• shafi_banner

Labarai

A cikin wannan fitowar ta Matsalolin Clinical, Bendu Konneh, BS, da abokan aiki sun gabatar da shari'ar wani mutum mai shekaru 21 da tarihin watanni 4 na ci gaba da kumburi na dama na dama.
Wani mutum mai shekaru 21 ya koka da ci gaba da kumburin ƙwanƙolin dama na tsawon watanni 4.Duban dan tayi ya bayyana wani babban taro mai kauri a cikin ɗigon dama, wani zato na mummunan neoplasm.Ƙarin jarrabawa ya haɗa da ƙididdigar ƙididdiga, wanda ya nuna 2 cm retroperitoneal Lymph node, babu alamun ƙwayar kirji (Fig. 1).Alamun ciwon ƙwayar cutar jini sun nuna ƙananan matakan alpha-fetoprotein (AFP) da matakan al'ada na lactate dehydrogenase (LDH) da gonadotropin chorionic na mutum (hCG).
An yi wa majiyyacin tiyatar inguinal orchiectomy na gefen dama.Ƙididdigar ilimin cututtuka ta bayyana 1% teratomas tare da manyan abubuwan somatic malignant na rhabdomyosarcoma na tayi da chondrosarcoma.Ba a sami mamayewar lymphovascular ba.Alamomin ciwace-ciwacen ciwace da aka maimaita sun nuna matakan al'ada na AFP, LDH da hCG.Binciken CT na bin diddigin a cikin ɗan gajeren lokaci ya tabbatar da mafi rinjaye na 2-cm mai tsaka-tsakin ƙwayar ƙwayar ƙwayar cuta ba tare da wata shaidar metastases mai nisa ba.Wannan majiyyaci ya sami retroperitoneal lymphadenectomy, wanda ya kasance mai kyau a cikin 1 na 24 lymph nodes tare da extrenodal tsawo na irin wannan malignancy na somatic wanda ya ƙunshi rhabdomyosarcoma, chondrosarcoma, da sarcoma cell spindle cell.Immunohistochemistry ya nuna cewa ƙwayoyin tumor suna da kyau ga myogenin da desmin da korau ga SALL4 (Hoto 2).
Ciwon daji na kwayar cutar kwayar cuta (TGCTs) sune ke da alhakin mafi yawan kamuwa da cutar sankara a cikin samari masu girma.TGCT wani ƙaƙƙarfan ƙwayar cuta ce tare da nau'ikan nau'ikan tarihi masu yawa waɗanda zasu iya ba da bayanai don sarrafa asibiti.1 TGCT ya kasu kashi 2: seminoma da wadanda ba seminoma ba.Marasa lafiya sun haɗa da choriocarcinoma, carcinoma na tayin, ƙwayar gwaiduwa, da teratoma.
An raba teratomas na jini zuwa nau'i na postpubertal da prepubertal.Prepubertal teratomas ba su da ƙarfi a cikin ilimin halitta kuma ba su da alaƙa da kwayar cutar neoplasia a wurin (GCNIS), amma teratomas na baya suna da alaƙa da GCNIS kuma suna da muni.2 Bugu da kari, bayan balaga teratomas sukan yi metastasize zuwa wuraren extragonadal kamar retroperitoneal lymph nodes.Da wuya, teratomas na testicular testicular bayan balaga na iya haɓaka zuwa cututtukan somatic kuma yawanci ana bi da su tare da tiyata.
A cikin wannan rahoto, mun gabatar da halayen kwayoyin halitta na lokuta masu wuyar gaske na teratom tare da wani abu mai muni na somatic a cikin tes da lymph nodes.A tarihi, TGCT tare da cututtukan somatic sun ba da amsa mara kyau ga radiation da maganin chemotherapy na al'ada na platinum, don haka amsar A ba daidai ba ce.3,4 Ƙoƙarin da aka yi a chemotherapy da aka yi niyya ya canza ilimin tarihi a cikin teratomas na metastatic sun sami sakamako gauraye, tare da wasu nazarin da ke nuna ci gaba mai kyau amsa wasu kuma ba su nuna amsa ba.5-7 Na bayanin kula, Alessia C. Donadio, MD, da abokan aiki sun nuna martani a cikin marasa lafiya na ciwon daji tare da nau'in tarihin tarihi guda ɗaya, yayin da muka gano nau'ikan nau'ikan nau'ikan 3: rhabdomyosarcoma, chondrosarcoma, da sarcoma cell spindle cell ba da bambanci.Ana buƙatar ƙarin karatu don kimanta amsawar chemotherapy da aka ba da umarni a TGCT da cututtukan cututtukan somatic a cikin saitin metastasis, musamman a cikin marasa lafiya tare da nau'ikan nau'ikan histological da yawa.Saboda haka, amsar B ba daidai ba ce.
Don bincika yanayin yanayin halittar wannan cutar kansa da kuma gano maƙasudin hanyoyin warkewa, mun gudanar da bincike-bincike gabaɗayan nau'in ƙari na al'ada (NGS) akan samfuran da aka tattara daga marasa lafiya tare da ƙwayar ƙwayar ƙwayar ƙwayar cuta ta aortic, a hade tare da jerin RNA.Binciken kwafi ta hanyar jeri na RNA ya nuna cewa ERBB3 ita ce kawai kwayar halitta ta wuce gona da iri.Halin ERBB3, wanda ke kan chromosome 12, lambobi don HER3, mai karɓar tyrosine kinase wanda aka saba nunawa a cikin membrane na sel epithelial.An ba da rahoton maye gurbi na somatic a cikin ERBB3 a wasu carcinomas na ciki da na urothelial.takwas
Ƙididdigar tushen NGS ta ƙunshi maƙasudin manufa (xT panel 648) na kwayoyin halitta 648 waɗanda aka fi sani da cututtukan daji da na jini.Panel xT 648 bai bayyana bambance-bambancen ƙwayoyin ƙwayoyin cuta ba.Koyaya, bambance-bambancen kuskuren KRAS (p.G12C) a cikin exon 2 an gano shi azaman maye gurbin somatic kawai tare da bambance-bambancen rabo na 59.7%.Halin KRAS yana ɗaya daga cikin mambobi uku na RAS oncogene iyali da ke da alhakin daidaitawa da yawa hanyoyin salula masu alaƙa da girma da bambanta ta hanyar siginar GTPase.9
Kodayake maye gurbi na KRAS G12C ya fi zama ruwan dare a cikin ciwon huhu mara ƙananan ƙwayoyin cuta (NSCLC) da kuma ciwon daji na launi, an kuma bayar da rahoton maye gurbin KRAS a cikin TGCTs na codons daban-daban.10,11 Gaskiyar cewa KRAS G12C shine kawai maye gurbi da aka samu a cikin wannan rukunin yana nuna cewa wannan maye gurbi na iya zama abin da ke haifar da mummunan tsarin canji.Bugu da ƙari, wannan dalla-dalla yana ba da hanyar da za ta yiwu don maganin TGCTs masu jure wa platinum irin su teratomas.Kwanan nan, sotorasib (Lumacras) ya zama farkon mai hanawa KRAS G12C don kai hari ga ciwace-ciwacen mutant KRAS G12C.A cikin 2021, FDA ta amince da sotorasib don maganin kansar huhu mara ƙarami.Babu wata shaida da za ta goyi bayan amfani da adjuvant translational histological far for TGCT with a somatic malignant bangaren.Ana buƙatar ƙarin karatu don kimanta martanin tarihin fassarar fassarar zuwa maganin da aka yi niyya.Saboda haka, amsar C ba daidai ba ce.Duk da haka, idan marasa lafiya sun sami irin wannan sake dawowa na sassan jiki, ana iya ba da maganin ceto tare da sotorasib tare da yuwuwar bincike.
Dangane da alamomin rigakafi, ƙwayoyin microsatellite barga (MSS) sun nuna nauyin maye gurbi (TMB) na 3.7 m/MB (kashi 50).Ganin cewa TGCT ba shi da babban TMB, ba abin mamaki ba ne cewa wannan shari'ar tana cikin kashi 50th idan aka kwatanta da sauran ciwace-ciwacen daji.12 Idan aka ba da ƙarancin TMB da matsayi na MSS na ciwace-ciwacen daji, an rage yiwuwar haifar da amsawar rigakafi;ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwacen ciwace-ciwanci) na iya ba da amsa ga maganin hanawa na rigakafi.13,14 Saboda haka, amsar E ba daidai ba ce.
Alamar ciwon ƙwayar cuta (STMs) suna da mahimmanci ga ganewar asali na TGCT;suna ba da bayanai don tsarawa da ƙaddamar da haɗari.STM na yau da kullun da ake amfani da su don ganewar asibiti sun haɗa da AFP, hCG, da LDH.Abin takaici, ingancin waɗannan alamomi guda uku yana iyakance a wasu ƙananan nau'ikan TGCT, gami da teratoma da seminoma.15 Kwanan nan, microRNAs da yawa (miRNAs) an sanya su azaman masu alamar halitta don wasu ƙananan nau'ikan TGCT.An nuna MiR-371a-3p yana da ingantacciyar ikon gano ɓangarorin TGCT da yawa tare da azanci da ƙayyadaddun ƙimar da suka kama daga 80% zuwa 90% a wasu wallafe-wallafe.16 Ko da yake waɗannan sakamakon suna da ban sha'awa, miR-371a-3p ba yawanci ana ɗaukaka ba a cikin al'amuran teratoma.Wani bincike mai yawa da Klaus-Peter Dieckmann, MD, da abokan aiki suka yi ya nuna cewa a cikin rukuni na 258 maza, miP-371a-3p magana ya kasance mafi ƙasƙanci a cikin marasa lafiya tare da teratoma mai tsabta.17 Ko da yake miR-371a-3p ba ya aiki da kyau a cikin tsantsar teratomas, abubuwan da ke haifar da mummunan canji a ƙarƙashin waɗannan sharuɗɗan suna nuna cewa bincike yana yiwuwa.Anyi nazarin MiRNA akan maganin da aka ɗauka daga marasa lafiya kafin da kuma bayan lymphadenectomy.An haɗa maƙasudin miR-371a-3p da miR-30b-5p a cikin bincike.An ƙididdige maganganun MiP-371a-3p ta hanyar jujjuyawar sarkar polymerase.Sakamakon ya nuna cewa an sami miP-371a-3p a cikin ƙaramin adadin a cikin samfuran magani na farko da kuma bayan tiyata, yana nuna cewa ba a yi amfani da shi azaman alamar ƙari ba a cikin wannan majiyyaci.Ma'anar sake zagayowar samfuran riga-kafi shine 36.56, kuma ba a gano miP-371a-3p ba a samfuran bayan aiki.
Mai haƙuri bai karɓi maganin adjuvant ba.Marasa lafiya sun zaɓi sa ido mai aiki tare da hoton ƙirji, ciki, da ƙashin ƙugu kamar yadda aka ba da shawarar da STM.Saboda haka, amsar daidai ita ce D. Shekara guda bayan cire nodes na retroperitoneal lymph nodes, babu alamun sake dawowa da cutar.
Bayyanawa: Mawallafin bashi da sha'awar kuɗi na kayan aiki ko wata alaƙa tare da ƙera kowane samfurin da aka ambata a cikin wannan labarin ko tare da kowane mai bada sabis.
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, da Aditya Bagrodia, MD1.31 Sashen Urology, Jami'ar Texas Southwestern Medical Center, Dallas, TX


Lokacin aikawa: Satumba-23-2022