I-Plasma cell neoplasm

nguRosemarie Tremblay-LeMay MD MSc FRCPC kanye noVathany Kulasingam, PhD, FCACB
Mashi 2, 2022


Iyini i-plasma cell neoplasm?

I-plasma cell neoplasm wuhlobo lomdlavuza oluqala kumangqamuzana omzimba akhethekile abizwa ngokuthi amaseli e-plasma. Amangqamuzana e-plasma avamile enza izinhlobo ezahlukene zamaprotheni okuthiwa ama-immunoglobulins (amasosha omzimba) asiza ukuvikela umzimba ezintweni ezincane ezifana amagciwane. Ngokuphambene, wonke amaseli e-plasma ku-plasma cell neoplasm enza uhlobo olufanayo lwe-immunoglobulin. Amaseli e-plasma angajwayelekile nawo enza i-immunoglobulin eningi kakhulu kunamaseli e-plasma avamile.

Ayini amaseli e-plasma?

Amaseli e-plasma qala impilo njengohlobo olukhethekile lwamangqamuzana omzimba omzimba olubizwa ngokuthi ama-B-lymphocyte. Uma i-B-lymphocyte iphenduka ingqamuzana le-plasma, inamandla okukhiqiza amaprotheni akhethekile okuthiwa ama-immunoglobulins (Ig), ezibizwa nangokuthi amasosha omzimba. Ama-immunoglobulins avikela imizimba yethu ngokunamathela kuma-bacteria kanye amagciwane, okwenza kube lula ukuwakhipha emzimbeni. Ama-Immunoglobulins nawo anganamathela kumaseli angavamile noma amaseli ayeke ukusebenza ngendlela evamile.

I-Plasma Cell

Ama-immunoglobulins akhiwe izingxenye ezine futhi ingxenye ngayinye ibizwa ngokuthi iketango. I-immunoglobulin eyodwa yenziwe ngamaketango amabili asindayo namaketango amabili alula. Kunezinhlobo ezinhlanu ezahlukene zamaketango asindayo, abizwa ngokuthi A, G, D, E, M, kanye nezinhlobo ezimbili ezahlukene zamaketango alula abizwa ngokuthi i-kappa ne-lambda. Noma iyiphi inhlanganisela yamaketanga asindayo nalula ingasetshenziswa ukwenza i-immunoglobulin. Lezi zinketho zivumela umzimba wakho ukuthi ukhiqize izinhlobo eziningi zama-immunoglobulins (isibonelo IgA kappa, IgG lambda, njll.).

Nakuba isimiso somzimba sokuzivikela ezifweni sinamandla okwenza izinhlobo eziningi zama-immunoglobulins, ingqamuzana ngalinye le-plasma lenza uhlobo olulodwa lwe-immunoglobulin. Ngenxa yokuthi isimiso sethu somzimba sokuzivikela ezifweni senza izigidi zamangqamuzana e-plasma ahlukahlukene, kuyinto evamile ukuthola izinhlobo eziningi zama-immunoglobulins emzimbeni nganoma yisiphi isikhathi.

Yiziphi izivivinyo odokotela abazenzayo ukuze babheke ama-immunoglobulins angajwayelekile?

Udokotela wakho anga-oda ukuhlolwa okubizwa nge-serum protein electrophoresis ukuze abone ama-immunoglobulins egazini noma emchameni wakho. Imiphumela yokuhlolwa ivela njengomugqa kugrafu. Umphumela ojwayelekile ubukeka njengomugqa onamaqhubu amaningi amancane. Iqhubu ngalinye elincane emgqeni liwuhlobo oluhlukile lwe-immunoglobulin. Umphumela ongavamile ubonisa ukuphakama okukhulu (bona indawo emnyama esithombeni esingezansi). Lesi siqongo esikhulu yi-immunoglobulin engavamile. Okunye ukuhlola kungabonisa ukunqwabelana kwamaketanga okukhanya egazini lakho noma emchameni.

Amaseli e-plasma angajwayelekile ku-plasma cell neoplasm azokhiqiza uhlobo olulodwa kuphela lwe-immunoglobulin. Lokhu kuzophumela emananini anyukile e-IgG noma e-IgA (noma okungavamile ukuba yi-IgD noma i-IgE) kanye nenani eleqile le-kappa noma i-lambda uma liqhathaniswa nokujwayelekile.

I-serum protein electrophoresis esigulini esine-plasma cell neoplasm
I-Serum protein electrophoresis yama-immunoglobulins abonisa inani eliphakeme elingavamile esigulini esine-plasma cell neoplasm.

Izazi ze-pathologists zikwenza kanjani ukuxilonga kwe-plasma cell neoplasm?

Ukuxilongwa kwe-plasma cell neoplasm ngokuvamile kwenziwa ngemva kokuba udokotela wakho ethatha ucezu oluncane lomnkantsha wakho ngendlela ebizwa ngokuthi i-biopsy. Kwezinye iziguli, amaseli e-plasma angajwayelekile akha isimila ngaphandle kwethambo. Kuleso simo, udokotela wakho angase enze i-biopsy yaleso simila esikhundleni salokho. Kuyaqabukela, amangqamuzana e-plasma abonakale egazini lakho. Izicubu zibe sezithunyelwa kudokotela wakho wezifo ozihlola ngesibonakhulu.

Ngokuhlola izicubu ngaphansi kwesibonakhulu, udokotela wakho wezifo uzonquma iphesenti lamaseli e-plasma angajwayelekile akhona kumnkantsha wakho wethambo. Udokotela wakho uzokwazi ukuhlanganisa lolu lwazi neminye imiphumela yokuhlolwa ukuze anqume uhlobo lwe-plasma cell neoplasm.

i-plasma cell neoplasm
Amaseli e-plasma angajwayelekile esigulini esine-plasma cell neoplasm.

Yiziphi ezinye izivivinyo ezenziwa odokotela bezifo ze-plasma cell neoplasm?

Immunohistochemistry

I-pathologist yakho izokwenza ukuhlolwa okubizwa i-immunohistochemistry ukuze ufunde kabanzi mayelana namaseli e-plasma kusampula yakho yethishu futhi uqinisekise ukuthi awavamile. 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-plasma cell neoplasms avela kumaseli e-plasma futhi ngenxa yalokho, akhiqiza amaprotheni ngokuvamile enziwe amaseli e-plasma, njenge-CD138, MUM1, noma i-CD79a. Angakwazi futhi ukukhiqiza amaprotheni angakhiqizwa amangqamuzana e-plasma avamile, njenge-CD20, CD117, CD56, noma i-CyclinD1.

In hybridation in situ

I-pathologist yakho ingase futhi yenze ukuhlolwa okubizwa ngokuthi i-in situ hybridization (ISH) ukuze inqume ukuthi yikuphi ama-immunoglobulins akhiqizwa amaseli e-plasma angajwayelekile. Njengoba kuchazwe ngenhla, lawa maseli e-plasma angavamile ku-plasma cell neoplasm azokhiqiza uhlobo olulodwa kuphela lwe-immunoglobulin, isibonelo, i-IgG kappa noma i-IgG lambda.

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 ingqamuzana ukuthi iphile isikhathi eside kunamanye amangqamuzana noma isabalale kwezinye izingxenye zomzimba, ingqamuzana ingaba umdlavuza. Amangqamuzana ayingozi nawo angalahlekelwa noma azuze ucezu lwe-DNA.

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.

Izinhlobo ezahlukene zokungajwayelekile zingabonakala kuma-neoplasms e-plasma cell. Kubandakanya ukuhanjiswa okubandakanya iphrotheni IGH, ukulahleka kwe-chromosome 1p noma 17p (amakhodi ofuzo TP53), kanye nokuzuza kwe-chromosome 1q. Ukuba khona kwalokhu okungavamile kungasiza udokotela wakho ukuthi anqume ukuthi owakho isibikezelo.

Amaseli e-plasma angajwayelekile ku-plasma cell neoplasm awulimaza kanjani umzimba?

Kunezindlela ezintathu i-plasma cell neoplasm elimaza ngayo umzimba:

  • Ukulimala kwezinso – Izinso zinesibopho sokukhipha imfucuza namakhemikhali ayingozi egazini lakho. Izinso ngokuvamile zikhipha ama-immunoglobulins egazini, kodwa amazinga aphezulu ama-immunoglobulins angalimaza izinso zakho.
  • Ukulimala kwamathambo - Amaseli e-plasma angakheka ngaphakathi emathanjeni. Lokhu kubangela ukulimala kwamathambo kanye nenani elengeziwe le-calcium egazini.
  • Ukuncipha kwamaseli abomvu egazi (i-anemia) – Ukukhiqizwa kwamangqamuzana abomvu egazi kuncike kukho kokubili izinso ezinempilo nomnkantsha wamathambo. Ngenxa yalokho, iziguli ezine-plasma cell neoplasm ngokuvamile zikhiqiza amangqamuzana abomvu egazi ambalwa ngenxa yokulimala kwezinso namathambo azo. Lesi simo sibizwa nge-anemia.
Yiziphi izinhlobo ze-plasma cell neoplasms?

I-Plasma cell neoplasm ingahlukaniswa ngezigaba ezahlukahlukene ngokuya ngokuthi yimalini i-immunoglobulin itholakala egazini noma emchamweni wakho, kanye nokuthi mangaki amangqamuzana e-plasma abonakala emnkantsheni wakho nokuthi abukho yini ubufakazi bokulimala kwezitho zakho.

  • I-Monoclonal gammopathy yokubaluleka okungaqinisekisiwe (MGUS) - Lokhu kuxilongwa kwenziwa lapho amangqamuzana e-plasma emelela angaphansi kuka-10% wamangqamuzana omnkantsha, ama-immunoglobulins atholakala egazini noma emchameni angaphansi komngcele othile, futhi akukho monakalo ezithweni zakho. I-MGUS ithathwa njengesimo sangaphambi komdlavuza ngoba iphesenti elincane kuphela labantu abanalesi simo elizodlulela esigabeni esilandelayo.
  • I-Plasma cell myeloma - Lokhu kuxilongwa kwenziwa lapho kunamaseli e-plasma angaphezu kuka-10% emnkantsheni wakho futhi ama-immunoglobulins atholakala egazini noma emchameni wakho engaphezulu komkhawulo othile.
    • Uma bungekho ubufakazi bokulimala ezithweni zakho, lokhu kubizwa ngokuthi i-asymptomatic (noma eshunqayo) i-plasma cell myeloma.
    • Uma kunobufakazi bokulimala kwezitho zakho noma ngaphezu kuka-60% wamaseli e-plasma emnkantsheni wakho, lokhu kubizwa ngokuthi i-plasma cell myeloma noma i-myeloma eminingi.
Iyini i-plasmacytoma?

Kwesinye isikhathi amangqamuzana e-plasma angahlangana ukuze akhe isimila. Isimila esakhiwe ngamaseli e-plasma angajwayelekile sibizwa ngokuthi i-plasmacytoma. Lapho i-plasmacytoma yakheka ngaphandle kwethambo ibizwa ngokuthi i-extraosseous plasmacytoma. Uma kutholakala isimila esisodwa ethanjeni ngaphandle kokulimala kwezinye izingxenye zomzimba, kubizwa ngokuthi i-plasmacytoma eyodwa yethambo.

Iyini i-plasma cell leukemia?

Amaseli e-plasma angajwayelekile nawo angangena egazini. Uma imelela ngaphezu kuka-20% wamangqamuzana amhlophe egazi egazini, izobizwa ngokuthi i-plasma cell leukemia.

Iyini i-amyloidosis?

Kwesinye isikhathi, ama-immunoglobulins angajwayelekile akhiqizwa amaseli e-plasma azokwakhelana ezicutshini. Uma lokhu kwenzeka, kungakha into ebizwa ngokuthi i-amyloid. I-Amyloidosis yisimo lapho inani elikhulu lama-amyloid akheka emzimbeni futhi libangele ukulimala kwezitho. Ku-amyloidosis, kungase kube nenani elincane kuphela lamaseli e-plasma angajwayelekile abonwa emnkantsheni wamathambo. Ukuze ubone i-amyloid, udokotela wakho wezifo angasebenzisa a ibala elikhethekile ebizwa ngokuthi i-Congo Red. Ukusebenzisa leli bala i-amyloid ibonakala ibomvu ngaphansi kokukhanya okuvamile kanye nohlaza lwe-apula ngaphansi kokukhanya okukhethekile.

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