Amakuru

Muri iyi nimero y’ibibazo by’amavuriro, Bendu Konneh, BS, na bagenzi be berekana ikibazo cy’umusore w’imyaka 21 ufite amateka y’amezi 4 y’indwara ya testicular yateye imbere.
Umusore wimyaka 21 yinubiye kubyimba gahoro gahoro ya testicle iburyo amezi 4.Ultrasound yerekanye misa ikomeye itavanze muri testicle iburyo, ikekwa na neoplasme mbi.Ubundi bushakashatsi bwarimo tomografi yabazwe, yerekanaga cm 2 retroperitoneal lymph node, nta kimenyetso cyerekana metastase yo mu gatuza (Ishusho 1).Ibimenyetso by'ibibyimba bya serumu byerekanaga urugero rwinshi rwa alpha-fetoproteine ​​(AFP) hamwe n'urwego rusanzwe rwa lactate dehydrogenase (LDH) na chorionic gonadotropine ya muntu (hCG).
Umurwayi yabazwe iburyo bwa radical inguinal orchiectomy.Isuzumabumenyi rya pathologiya ryerekanye 1% teratoma hamwe na somatike ya kabiri ya somatike mbi yibice bigize rhabdomyosarcoma na chondrosarcoma.Nta gitero cya lymphovasculaire cyabonetse.Ibimenyetso byibibyimba inshuro nyinshi byerekanaga urwego rusanzwe rwa AFP, LDH na hCG.Gukurikirana CT scan mugihe gito byemeje ko byiganjemo cm 2 interluminal aortic lymph node nta kimenyetso cyerekana metastase ya kure.Uyu murwayi yabazwe na lymphadenectomy ya retroperitoneal, ikaba yari nziza muri 1 kuri 24 ya lymph node hamwe no kwaguka kwa extranodal kwandura indwara mbi ya somatike igizwe na rhabdomyosarcoma, chondrosarcoma, na sarcoma selile spindle itandukanye.Immunohistochemie yerekanaga ko selile yibibyimba yari nziza kuri myogenine na desmin ndetse na SALL4 (Ishusho 2).
Ibibyimba bya mikorobe ya Testicular (TGCTs) bifite uruhare runini mu kwandura kanseri ya testicular ku basore bakuze.TGCT ni ikibyimba gikomeye hamwe nubwoko butandukanye bwamateka ashobora gutanga amakuru yubuyobozi bwamavuriro.1 TGCT igabanyijemo ibyiciro 2: seminoma na non-seminoma.Nonseminoma harimo choriocarcinoma, kanseri y'inda, ikibyimba cy'umuhondo, na teratoma.
Testicular teratoma igabanijwe muburyo bwa postpubertal na preubertal.Prepubertal teratoma ntishobora kubamo ibinyabuzima kandi ntabwo ifitanye isano na selile mikorobe ya neoplasia ihagaze (GCNIS), ariko teratoma nyuma yo kubyara ifitanye isano na GCNIS kandi ni mbi.2 Byongeye kandi, teratoma ya postpubertal ikunda metastasize kurubuga rudasanzwe nka lymph node ya retroperitoneal.Ni gake, teratomasi ya testicular nyuma yo kubyara irashobora gukura mubi malariya mbi kandi mubisanzwe bavurwa no kubagwa.
Muri iyi raporo, turerekana molekulike iranga indwara zidasanzwe za teratoma hamwe na somatike mbi yibintu muri testes na lymph node.Mu mateka, TGCT ifite indwara mbi ya somatike yakiriye nabi imirasire hamwe na chimiotherapie isanzwe ya platine, bityo igisubizo A ntabwo aricyo.3,4 Kugerageza kuri chimiotherapie yibanda ku mateka yahinduwe muri teratomasi ya metastatike byagize ibisubizo bivanze, hamwe nubushakashatsi bumwe bwerekanye igisubizo gihamye kandi ibindi ntibigaragaza.5-7 Icyitonderwa, Alessia C. Donadio, MD, na bagenzi be bagaragaje ibisubizo ku barwayi ba kanseri bafite ubwoko bumwe bw’amateka, mu gihe twabonye ubwoko 3: rhabdomyosarcoma, chondrosarcoma, na sarcoma selile idasanzwe.Iyindi nyigisho irakenewe kugirango hamenyekane igisubizo cya chimiotherapie yerekejwe kuri TGCT na somatike malignant histology mugushiraho metastasis, cyane cyane kubarwayi bafite subtypes nyinshi zamateka.Kubwibyo, igisubizo B ntabwo aricyo.
Kugirango tumenye imiterere ya genomic na transcriptome yiyi kanseri no kumenya intego zishobora kuvurwa, twakoze isesengura ryibibyimba byose byanditswemo (NGS) kubigereranyo byakusanyirijwe mubarwayi bafite aortic lumenal lymph node metastase, hamwe na RNA ikurikirana.Isesengura ryakozwe na RNA ikurikirana ryerekanye ko ERBB3 ari yo yonyine gene ikabije.Gene ya ERBB3, iherereye kuri chromosome 12, kode ya HER3, reseptor ya tyrosine kinase isanzwe igaragara muri membrane ya selile epithelia.Guhinduka kwa somatike muri ERBB3 byagaragaye muri kanseri zimwe na zimwe na gastrointestinal na urothelial.umunani
Ubushakashatsi bushingiye kuri NGS bugizwe nintego (xT panel 648) ya genes 648 zikunze guhuzwa na kanseri ikomeye kandi yamaraso.Panel xT 648 ntiyagaragaje impinduka ziterwa na mikorobe.Nyamara, KRAS missense variant (p.G12C) muri exon 2 byagaragaye ko ari mutation yonyine ya somatike hamwe na allele umugabane wa 59.7%.Gene ya KRAS ni umwe mu bantu batatu bagize umuryango wa RAS oncogene ushinzwe guhuza inzira nyinshi za selile zijyanye no gukura no gutandukana binyuze mu kimenyetso cya GTPase.9
Nubwo ihinduka rya KRAS G12C rikunze kugaragara cyane muri kanseri y'ibihaha itari ntoya (NSCLC) na kanseri yibara, ihinduka rya KRAS ryanagaragaye muri TGCTs za code zitandukanye.10,11 Kuba KRAS G12C niyo mutation yonyine iboneka muri iri tsinda byerekana ko iyi ihinduka rishobora kuba imbaraga zitera inzira mbi yo guhindura ibintu.Mubyongeyeho, ibi bisobanuro bitanga inzira ishoboka yo kuvura TGCT irwanya platine nka teratoma.Vuba aha, sotorasib (Lumacras) ibaye inhibitor ya mbere ya KRAS G12C yibasiye ibibyimba bya KRAS G12C.Mu 2021, FDA yemeje sotorasib yo kuvura kanseri y'ibihaha itari ntoya.Nta kimenyetso na kimwe gishyigikira ikoreshwa rya terambere rya histologiya igamije kuvura TGCT hamwe na somatike mbi.Iyindi nyigisho irakenewe kugirango dusuzume igisubizo cyamateka yubuhinduzi yubuvuzi bugamije kuvura.Kubwibyo, igisubizo C ni kibi.Ariko, niba abarwayi bahuye nibisubiramo ibice byumubiri, kuvura salvage hamwe na sotorasib birashobora gutangwa hamwe nubushobozi bwo gukora ubushakashatsi.
Kubyerekeranye nibimenyetso byikingira, ibibyimba bya microsatellite bihamye (MSS) byerekanaga umutwaro wa mutation (TMB) wa 3,7 m / MB (50th centile).Urebye ko TGCT idafite TMB ndende, ntabwo bitangaje kuba uru rubanza ruri kuri 50% kwijana ugereranije nibindi bibyimba.12 Urebye uko TMB na MSS biri hasi yibibyimba, amahirwe yo gukurura ubudahangarwa bw'umubiri aragabanuka;ibibyimba ntibishobora gusubiza ubudahangarwa bw'umubiri.13,14 Kubwibyo, igisubizo E ntabwo aricyo.
Ibibyimba bya serumu (STMs) nibyingenzi mugupima TGCT;batanga amakuru yo gutondeka no gutondeka ibyago.Indwara zisanzwe zikoreshwa mugupima kwa muganga zirimo AFP, hCG, na LDH.Kubwamahirwe, efficacy yibi bimenyetso bitatu igarukira muburyo bumwe bwa TGCT, harimo teratoma na seminoma.15 Vuba aha, microRNA nyinshi (miRNAs) zashyizwe ahagaragara nkibishobora kuba biomarkers kubintu bimwe na bimwe bya TGCT.MiR-371a-3p yerekanwe ko ifite ubushobozi bwongerewe bwo kumenya isoforms nyinshi za TGCT zifite sensibilité hamwe nagaciro kihariye kuva kuri 80% kugeza 90% mubitabo bimwe.16 Nubwo ibisubizo bitanga icyizere, miR-371a-3p ntabwo isanzwe izamuka mubihe bisanzwe bya teratoma.Ubushakashatsi bwakozwe na Klaus-Peter Dieckmann, MD, na bagenzi be bwerekanye ko mu itsinda ry’abagabo 258, imvugo ya miP-371a-3p yari hasi cyane ku barwayi bafite teratoma yuzuye.17 Nubwo miR-371a-3p idakora neza muri teratoma yera, ibintu byo guhinduka nabi muri ibi bihe byerekana ko iperereza rishoboka.Isesengura rya MiRNA ryakozwe kuri serumu yakuwe ku barwayi mbere na nyuma ya lymphadenectomy.Intego ya miR-371a-3p na miR-30b-5p gene yerekanwe mubisesengura.Imvugo ya MiP-371a-3p yagereranijwe no guhinduranya inyandiko ya polymerase.Ibisubizo byerekanye ko miP-371a-3p yabonetse ku gipimo gito mu byitegererezo bya serumu mbere yo gutangira na nyuma yo kubagwa, byerekana ko itakoreshejwe nk'ikimenyetso cy'ibibyimba muri uyu murwayi.Ikigereranyo cyo kuzenguruka cy’icyitegererezo mbere yo gutangira cyari 36.56, kandi miP-371a-3p ntiyagaragaye mu byitegererezo nyuma yo kubagwa.
Umurwayi ntabwo yahawe imiti ivura.Abarwayi bahisemo kugenzura neza bakoresheje amashusho yigituza, inda, nigitereko nkuko babisabwe na STM.Kubwibyo, igisubizo cyukuri ni D. Umwaka umwe nyuma yo gukuraho lymph node ya retroperitoneal, nta kimenyetso cyerekana ko indwara yongeye kugaruka.
Kumenyekanisha: Umwanditsi nta nyungu zamafaranga afite cyangwa ubundi busabane nuwakoze ibicuruzwa byose bivugwa muriyi ngingo cyangwa nuwitanga serivisi.
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, na Aditya Bagrodia, MD1.31 Ishami rya Urology, Ishuri Rikuru ry’Ubuvuzi rya kaminuza ya Texas, Dallas, TX