Nkhani

M'nkhani ino ya Clinical Difficulties, Bendu Konneh, BS, ndi anzake akupereka nkhani ya bambo wazaka 21 yemwe ali ndi mbiri ya miyezi 4 ya edema yopita patsogolo ya testicular.
Mnyamata wina wazaka 21 adadandaula za kutupa kwa testicle yoyenera kwa miyezi inayi.Ultrasound inavumbulutsa misa yolimba kwambiri mu testicle yoyenera, kukayikirana kwa neoplasm yoyipa.Kufufuza kwina kunaphatikizapo computed tomography, yomwe inavumbulutsa 2 cm retroperitoneal lymph node, panalibe zizindikiro za chifuwa cha metastases (mkuyu 1).Zolemba za chotupa mu seramu zimawonetsa milingo yokwezeka pang'ono ya alpha-fetoprotein (AFP) ndi milingo yabwinobwino ya lactate dehydrogenase (LDH) ndi chorionic gonadotropin (hCG).
Wodwalayo anachitidwa opaleshoni ya inguinal ya mbali yakumanja.Kuwunika kwa pathological kunavumbulutsa 1% teratomas yokhala ndi zigawo zowopsa za fetal rhabdomyosarcoma ndi chondrosarcoma.Palibe kuukira kwa ma lymphovascular komwe kunapezeka.Zolemba zobwerezabwereza zotupa zotupa zimawonetsa milingo yabwinobwino ya AFP, LDH ndi hCG.Kuwunika kwa CT kwakanthawi kochepa kumatsimikizira kuti pali 2-cm interluminal aortic lymph node popanda umboni wa ma metastases akutali.Wodwalayu adachitidwa opaleshoni ya retroperitoneal lymphadenectomy, yomwe inali yabwino mu 1 ya 24 lymph nodes ndi extranodal extension of somatic somatic malignancy yomwe imakhala ndi rhabdomyosarcoma, chondrosarcoma, ndi sarcoma yosadziwika ya spindle cell.Immunohistochemistry inasonyeza kuti maselo a chotupa anali abwino kwa myogenin ndi desmin ndi zoipa kwa SALL4 (Chithunzi 2).
Ma testicular germ cell tumors (TGCTs) ndi omwe amachititsa kuchuluka kwa khansa ya testicular mwa amuna achikulire.TGCT ndi chotupa cholimba chokhala ndi ma subtypes angapo a histological omwe angapereke chidziwitso cha kasamalidwe kachipatala.1 TGCT imagawidwa m'magulu awiri: seminoma ndi non-seminoma.Nonseminomas monga choriocarcinoma, fetal carcinoma, yolk sac chotupa, ndi teratoma.
Ma testicular teratomas amagawidwa mu postpubertal ndi prepubertal form.Prepubertal teratomas imakhala yosasamala mwachilengedwe ndipo samalumikizidwa ndi germ cell neoplasia in situ (GCNIS), koma postpubertal teratomas imalumikizidwa ndi GCNIS ndipo ndi yowopsa.2 Kuphatikiza apo, postpubertal teratomas imakonda kufalikira ku malo a extragonadal monga retroperitoneal lymph nodes.Nthawi zambiri, postpubertal testicular teratomas imatha kukhala zilonda zam'mimba ndipo nthawi zambiri amathandizidwa ndi opaleshoni.
Mu lipotili, tikuwonetsa mawonekedwe a maselo a teratoma omwe ali ndi gawo loyipa la somatic mu testes ndi ma lymph nodes.M'mbiri, TGCT yokhala ndi zilonda zam'mimba sizinayankhe bwino ku radiation ndi chemotherapy wamba, chifukwa chake yankho A ndilolakwika.3,4 Kuyesa kutsata mankhwala a chemotherapy kunasintha histology mu metastatic teratomas kwakhala ndi zotsatila zosiyanasiyana, kafukufuku wina akuwonetsa kuyankha kwabwino kosalekeza ndipo ena osayankha.5-7 Zindikirani, Alessia C. Donadio, MD, ndi anzake adawonetsa mayankho kwa odwala khansa omwe ali ndi subtype imodzi ya histological, pamene tidazindikira 3 subtypes: rhabdomyosarcoma, chondrosarcoma, ndi osandifferentiated spindle cell sarcoma.Maphunziro owonjezera akufunika kuti awone momwe chemotherapy imayankhira ku TGCT ndi somatic malignant histology pokhazikitsa metastasis, makamaka kwa odwala omwe ali ndi ma subtypes angapo a histological.Choncho yankho B ndilolakwika.
Kuti tifufuze momwe ma genomic ndi transcriptome amtundu wa khansara amachitira ndikuzindikira zomwe angachite kuti azichiza, tidachita kafukufuku wamtundu uliwonse wamtundu wamtundu wamtundu uliwonse (NGS) pazitsanzo zomwe zasonkhanitsidwa kuchokera kwa odwala omwe ali ndi aortic lumenal lymph node metastases, kuphatikiza ndi ma RNA.Kusanthula kwa Transcriptome ndi kutsatizana kwa RNA kunawonetsa kuti ERBB3 ndiye jini yokhayo yomwe idawonetsedwa mopambanitsa.Jini la ERBB3, lomwe lili pa chromosome 12, ma code HER3, cholandilira cha tyrosine kinase chomwe chimawonetsedwa mu nembanemba ya ma cell a epithelial.Kusintha kwa Somatic mu ERBB3 kwanenedwa m'matenda ena am'mimba ndi urothelial carcinomas.eyiti
Kuyesa kochokera ku NGS kumakhala ndi gulu lomwe mukufuna (xT panel 648) la majini 648 omwe nthawi zambiri amakhudzana ndi khansa yolimba komanso yamagazi.Gulu la xT 648 silinawonetse mitundu ya majeremusi a pathogenic.Komabe, mtundu wa KRAS missense (p.G12C) mu exon 2 udadziwika ngati kusintha kokhako komwe kumakhala ndi gawo losiyana la 59.7%.Jini la KRAS ndi m'modzi mwa mamembala atatu a banja la RAS oncogene omwe ali ndi udindo woyanjanitsa ma cell angapo okhudzana ndi kukula ndi kusiyanitsa kudzera pa siginecha ya GTPase.9
Ngakhale kusintha kwa KRAS G12C kumakhala kofala kwambiri mu khansa yosakhala yaying'ono ya m'mapapo (NSCLC) ndi khansa ya colorectal, kusintha kwa KRAS kwanenedwanso mu TGCTs ya ma codon osiyanasiyana.10,11 Mfundo yakuti KRAS G12C ndiyo yokhayo yomwe imapezeka m'gululi ikusonyeza kuti kusintha kumeneku kungakhale kulimbikitsa kusintha koyipa.Kuphatikiza apo, izi zimapereka njira yotheka yochizira ma TGCT osamva platinamu monga teratomas.Posachedwapa, sotorasib (Lumacras) idakhala inhibitor yoyamba ya KRAS G12C kuloza zotupa zosinthika za KRAS G12C.Mu 2021, a FDA adavomereza sotorasib kuti azichiza khansa ya m'mapapo yosakhala yaying'ono.Palibe umboni wotsimikizira kugwiritsa ntchito adjuvant translational histological targeted therapy kwa TGCT yokhala ndi somatic malignant component.Maphunziro owonjezera akufunika kuti awunike kuyankha kwa histology yomasulira kumankhwala omwe akuwunikiridwa.Chifukwa chake, yankho la C ndilolakwika.Komabe, ngati odwala akumananso ndi kubwereza kofanana kwa zigawo za thupi, chithandizo cha salvage ndi sotorasib chingaperekedwe ndi kuthekera kofufuza.
Pankhani ya zizindikiro za immunotherapy, zotupa za microsatellite khola (MSS) zinawonetsa kusintha kwa kusintha (TMB) kwa 3.7 m / MB (50th percentile).Popeza kuti TGCT ilibe TMB yapamwamba, n'zosadabwitsa kuti nkhaniyi ili mu 50 peresenti poyerekeza ndi zotupa zina.12 Poganizira za kuchepa kwa TMB ndi MSS za zotupa, mwayi woyambitsa kuyankha kwa chitetezo cha mthupi umachepa;zotupa mwina sangayankhe ku chitetezo chamthupi checkpoint inhibitor therapy.13, 14 Chifukwa chake, yankho E ndilolakwika.
Zolemba zotupa za seramu (STMs) ndizofunikira kwambiri pakuzindikira kwa TGCT;amapereka zidziwitso za siteji ndi stratification chiopsezo.Matenda opatsirana pogonana omwe amagwiritsidwa ntchito panopa pozindikira matenda ndi monga AFP, hCG, ndi LDH.Tsoka ilo, mphamvu ya zolembera zitatuzi ndizochepa m'magulu ena a TGCT, kuphatikiza teratoma ndi seminoma.15 Posachedwapa, ma microRNAs angapo (miRNAs) adanenedwa kuti akhoza kukhala ndi ma biomarkers amtundu wina wa TGCT.MiR-371a-3p yawonetsedwa kuti ili ndi kuthekera kowonjezereka kozindikira ma isoform angapo a TGCT okhala ndi chidwi komanso mayendedwe ake kuyambira 80% mpaka 90% m'mabuku ena.16 Ngakhale zotsatira izi ndi zabwino, miR-371a-3p nthawi zambiri sichikwera muzochitika za teratoma.Kafukufuku wambiri wa Klaus-Peter Dieckmann, MD, ndi anzake adawonetsa kuti mu gulu la amuna a 258, miP-371a-3p kufotokoza kunali kochepa kwambiri kwa odwala omwe ali ndi teratoma yoyera.17 Ngakhale miR-371a-3p sichita bwino mu teratomas yoyera, zinthu zakusintha koyipa pansi pamikhalidwe iyi zikuwonetsa kuti kufufuza ndi kotheka.Kusanthula kwa MiRNA kunachitika pa seramu yotengedwa kwa odwala isanachitike komanso pambuyo pa lymphadenectomy.Cholinga cha miR-371a-3p ndi miR-30b-5p jini yofotokozera idaphatikizidwa pakuwunika.Mawu a MiP-371a-3p adatsimikiziridwa ndi reverse transcript polymerase chain reaction.Zotsatira zinasonyeza kuti miP-371a-3p inapezeka pang'onopang'ono m'masampuli a seramu ya preoperative ndi postoperative, zomwe zimasonyeza kuti sizinagwiritsidwe ntchito ngati chotupa mwa wodwala uyu.Kuwerengera kwapakati pazitsanzo za preoperative kunali 36.56, ndipo miP-371a-3p sinapezeke mu zitsanzo za postoperative.
Wodwala sanalandire chithandizo chamankhwala.Odwala anasankha kuyang'anitsitsa mwachidwi ndi kujambula pachifuwa, mimba, ndi chiuno monga momwe analimbikitsira ndi STM.Choncho, yankho lolondola ndi D. Chaka chotsatira kuchotsa retroperitoneal mwanabele, panalibe zizindikiro za muyambirenso matenda.
Kuwulura: Wolemba alibe chidwi pazachuma kapena ubale wina ndi wopanga chilichonse chomwe chatchulidwa m'nkhaniyi kapena ndi aliyense wopereka chithandizo.
Corresponding author: Aditya Bagrodia, Associate Professor, MDA, Department of Urology UC San Diego Suite 1-200, 9400 Campus Point DriveLa Jolla, CA 92037Bagrodia@health.ucsd.edu
Ben DuConnell, BS1.2, Austin J. Leonard, BA3, John T. Ruffin, PhD1, Jia Liwei, MD, PhD4, ndi Aditya Bagrodia, MD1.31 Dipatimenti ya Urology, University of Texas Southwestern Medical Center, Dallas, TX