwa i-immunohistochemistry ukugqamisa isimila kangcono futhi ukhiphe ezinye izifo ezingabukeka zifana ne-mantle cell lymphoma ngaphansi kwe-microscope.

I-Immunohistochemistry ukuhlolwa okusebenzisa amasosha omzimba ukugqamisa izinhlobo ezahlukene zamaphrotheni akhiqizwa amaseli. Lapho amangqamuzana ekhiqiza iphrotheni, izazi zezifo zichaza umphumela njengomuhle noma osebenzayo. Uma amangqamuzana engawakhiqizi amaprotheni, umphumela uchazwa ngokuthi awunayo noma awusebenzi.

Amaseli omdlavuza ku-mantle cell lymphoma avela ku-B-lymphocyte futhi akhiqiza amaprotheni ngokuvamile enziwe ama-B-lymphocyte afana ne-CD20, i-PAX5 noma i-CD79a. Baphinde bakhiqize i-BCL2 ne-CD5. Amaseli omdlavuza akhiqiza i-cyclin D1 ku->95% yezimo futhi iwuphawu oluhle lwe-mantle cell lymphoma, njengoba kuphela ezinye izinhlobo ezimbalwa ze-lymphoma ezivumayo ku-cyclin D1.

Enye iphrotheni evamile i-SOX11, ezoba futhi ibe yinhle ezimweni ezimbalwa ze-cyclin D1-negative. Amanye amaprotheni avame ukuhlolwa ekuxilongweni kwe-lymphomas, njenge-CD10, Bcl6, noma i-LEF1, ngokuvamile awanayo.

Ama-pathologists angasebenzisa futhi i-immunohistochemistry ukunquma inkomba yokwanda. Inkomba yokwanda iyisilinganiso sokuthi amangqamuzana omdlavuza ahlukana ngokushesha kangakanani ukuze akhe amangqamuzana omdlavuza amasha. Kushaye umaka Ki-67 (ebuye ibizwe nge-MIB1) izoba yinhle kumaseli asendleleni yokuhlukana ukuze akhiqize amaseli amaningi. Ngokuvamile, i-tumor ene-high proliferation index ikhula ngokushesha futhi iziphatha ngendlela ehlukumezayo.

Ukuhlolwa kwamangqamuzana

Ingqamuzana ngalinye emzimbeni wakho linesethi yeziqondiso ezitshela ingqamuzana ukuthi liziphathe kanjani. Lezi ziqondiso zibhalwe ngolimi olubizwa ngokuthi i-DNA futhi iziqondiso zigcinwa kuma-chromosome angu-46 engqamuzaneni ngayinye. Ngenxa yokuthi iziqondiso zinde kakhulu, zihlukaniswa zibe izingxenye ezibizwa ngokuthi izakhi zofuzo futhi isakhi sofuzo ngasinye sitshela ingqamuzana indlela yokukhiqiza ucezu lomshini olubizwa ngokuthi iphrotheni.

Ngezinye izikhathi, ucezu lwe-DNA luyawa ku-chromosome eyodwa bese lunamathela ku-chromosome ehlukile. Lokhu kubizwa ngokuthi i-translocation futhi kungaholela ekutheni iseli lenze iphrotheni entsha nengajwayelekile. Uma iphrotheni entsha ivumela iseli ukuthi liphile isikhathi eside kunamanye amaseli noma lisakazekele kwezinye izingxenye zomzimba, ingqamuzana ingaba umdlavuza (ithumba eliyingozi).

I-Mantle cell lymphoma ibonakala ngokudluliswa kwesakhi sofuzo i-CCND1, esifaka ikhodi ye-protein cyclin D1 (bona i-Immunohistochemistry ngenhla). Izazi ze-pathologists zivame ukuhlola lezi zinguquko zamangqamuzana ngokwenza I-fluorescence in situ hybridization (INHLANZI) ocezwini lwesicubu esisuka esimila. Lolu hlobo lokuhlola lungenziwa ku- i-biopsy isifanekiso noma lapho isimila sakho sikhishiwe ngokuhlinzwa. Lezi zivivinyo zisetshenziselwa ukuqinisekisa ukuxilongwa kwe-mantle cell lymphoma, okuwusizo ikakhulukazi uma imiphumela ye- i-immunohistochemistry okwenziwe bekungejwayelekile.

Kusho ukuthini ukuhluka kwe-blastoid ye-mantle cell lymphoma?

I-Mantle cell lymphoma ngokuvamile yenziwe ngama-B-lymphocyte avuthiwe (athuthuke ngokugcwele). I-Mantle cell lymphoma ichazwa njengokuhluka kwe-blastoid uma amaseli wesimila ebukeka njengama-B-lymphocyte angavuthiwe (athuthuke kancane). Okuhlukile kwe-blastoid kubalulekile ngoba kuhlotshaniswa nokuziphatha okunolaka kune-mantle cell lymphoma yakudala (okungaguquki).

Kusho ukuthini ukuhluka kwe-pleomorphic kwe-mantle cell lymphoma?

I-Mantle cell lymphoma ngokuvamile yakhiwa amaseli wesimila amancane kuya kwaphakathi nendawo abukeka afana kakhulu elinye nelinye. I-Mantle cell lymphoma ichazwa njengokuhluka kwe-pleomorphic uma amaseli wesimila ehluka kakhulu ngokuma noma usayizi. Amanye amaseli wesimila amakhulu kakhulu nawo avame ukubonakala. Ukuhluka kwe-pleomorphic kubalulekile ngoba kuhlotshaniswa nokuziphatha okunolaka kune-classic (okungaguquki) i-mantle cell lymphoma.