Pathology

Pathology waa mid ka mid ah qaybaha hoos yimaada adeegyada shaybaadhka kaas oo ah go'aamiyaha ugu muhiimsan ee ogaanshaha, oo saadaaliya koorsada caafimaad ee suurtogalka ah taas oo samaynaysa aasaaska maamulka.
Shaybaarka shaybaarka bayoolajiga waxa la mariyaa hagaajinta nudaha oo ay ku xigto diyaarinta farsamooyin naga caawiya in aan ku lafaguro unugyada hoostooda mikroskoob. Unug si sax ah loo hagaajiyay oo loo habeeyey ayaa ogolaanaya kaydinta saxda ah ee nudaha iyo ka faa'iidaysiga nudaha baadhitaano dheeraad ah oo ay ku jiraan Immuno histochemistry iyo molecular studies. Noocyada ugu muhiimsan ee shaybaarka cudur-sidaha waxaa ka mid ah muunado waaweyn oo xubnaha oo dhan ah ama qaybo ka mid ah, kuwaas oo laga saaro inta lagu jiro qalliinka. Qaybaha nudaha halkii xubnaha oo dhan laga saari lahaa si ka-soo-baxyo ah sida jeexjeexyada goynta - unugyada waxaa lagu soo saaraa maqaarka maqaarka (tusaale goynta maqaarka ee bar laga shakiyo), bayobsi xudunta ah- irbad ayaa la geliyey tiro shaki leh si looga saaro xudunta unug waxaa lagu baari karaa mikroskoob hoostiisa (tusaale si loo baaro buro naasaha) iyo xitaa baaritaanka dhuuxa lafta ujeeddooyin lagu ogaanayo / ogaanshaha.  Si loo ogaado ogaanshaha degdega ah iyo heerka margin inta lagu jiro nidaamka qalliinka (qiimaynta qaliinka gudaha) waxaa la sameeyaa qayb barafaysan. Tani waxay u oggolaanaysaa dhakhtarka qalliinka inuu go'aan ka gaaro baaxadda qalliinka ee masraxa qalliinka laftiisa.

Immuno histochemistry waa farsamo shaybaar oo loo isticmaalo in lagu ogaado antigens (protein) gaar ah oo unugyo ah oo ku salaysan aqoonsiga antigen-antibody. Dhakhaatiirta cilminafsiyeedka waxay isticmaalaan IHC si ay u baaraan haddii buradu ay tahay mid aan fiicneyn ama aan fiicneyn, si loo go'aamiyo marxaladda iyo darajada, iyo si loo ogaado nooca unugyada iyo asalka metastasis si loo helo goobta burada asaasiga ah. Waxaan sameynaa Immuno histochemistry annagoo isticmaalna qalab si otomaatig ah u dhameystiran oo lagu baari karo, calaamado saadaaliya oo kala duwan iyo saadaaliya cudurada kansarka. Waxaan haynaa baalal loogu talagalay kansarka, sarcomas iyo lymphomas. Kooxda soo-dhoweynta hoormoonkayaga ayaa diyaar u ah sida calaamadaha Lymphoma Panel CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD15, CD20, CD21, CD23, CD30, CD43, CD56, CD68, CD79a, CD138, LCA, LMP, BCL2, BCL6, HOOYO-1, Oct-2, BOB -1, CYCLIND1, CD138, KAPPA, LAMBDA, c- Myc, ALK iyo guddi aan Lymphoma ahayn ALKD5F3, CD31, CD34, CD99, CK,CK(HMW), CK7, CK20, CK5/6, CK8/18, EMA, GATA-3, Glypican - 3, GCDFP-15, SMA, MSA, PSA, PSAP, PLAP, VIMENTIN, DESMIN, HMB45, HER2NEU, CA125, CALDESMON, ,INHIBIN ALPHA,CALRETININ, BEREP4, TTF, GCDFP15, CKIT, CEA(Monoclonal), CEA (polyclonal), SYNAPTOPHYSIN, CHROMCIN, CALDESMON THYROGLOBULIN, MART100,MYOD1,CK1,CDX19,BETACATENIN,CD2a,AMACAR,ANNEXIN,ARGI NASE,CD1,HHV56,IgG8,IgG, EMA,PAX-4,PD-8,RCC,S1,SAT-B100,SOX , SOX-2, GFAP, IDH-10, ATRX, NF, OLIG-11, P1, P2, KI53, EBER -ISH, MLH- 63, MSH-67, PMS-1, MSH-2, BRAF, D2, CKIT, DOG-6, E-cadherin, GRANZYME- B, HEP-240, IgG, IgG1, INI-1, RCC, SALL4, STAT-1,WT-4, FLI. Waxa kale oo aanu samaynaa qaybo badan oo neuro-oncology immunohistochemistry panels oo loogu talagalay burooyinka habdhiska dhexe ee neerfayaasha. Intaa waxa dheer, shaybaadhkayagu waxa kale oo uu isticmaalaa imtixaanada sida isku-dhafka goobta ee Fayraska Epstein-Barr, Microsatellite Insability Panel, Tijaabada BRAF, PD-L6 (SP1 iyo SP1) kuwaas oo door muhiim ah ka ciyaara shakhsiyeynta maareynta bukaanka iyada oo loo marayo daaweynta tallaalka ee la beegsanayo.

Caadi ahaan iyo ultrasound waxay hagayaan hababka hamiga irbadda wanaagsan: Dheecaan iyo qaybo yaryar oo unugyo ah (unugyo gaar ah halkii ay ka ahaan lahaayeen kooxo unugyo ah, tusaale ahaan dareere ka yimaada sambabada agagaarka) ayaa la heli karaa hamiga irbad fiican. Tan waxa lagu sameeyaa iyada oo la isticmaalayo irbad ka khafiifsan tii lagu isticmaalay biopsy xudunta u ah, laakiin leh farsamo la mid ah. Qalabka noocan oo kale ah ayaa badanaa dareere ah halkii uu ka ahaan lahaa mid adag, waxaana loo gudbiyaa cytology halkii uu ka ahaan lahaa histology. Cytology waxay ku lug leedahay diyaarinta boggaga iyo ka warbixinta haweenka (Pap smears) iyo shaybaarada aan dumarka ahayn (dareeraha jidhka iyo dareeraha maskaxda). Waxaan samaynaa Cytology ku salaysan dareere anagoo adeegsanayna nidaam nus iswada si aan u abuurno faafitaan isku mid ah oo unugyada epithelial taasoo awood noo siinaya inaan bixino natiijooyin aad loogu qanco. Waxaan sidoo kale u isticmaalnaa blocks-ka unug ahaan si joogta ah oo ku xiran smears cytological ee caadiga ah ee loo sameeyay baaritaanka dareeraha. Unugyadaan blocks ayaa markaa si dheeraad ah loogu isticmaali karaa immunohistochemistry iyo daraasaadka molecular.

Waax diiradda saarta dhiigga iyo kansarka dhiigga la xiriira oo qiyaastii 10% ka ah dhammaan kansarrada. Waxay ka timaadaa dhuuxa lafta oo ah isha ugu weyn ee wax soo saarka dhiigga waxayna saamaysaa wax soo saarka iyo shaqada unugyada dhiigga. Dhiiggu wuxuu ka kooban yahay saddex nooc oo unugyo ah: Unugyada dhiigga cas, Unugyada dhiigga ee cad iyo Platelets. Haddii uu kansarku jiro, habka wax-soo-saarka dhiigga waa la gooyaa sababtoo ah koritaanka nooc aan caadi ahayn oo unugyada dhiigga ah. Noocyada kala duwan waxaa ka mid ah:  Leukemia: Tani waxaa sababa soo saarista degdega ah ee unugyada dhiigga aan caadiga ahayn ee dhuuxa lafta kuwaas oo saameeya awoodda dhuuxa lafta si ay u soo saaraan unugyada dhiigga cas iyo platelets.  Lymphoma: Kani waa nooc ka mid ah kansarka dhiigga oo saameeya hab-dhiska lymphatic kaas oo ka masuul ah soo saarista lymphocytes (nooc ka mid ah unugyada dhiigga cad ee la dagaallama caabuqa) iyo ka saarista dareeraha xad-dhaafka ah ee jirka. Koritaanka aan la koontarooli karin ee lymphocytes-kan aan caadiga ahayn waxay sababtaa lymfoma oo ku faafta qanjidhada iyo unugyada kale.  Myeloma: Waa nooca kansarka dhiigga ee saameeya unugyada plasma (unugyada dhiigga cad ee ka mas'uulka ah soo saarista unugyada difaaca jirrooyinka ee jirka), taasoo keenta habdhiska difaaca oo daciifa.

Haemato Oncology waxa ay ku qalabaysan tahay mishiinka socodka Cytometry ee casriga ah kaas oo ka eegaya walxaha qaarkood (calaamadaha/antibodies) gudaha ama unugyada kuwaas oo ka caawiya in la aqoonsado noocyada unugyada ay yihiin. Baaritaankaan waxaa loo isticmaali karaa in lagu arko haddii lymphocytes ee muunada dhiigga ay ku jiraan unugyo CLL ah. Sidoo kale qulqulka Cytometry waxa loo isticmaali karaa in lagu ogaado unugyo cad oo aan caadi ahayn oo loo yaqaan qaraxyada mid ka mid ah dhuuxa lafta ama dhiigga ku wareegsan. Qaraxyadan marka lagu helo tiro badan oo ku jira dhiigga durugsan ama dhuuxa lafta waxaa loo yaqaannaa leukemia ba'an. Cytometry Flow waxay sidoo kale awood u yeelataa aqoonsiga noocyada kala duwan ee leukemia. Daaweynta ka dib, qulqulka Cytometry ayaa loo isticmaali karaa si loo qiimeeyo in qaraxyadu wali jiraan ama gabi ahaanba lagu baabi'iyay kiimoterabi. Tan waxa loo yaqaan ogaanshaha cudurka haraaga ugu yar ama MRD. Cytometry Flow waxay ku ogaan kartaa Lymphoma Classical Hodgkin Lymph Nodes oo leh dareen sare iyo gaar ahaaneed oo ay la socoto lymphomas kale oo aan Hodgkin ahayn halkaas oo baaritaanka baaritaanka lagu sameyn karo si loo go'aamiyo in lymphoma uu jiro iyo in kale. Cytometry Flow waxaa loo isticmaalaa soo saarida Immuno phenotyping ee noocyo kala duwan oo muunado ah, oo ay ku jiraan dhiiga oo dhan, dhuuxa lafta, dareeraha daloolka serous, dareeraha maskaxda, kaadida, iyo unugyo adag. Qulqulka Cytometry, muunadda unugyada laga soo qaaday biopsy, shaybaarka cytology, ama tijaabada dhiigga ayaa lagu daweeyaa unugyada difaaca gaarka ah. Unug kastaa waxa uu ku dheggan yahay oo keliya noocyo unugyo ah oo leh antigens-ka ku habboon. Caadi ahaan, waxa kaliya ee ay qaadanayso si loo aqoonsado nooc gaar ah oo unug ah waa in la abuuro antibody monoclonal si loo aqoonsado unuggaas. Kadibna dheeha fluorescent ayaa ku xiran antibody-ka, socodka Cytometry wuxuu heli karaa dhammaan unugyada difaaca jirka ka hortaga. Unugyada ayaa markaa la hor mariya laydhka laysarka si ay u soo saaraan xogo faa'iido leh oo cytometrist xirfad leh u fasiro. Calaamadaha Leukemia-ka Ba'an- B-Lymphoid Calaamadaha & Baadhista Myeloid Leukemia Panel B-Lymphoid Calaamadaha waxaa ku jira CD10, CD19, CD20, CD22, Nuclear TDT T- Lymphoid iyo NK Markers CD1a, CD 2, CD3, CD4, CD5, CD7, CD8, CD56 Calaamadaha Myeloid CD13, CD15, CD16, CD33, CD117 Monocytic Markers CD4, CD11b, CD14, CD64 Cytoplasmic Markers - MPO, CD79a iyo CD3 Calaamadaha Aan-Lineage-ka ahayn CD34, HLADR, CD45, Myeloma Panel Cyto Kappa, cyto Lambda, CD56, CD10, CD38, CD138 & CD19, Kooxda Chronic B Lymph Proliferative Disorder Panel Kappa, Lambda, CD28, CD20, CD45c, CD38, CD10, CD11, CD19, CD5, CD20, IgM, CD103, CD180, CD200, CD43, CD21, CD3, CD16, CD56, TCR g/d , FMC7, CD8 & CD4, CD7+ unugga stem tirinta CD23, Kontoroolka Iso clonic, dheeha jiri kara, kuul tirinta jirida.