nguJason Wasserman MD PhD FRCPC
Kwangathi 4, 2023
I-Salivary duct carcinoma wuhlobo lomdlavuza wendlala yamathe. I-Salivary duct carcinoma ingumdlavuza ohlaselayo ovame ukusabalala uye esicutshini esizungeze indlala yamathe nakwezinye izitho ezifana nalezi. ama-lymph node namaphaphu.
Indawo ejwayeleke kakhulu ye-salivary duct carcinoma yindlala ye-parotid, nokho-ke, isimila singase sivele ku-submandibular noma indlala engaphansi.
Izimpawu ze-salivary duct carcinoma ngokuvamile zihlanganisa isisindo esikhula ngokushesha esihlathini noma entanyeni enobuhlungu noma ubuthakathaka ebusweni.
Imbangela ye-salivary duct carcinoma ayaziwa okwamanje.
I-salivary duct carcinoma ex pleomorphic adenoma igama elithi pathologists elisetshenziswa ukuchaza i-salivary duct carcinoma eqala ngaphakathi kwesimila esasingenawo umdlavuza esasibizwa ngokuthi. i-pleomorphic adenoma.
Ukuxilongwa kwe-salivary duct carcinoma ngokuvamile kwenziwa ngemva kokukhishwa kwesampula encane yesimila ngenqubo ebizwa ngokuthi i-salivary duct carcinoma. i-biopsy. Ukuxilonga kungenziwa futhi ngemva kokuba isimila sisusiwe ngokuhlinzwa okukhulu okubizwa ngokuthi a ukukhishwa kabusha. Izicubu zibe sezithunyelwa kudokotela wezifo ukuze ayohlolwa.
Lapho ihlolwa ngesibonakhulu, i-salivary duct carcinoma yenziwa amaseli amakhulu aphinki. Izazi ze-pathologists zichaza lawa maseli njenge-eosinophilic. Amaseli wesimila ku-salivary duct carcinoma achazwa ngokuthi okuhlekisayo ngoba abukeka ngendlela engavamile kakhulu uma eqhathaniswa namaseli avamile, anempilo. Ukuhlukanisa amaseli wesimila kubizwa izibalo ze-mitotic zivame ukubonakala. Amaseli wesimila ngokuvamile axhuma ndawonye ukuze akhe ama-projections amancane afana nomunwe okuthiwa i-papillae noma micropapillae. Izikhala ezincane ezivulekile ezibizwa ama-cysts kungase futhi kubonakale ku-tumor.
Nini i-immunohistochemistry (IHC) kwenziwa amaseli wesimila ku-salivary duct carcinoma ngokuvamile avuma i-androgen receptor (AR), i-pan-cytokeratin, i-GATA-3, ne-mammaglobin. Amaseli wesimila ngokuvamile awanayo i-S100 ne-cytokeratin 20.
Ngemva kokuba isimila sesikhishwe ngokuphelele sizokalwa futhi nosayizi uzochazwa embikweni wakho. Usayizi wesimila ubalulekile ngoba usetshenziselwa ukunquma isigaba se-pathologic tumor (pT).
Igama elithi extraparenchymal extension lichaza isimila esikhule sadlula indlala yamathe evamile saba izitho ezizungezile noma izicubu. Ukunwetshwa kwe-Extraparenchymal kubalulekile ngoba izimila ezikhombisa ukwanda kwe-extraparenchymal cishe zisabalele kwezinye izingxenye zomzimba njenge ama-lymph node. Ukunwetshwa kwe-Extraparenchymal nakho kusetshenziselwa ukunquma isigaba se-pathologic tumor (pT).
Imizwa ifana nezintambo ezinde ezakhiwe ngamaqoqo amangqamuzana abizwa ngokuthi ama-neurons. Imizwa itholakala kuwo wonke umzimba futhi inesibopho sokuthumela ulwazi (njengokushisa, ukucindezela, nobuhlungu) phakathi komzimba wakho nobuchopho bakho. Ukuhlasela kwe-Perineural yigama elithi pathologists elisetshenziswa ukuchaza amangqamuzana e-tumor ahlanganiswe nenzwa. Ukuhlasela kwe-Perineural kubalulekile ngoba amaseli e-tumor angasebenzisa i-nerve ukuze asakaze ezicutshini ezizungezile. Lokhu kwandisa ingozi yokuthi isimila sizophinde sikhule ngemva kokwelashwa.
Igazi lihamba lizungeza umzimba ngamashubhu amade azacile abizwa ngokuthi imithambo yegazi. Olunye uhlobo loketshezi olubizwa ngokuthi i-lymph oluqukethe udoti namangqamuzana amasosha omzimba anyakaza umzimba ngokusebenzisa imikhumbi ekhethekile ebizwa ngokuthi i-lymphatics. Igama elithi ukuhlasela kwe-lymphovascular lisetshenziselwa ukuchaza amaseli wesimila atholakala ngaphakathi kwegazi noma isitsha se-lymphatic. Ukuhlasela kwe-lymphovascular kubalulekile ngoba la maseli ayakwazi i-metastasis (sakaza) kwezinye izingxenye zomzimba njengalokhu ama-lymph node noma amaphaphu.
A wekhasi yinoma yisiphi isicubu esisikwe udokotela ohlinzayo ukuze akhiphe isimila emzimbeni wakho. Noma nini lapho kungenzeka, odokotela abahlinzayo bazozama ukusika izicubu ngaphandle kwesimila ukuze banciphise ingozi yokuthi noma yimaphi amangqamuzana omdlavuza azosala ngemva kokukhishwa kwesimila. Imibiko eminingi izochaza amamajini kuphela ngemva kokuba isimila sesisusiwe.
Udokotela wakho wezifo uzohlola ngokucophelela wonke amaphethelo esampula yezicubu zakho ukuze abone ukuthi amangqamuzana omdlavuza asondele kangakanani emaphethelweni ezicubu ezisikiwe. Imajini engalungile isho ukuthi awekho amaseli omdlavuza emaphethelweni ezicubu ezisikiwe. Uma wonke amamajini engemihle, imibiko eminingi ye-pathology izovame ukusho ukuthi amangqamuzana omdlavuza asondele kakhulu kangakanani emaphethelweni. Ibanga ngokuvamile lichazwa ngamamilimitha. Imajini eqondile isho ukuthi bekunamaseli omdlavuza emaphethelweni ezicubu ezisikiwe. Imajini eqondile ihlotshaniswa nengozi enkulu yokuthi isimila sikhule sibuyele endaweni efanayo ngemva kokwelashwa (ukuphindaphinda kwendawo).
Izindawo ezinama-lymph amasosha omzimba amancane atholakala kuwo wonke umzimba. Amaseli e-tumor angahamba esuka esimila aye ku-lymph node ngokusebenzisa imigudu ye-lymphatic etholakala ngaphakathi naseduze kwesimila (bheka i-Lymphovascular invasion ngenhla). Ukunyakaza kwamangqamuzana e-tumor kusuka esimila kuya ku-lymph node kubizwa i-metastasis.
Ngezinye izikhathi ama-lymph nodes entanyeni akhishwa ngesikhathi esifanayo ne-tumor enkulu enkambweni ebizwa ngokuthi i-neck dissection. 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.
I-pathologist yakho izohlola ngokucophelela i-lymph node ngayinye yamaseli e-tumor. Ama-lymph nodes aqukethe ama-tumor cells ngokuvamile abizwa ngokuthi ama-positive kuyilapho lawo angenawo amangqamuzana e-tumor abizwa ngokuthi i-negative. Imibiko eminingi ihlanganisa inani eliphelele lama-lymph nodes ahloliwe kanye nenombolo, uma ikhona, equkethe amaseli esimila.
Isigaba se-pathologic se-salivary duct carcinoma sisekelwe ohlelweni lwesiteji lwe-TNM, uhlelo olwaziwayo emhlabeni wonke olwasungulwa 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 kanye nesibi kakhulu isibikezelo.
I-salivary duct carcinoma inikezwa isigaba sesimila ukusuka koku-1 kuye kwesi-4 ngokusekelwe kusayizi wesimila kanye nokuthi amangqamuzana omdlavuza asabalele ngaphandle kwendlala yamathe (isandiso se-extraparenchymal).
I-salivary duct carcinoma inikezwa isigaba se-nodal ukusuka ku-0 kuye ku-3. Uma kungekho mangqamuzana omdlavuza abonwa kunoma yiliphi ama-lymph node ihlolwe, isiteji se-nodal ngu-N0. Uma amangqamuzana omdlavuza ebonakala ku-lymph node, udokotela wakho uzobheka izici ezilandelayo ukuze anqume isigaba se-nodal:
I-salivary duct carcinoma inikezwa isigaba se-metastatic sika-0 noma 1 ngokusekelwe ekutholweni kwamaseli omdlavuza endaweni ekude emzimbeni (isibonelo amaphaphu). Isigaba se-metastatic singanqunywa 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.