BENH VIEN DA Lliu TP.HO CHI MINH (1986 - 2005) TRUONG HOP UNG THU DA Dliu TR! TAI DAC DII^M DAI THi VA VI THi CUA 317

DAC DII^M DAI T H i VA VI THi CUA 317 TRUONG HOP UNG THU DA D l i u TR! TAI BENH VIEN DA L l i u TP.HO CHI MINH (1986 - 2005)

Ha Van Phiro^c*, Pham \ an Biic*

T d M TAT

Mcf dau: Ung tht/da Id mdt trong nhtJmg ung thi/thi/dng gdp. VI&tNam Id quocgia dvOng nht$tif<^ cho n^n ung thi/da cung rat hay gdp. Khdo sdtddc diem dgi thSvd vl th^a^a cdc logi ung thi/da th'i/dng gdp hy vgng gdp phdn giOp cdc bdcslldm sdng c6 hUdng dinh b&nh sdm dexOtriklp thdi cdclogi ung thi/da dc t!nh,

Ooi tUtfng va phUcmg phap nghien cijfu: Ddy Id mdt nghi^n ciiu cdt ngang md td, h6i oAi, SCfdung du liSu thCtcdp Id cdc b&nh 6n cOa binh nhdn ung thi/da dieu tri tgi Binh viin Da liiu TR HCM td 1986-2005.

Ketqud:Oa sold Carcinome tebdo ddy (215/317) keden Id Carcinoma tebdo gai (85/317).

- Carcinome tebdo ddy da sold d vOng ddu mdt c6, trong khi Carcinome tebdo gai da so d tdchi.

• Cardnome tebdo ddy thl Idm sdng bifdu lo^tld chiem da sovd type md hoc dang dgc (type sdide) Id chOyeu - Carcinome tebdo gai thl hinh dnh Idm sdng lo^t sui Id chiem da so

Khdng c6 trWdng hop ndo Carcinome te bdo ddy difpc ghi nhdn Id di cdn trong khi d6 c6 khodng 6%

tn/drng hap Carcinome tebdo gai di cdn hgch.

Tu* khoa: Una thuda, Carcinome tebdo ddy, Carcinome tebdo gai

I. MUC TIEU NGHIEN CCTU - Phiiang phap tien hanh: hoi CLTU tat cacac benh Khao sat dac diem dai t h e va vl the cua ung t h i l an c6 chan doan la ung thu-da lUu tai Benh vien Da da dieu tri tai Benh vien Da L i l u TR Ho Chi Minh. li^u trong khoang thcfi gian t(i 1986 den 2005.

I I . O O I TircJNG VA PHU-CTNG P H A P NGHIEN CtfU + ^^' ^h' ^° "^^^ '^ ^^°^^ ^^" ^^°'' 9'^' ^'"^

2 . 1 . O o i tUtfng nghien cih. + ^ ^ ^ ^^' '° "^ ^^^ "^'^"^ '^"^ ^ ^ " 9 ^^ ^'""^ ^"^^

Tat ca hoscf benh nhan bi ung thu'da den kham tai Benh vien Da lieu tir nam 1986 - 2005.

n o hoc theotL/ng loai ung thu'da.

2.3. XCrliva phan tich so lieu

2.2. Phiftfng phap tie'n hanh = ° ' ' ^ " <'^'?' " * " " = P'"^" "'^'^ ' ' * " 9 P'^^" "^^"^

Epi-info 2002.

- Thiet ke nghien CLfu: mo ta cat ngang, hoi ciiu.

*Benh vien Da Lieu TP. Ho Chi Minh

III.KETQUA

3 . 1 , Oac diem m l u nghien cuiu

So 07 (Thang 07/2012)

DA Lieu HOC I 5

NGHliN cCrU KHOA HpC i k - ^ - ^ " •

Bing I. Phin b6theotu6l

^ ^ ^ Tuoi

EBC ESC M - M

Carcinome phan phu L y m p h o m e d a K t h i r p h a t Cong

0 - 1 0

1

1

2 1 1 - 2 0

1

1 2 1 - 3 0

3

1

4 3 1 - 4 0

16 7

2

25 4 1 - 5 0

35 12

1 1 49

5 1 - 6 0

54 30 1

5 1 91

6 1 - 7 0

48 20

1

69

> 7 0

58 15 1

1 1 76

Cong

215

85

1 10 3

317

Bing 2. Phin bStheo gl6l

~ ~——___^^^ Gi*i

Loai — ^ ^ EBC

ESC M - M

Carcinome phan phu L y m p h o m e d a KthCrphat Cong

Nam

90 53 2

5 1 151

NCr

125 32 1 1 5 2 166

Tong cong

215 85 3 1 10 3 317

Bang 3. Phdn botheo vj tri

""-^^^^ V i t r i Loai ^"~-^-^^^

EBC ESC M - M

Carcinome phan phu Lymphome da KthCrphat Tong cong

Oau mat c6 189

3

192

Than 19 17

8 3 47

Chi tren 5 15

1

21

Chidudi 2 42 3 1 1

49

Niem mac

8

8

Tong cong

215

85 3 1 10 3

317

6 I DA LIEU HOC So 07 (Thang 07/2012)

^ 4 " T " ^ NGHIEN CUU KHOA HQ

3.2. Dac diem dai tlie va vi t h e cua Carcinome t e bao day (EBC)

Bdng 4. Ode diem dgl the ci)a EBC Bdng 5. PhAn log! md hoc cOa EBC

Dang

So ca T i l e %

Biidu loet 194 90.23%

Hong ban

10 4.65%

Sui

6 2.79%

S i c to don thuan

5 2.32%

Tong cong 215 100%

Lofi mo hoc So ca T l l e %

Dang dac 173 80.46%

Dang tuyen 27 12.55%

Dang sirng 5 2.32%

Dang nong 10 4.65%

Tong cong 215 100%

Bing 6. Phdn bo type mo hoc cua EBC theo vj trfcothe

~ ~ ~ - - - - , _ ^ ^ V i t r i Type mo hoc~~~~---,..^

Type dac Type tuyen Type SL/ng Type nong Tat ca cac type

Oau mat c6 169 20

189

Than

7 4 8 19

Chi tren 3

2 5

Chidudi 1

1

2

Tong cong 173 27

5 10 215

Bang 7. Lien quan lam sang vdi gidiphdu benh cua EBC

~~~""""~—-..^Loai mo hoc Dang lam sang"""""^^-^-...,^

Hong ban B\J6U loet Sac to dan thuan Sui

Tong cong

Dang nong 10

10

Dang dac

165 5 3 173

Dang sCrng

3

2 5

Dang tuyen

26

1 27

Tong cong 10 194

5 6 215

3.3. Dac drem dai tlie va vi the cua Carcinome te bao gai (ESC)

Bang 8. Dang dgi the cOa ESC Bang 9. Do biet hda cua ESC

Dang So ca T l l e %

Loet sui 48 56.47%

Sui 10 11.76%

Carcinome Verruqueux 27 31.76%

Tong cong 85 100%

D o mo hoc So ca T i l e %

D 6 I 73 85.88%

D o l l 10 11.76%

D o III 2 2.35%

B o IV 0 0%

Tong cong 85 100%

So 07 (Thang 07/2012) D A L I E U H O C 7

NQHIEN cCrU KHOA HQC | k - ^ " ^ " ^

chuy.

06 I: hon 75% te bJo gai bi4t h6a Bo II: hon 50% te bao gai bi4t h6a 06 III: hon 25% te biio gai biet h6a 06 IV: it hon 25% te bJo gai bi^t h6a

3.4. Nh6m CARCINOMC VERRUQUEUX (dgng Sic bitt da ESC) Bing 10. Phdn bitheo tuSi

Tuoi Nam NL/

Tong cong

4 1 - 5 0 2 3 5

5 1 - 6 0 2 5 7

6 1 - 7 0 10

10

7 1 - 6 0 5

5

TJng c6ng 19

8 27

Bing IhPhinbithto the binh theo Ridley Jopling Bing 12. Phdn b6thto vl tri bitiu trtn gm bin <Mfi

The Soca carcinome So ca di can

TT BT 8

BB 12

BL 6 2

LL 1 1

V i t r i 1/3 sau 1 /3 trade Tong cong

Phii 7 5 12

Trai 10 5 15

Tong cong j 17 10 27 3.5. N/idm LYMPHOME da

Tuoi So ca

<10 1

1 1 - 2 0

Bing 13. Phin botheo tuoi

21 - 3 0 31 - 4 0 2

41 - S O 1

51 - 6 0 5

6 1 - 7 0

_.

>70 1 Bang 14. Phan botheo gicfi Sdng 15. Phdn botheo chan doan lAm sang d6u titn

Nam 5

NQ

5 I - Chan doan

Hansen the nhieu khuan Lao da

Benh huyet bi Mycosis f o n g o i d e Bang 16. Phdn botheo vj tri

Bing 17. Cdc dau hfiu todn thdn V i tri

Toan than Chi tren Chi du-cfi

Soca 8 1 1

Dau hieu Sut can NgLfa v e d e m Nong sot

S o c a 6 4 2

8 I DA Lieu HOC s6

07 (Thang 07/2012)

^ • 4 - • - > NGHIEN COU KHOA HO

Bing 18. Die di^m md hoc Bing 19. Kit qui hia mi mlin dich Dac d i e m

Thuang bl Teo vCj'a Tec nhe Day sang unna Dong te bao Lymphocyte Mo bao D o a c t i n h Cao Trung binh

S£fca

9 1 10

1

7 3

Ketqui

LCAdUOngtinh Tcell

Bcell

Mo bao

Soca 10 7 2 1 Bing 20. Cdcket qui cdn Idm sdng

K e t q u i AFB (-)

CTM ngoai bien binh t h a d n g Ph^n Ling sinh hda mau binh t h u d n g

So ca 10 10 10

3.6. NhimKthiiphit

Carcinome phan phu

Loai mo hoc: Malignant Ecerine porama

KdathiJrphat TrUcJng hcrp 1: Adeno - c a r c i n o m tuyen da day Trifcrng hdp 2: Carcinom tuyen vu TrLfdng hap 3: Carcinom tuyen vu

Bang 21. Phdn botheo di cdn

EBC ESC

Meianome a c t i n h

Di can 0 5 1

Khdng di can 215

80 2 Bang 22. Cdc ton thUcfng tien ung tht/di kem

TonthUOng So ca

Keratose senile 6

Keratose Arseninal

4

Seo Lupus do

3

Xeroderma Pigmentosum

3

Bach tang 1 IV. BAN LUAN

Qua ket qua neu tren, chung toi c6 nhCTng nhan xet sau:

<* V e t u o i t a c

- Oa so benh nhan Icfn tuoi, ngifcri nho tuoi nhat la 7 t u o i va Idn t u o i nhat la 82 tuoi.

- Carcinome te bao day CO so tuoi t r u n g binh la 53.85 nho ban t u o i t r u n g binh cua Carcinome t e bao

S6 07 (Thang 07/2012) D A L l E U H Q C l 9

NGHIEN CUU KHOA HQC

gai Id 62.33. D i ^ u nay phu hap v6i Y v3n t h e gidi Id Carcinome k h 6 n g c6 meianome t h u d n g x5y ra 6 ngudi g\k vdi dlnh cao Id 60 (16), t r o n g d 6 d l n h cao cCia carcinome t e b^o d i y Id 50 vd d l n h cao cCia carcinome te bao gai Id 60 (4)

Theo UICC (Union Internationale Centre le Cancer) t h i udc luang khoang 50% nhCrng ngudi tren 65 t u o i se b\ ung t h u da (17). N6i chung t u 6 i t h u d n g gap la 5 0 - 7 0 ( 1 5 )

•:* Vegiditinh

Nhin chung t l le nam nQ t r o n g ung t h U da gan bSng nhau. ft c6 chenh lech: 151 nam:166 nu' (1:1.099)

- Theo so lieu cua khoa Ung bucfu Benh vien Binh Dan thUchientCr 1 9 5 6 - 1970 thi t l le nam nCf la 1:1

- Theo so lieu t h o n g ke ciia Uc Dai Lai (18) t h i t l le nam nCf la 1.5:1

Theo UICC thl t i le nam nCf la 2:1

Theo Fitz Patnck (5) thi gidi nam van chiem nhieu hon nif Nhung doi vdi Viet Nam thi gidi n(i cung sinh boat va lao dong ngoai trdi nhieu nhU nam gidi, do d o t i le nam nCfgan n h u ngang nhau.

Tl le ngudi bi Carcinome te bao day t h u d n g nhieu hon la ngUdi b; Carcinome te bao gai. Tf le cua chung tot la EBCiESC - 2.52:1 cung gan giong vdi Y van t i l e la EBC:ESC 13 3:1 (8)

- Theo UICC thi 80% la Carcinome t e bao day va 20% la Carcinome te bao gai

• Ve v i tri:

Carcinome te bao day chu yeu d v u n g dau mat CO vdi 189/215 (87.90%) t r u d n g h g p . k e do la than, it thay chi tren va chi dudi, khong c6 d niem mac mieng,

Sosanh vdiso lieu t h o n g k e d U c t r e n 3795 benh nhan bj EBC d bang Victoria nam 1991 nhUsau:

Vjtrf

So tri/irng hop

Dau m&t

CO

2248

Than

977

Chi tren

227 Chi dlfori

343

S6 li$u tren cijng cho t h a y v u n g dau mdt co van Id vj tr( nhieu nhiit ke den la t h a n .

Garham vd Mac - Gaven (16) da cho thay mot sif lien h§ trUc tiep cua tuyen ba 6 noi da bi phai nAng vd tan suat cua EBC, c6 le vi t h e ma Carcinome te bdo ddy t h u d n g hien dien d mat vl nai day c6 nhieu tuyen ba.

Williamson vd cong sU da dang tren Y van mot v d i t r u d n g hap EBC d niem mac m i e n g , nhungthi/c chat Id u nguyen bao tao nen (Ameloblastome).

N h U v d y thi chUa ghi nhan t r u d n g hap nao EBC 6 niem mac mieng tren Y van t h e gidi.

Carcinome t e bao gat thi vj t r i nhieu nhat dctii dudi 42/85 (49.41%), t r u d n g hcrp ke den Id than vS chi tren va c6 8 t r u d n g h a p d niem mac mieng.

Theo Bean vd cong SU (1) t h i d vj t r i ban tay tan suat cua ESC t h u d n g cao gap 3 Ian EBC va EBC thi hiem xay ra d ban tay va ban chan (7).

Lymphome da t h i da so d t h a n , chf c6 2 trudng h g p k h u t r u d c h i t r e n v a c h i d u d i , t h e o Y v a n t h i d a so L y m p h o m e d a rSi rac t o a n t h a n .

<* Dac diem vi t h e cua EBC

Ve mat mo hoc thi Carcinome t e bao day chia t h a n h 2 n h o m la biet hda va khong biet boa.

Dang k h o n g biet boa t h u d n g gap nhat la dang dac (type solide), day la loai vi t h e t h u d n g gap nhat va chiem da so t r o n g cac dang vi t h e cua EBC theo so lieu cua chung t o i dang dac chiem 80.46%,cung phu h g p v d i Y v a n la 7 0 % (6), ke den la dang nong chiem 1 0 % - 15%.

1 0 I D A L I E U H O C S6 07 (Thang 07/2012)

NGHIEN cOU KHOA HOC

Dang biet hoa hUdng ve nang long thl goi Id t y p e Keratoide, neu hUdng ve tuyen mo hoi thl Id t y p e Adenoide, cdn hUdng ve tuyen ba thl goi la type Cystique.

Cac dang biet hda thi It gap t f o n g cdc dang vi t h e cua EBC t r o n g d d d a n g sCrng thl c o t h e h i n h thanh cac cau sCfng (globe corne) va can dugc phan biet cac cau sii'ng cCia ESC.

Bang tUOng quan lam s a n g - g i c i i phau benh cOa EBC theo Y van

~^~"""""""---___^ Loai mo hoc Dang lam sang ^^"""~~"^—--__^

Budu loet Nong Sac t o dan thuan

Dac

(+++)

(+)

SCfng

(+)

Nang

{+) (+)

Tuyen

(+) (+)

Nong

'> Dac diem dai t h e cua ESC

Dang loet sui thl chiem da so (56.47%) ke den la dang n h o m Carcinome Verruqueux (31.76%)

Carcinome Verruqueux hay con goi la Epithelioma cuniculatum la mot dang lam sang dac biet cua Carcinome t e bao gai vdi do ac t i n h thap, CO tien lugng t o t han.

Carcinome Verruqueux da duac mo ta dau tien vao nam 1941 va sau do mot vai nam cung de cap den cac t o n t h u a n g ac t i n h hien dien tren nen lo dao cua benh Hansen.

Chungtoi ghi nhan nhom Carcinome Verruqueux t h u d n g Idn t u o i (>50 tuoi) vdi 13 nam va 14 nuT.

Dieu nay k h a c v d i y van la 8 0 % - 90% la nam (5).

£)a so benh nhan thupc t h e phong BT va BB vi nhom nay t h u d n g c6 than kinh nang nhat,

Vitrf t h u a n g t o n la d ban chanvi n d c o lien quan den benh ll than kinh dan den loet dinh dudng.

Chung toi ghi nhan la c6 15 trUdng hgp la ben trai va 7 t r u d n g hgp la ben phai.

Ngoai yeu to bdc xa mat trdi do phai nang c6 t h e CO yeu to Id hoa chat n h u t h u d c trLfsau ciing vdi sUviem loet dinh dUdng kinh nien ma dan den thoai hda a c t i n h .

Trong 3 trUdng hap di can hach thi c6 2 trUdng hgp Id the BL va 1 t r u d n g hgp Id LL C^c trUdng hgp nay deu t U vong, c6 le la do mien djch t r u n g gian t e bao khong con nCfa dan den di can hach va t d vong.

*> Nhom Lymphome da nguyen phat Day la nhom benh actinh cua he Lympho bao CO nguon g o c t e b a o T . t e b a o h o a Bva mo bao. Da lavj t r i ngoai hach t h u d n g gap dUng hang thu'2 sau he t h o n g tieu hda vdi ti lela 0.5 - 1/100.00(13).

TUOI t h u d n g gap la 41 - 60, c6 mot trUdng hgp la 7 tuoi, t i le nam nufnhu nhau, dieu nay cung phu hgp vdi y van (20).

Lymphomeda nguyen phat t h u d n g c6 hinh anh lam sang rat da dang: not, mang hong ban, loet, bong nude, hoai t d l a m cho hUdng chan doan lam sang kho khan. Oieu nay noi len c6 3 trUdng hgp duac chan doan lam vdi Hansen t h e nhieu khuan, 2 trudng hgp la lao da va 5 trUdng hgp dugc n g h l den benh Lymphome da.

Ooi vdi cac trudng hgp chan doan lam vdi Hansen t h e nhieu khuan vi sang t h u a n g noi toan than CO khuynh hudng doi xdng rat giong vdi hinh anh lam sang cua Hansen t h e BL va LL. Do do

S6 07 (Thang 07/2012) D A L l g U H Q C l 1 1

NGHIEN CUtJ KHOA HQC

neu ket hop Id Fb t h f c h u n g ta c6 t h e loai trii dugc Hansen t r o n g trUdng hgp Fb (-). Vl da so hinh inh mo hoc cua Lymphome da nguyen p h M g^n g l 6 n g vdi Hansen t h ^ B L v d L L

• D6u hliu todn thdn: ga\ ^ nhieu nhSt Id t r i ^ u c h d n g ngOfa ve dem (4 t r u d n g hgp), t r i ^ u c h d n g t h u d n g gap Id d n h d m Lymphome d o n g T, ddc biftt Id Mycosis Fongoide t h u d n g ngda c6 r3t sdm c6 khi trudc luc phat ban ngoai da vd keo dai t r o n g tien t r i n h benh (21). NhU vdy, neu t r u d n g h g p c6 sang t h u a n g g i o n g Hansen t h e nhieu khuan cd ngda ve dem thl ta nghJ nhieu den Lymphome da.

• Cdc d d u h / f u c d n / d m sdng: ndi chung k h o n g CO gi thay ddi mac du nd lien quan den he t h o n g tao mau (dong Lympho) n h u n g t^t Cci cdc xet nghiem mau ngoai bien lai binh thUdng khdng thay cdc d o n g te bao bat t h u d n g , chf khi nao benh Ian tran khdp nai, t e bao b u d u an vao m d t u y , t r a n vao mach mau tao nen hinh i n h giong nhU benh bach cau (Leucemie) khi d d khdng t h e phan biet giUa 2 loai benh (16).

Dong te bdo: khi chUa c6 kT thuat hda m d mien djch t h i ngudi ta phan chia ra 3 d o n g t e bdo:

lymphocyte, lympboblaste vd m d bao Thudng do ac t i n h cua Lympboblaste va mo bao cao ban so vdi Lymphocyte

N h d CO hda mo mien djcb ngudi ta phan chia theo d o n g B, dong T va m d bao Ngoai ra cdn c6 loai t h d 4 khong xac dinh dugc loai te bao g o m nhUng bUdu khdng t h e xep vao 3 loai tren bang bat ki tieu chuan nao, dugc ggi la d o n g te bao U (khong xac dinh).

S u p h a n biet giUa d o n g B v a T c u n g c6 loi ve mat lam sang bdi vi tien lugng giUa 2 benh nay cung khac nhau Noi chung, t h o n g t h u d n g cac te bao d o n g T c6 khuynh hUdng xam Ian nhieu ban d o n g

B vd b i ^ u h i ^ n lam sdng c h o t h a y d o n g T thudng Ian tda d da t r o n g khi d d n g B t h u d n g xuat hien khu trCi vdi m d t sang t h u o n g .

C6 2 t r u d n g h g p Id t e bdo B, dieu nay cung phij h g p v d l Y v d n (21) Id L y m p h o m e d a t e b d o Bchiem 2 5 % t r o n g t^t ci cdc L y m p h o m e da, nhUng ddayco 2 trUdng h g p b i ^ u h i ^ n lam sang cd so lugng sang t h u a n g nhieu khac vdi Y van de cap, cd the day Is loai Intravascular cutaneous B Cell Lymphoma, c k te bao b u d u xam nhap vao mach m a u roi sau do Ian ra v u n g ke can tao ra nhieu 6 xam Ian.

7 t r u d n g h a p la L y m p h o m e t e b a o T , t^t cdcic trUdng h g p nay k h d n g t l m duac t e bao Sezary cho nen k h o n g d u yeu t o chan doan Id Mycosis Fongoide vd hoi c h d n g Sezary. Chf cd 1 trudng hgp CO hinh dnh lam sang rdt g t o n g Mycosis Fongoide do d d chung t o i n g h i trUdng h a p nay phu hgp vdi Mycosis Fongoide bdi v l t e bao Sezary trong mau cung dugc t i m thay t r o n g b a n 2 5 % trUdng htrp benh Mycosis Fongoide d giai doan t o n thuang dang m d n g hay b u d u

<' Ung t h u d a thuTphat + Trudng h a p 1:

Benh nhan dugc cat b d 2/3 da day vdi chan doan Carcinome tuyen da day, gan m d t nam sau benh nban noi cdc not day c o t h e va dUac sinh thiet vcii chan doan Carcinome t u y e n da day di can da.

Carcinome tuyen da day di can ra da thudng chiem khoAng 6 % t r o n g tat cd Carcinome thiTphat d d a ( 7 ) .

+ Trudng h g p 2 va 3:

Benh nhan noi cac not v u n g da quanh vu k h d n g dau mat do chac. Ket qua giai phau benh la Carcinome tuyen v u di can ra da. 6 phu niJfthi Carcinome tuyen v u di can ra da chiem 69% trong tat ca cac trUdng hgp ung t h U da t h d phat (7).

1 2 I D A L I E U H O C S 6 07 fThang 07/2012)

N G H l i N COU KHOA HOC

• Tien trinh di can

Carcinome t e bdo day hiem cho di can vi dien tien cham, do d c t i n h thap, theo Y van thi t l l e d i c a n la 0.05% (6).

Carcinome te bdo gai, t i le di can Id 0% - 50% (5).

Cac vj t r i d thai d u a n g , lung ban tay vd moi cho di can nhieu ban cac vj t r i khac (1). Carcinome t e bao gai d n i e m macvd d v u n g c o t o n t h u a n g trUdc nhU seo p h a n g , loet chan 16 d d v i e m xuang tuy thi mdc do di can cao ban t o n t h u a n g Keratose Senile (7).

Trudng hgp Meianome Malindi can hach, chung t o i ghi nhan Id 6 thang ke t d khi xuat hien budu nguyen phat d ngdn chan, sau do ndi hach va t h e o Y van thi Meianome Malm cho di can hach sdm, dien tien t h u d n g xau so vdi EBC va ESC.

V. K^T LUAN

Qua khiio s^t 317 t r u d n g hgp ung t h U da tai Benh vien Da lieu TR H6 Chf M i n h , chung t o i c6 mot so nhan xet nhU sau:

1. Carcinome te bao day (EBC) da so Id d v u n g dau mdt c6, c6 hinh cinh lam sang Id dang loet (90,23%) vd hinh dnh mo hoc chu yeu Id dang dac (80,46%) tien trien cham it di can.

2. Carcinome te bao gai (ESC) c6 hinh dnh lam sang chCi yeu Id dang loet sui (56,47%), da so hinh dnh md hoc biet hda t o t (85,88%), ti le di can khoang 6%.

3. Nhdm lymphome da da so Id dong T (7/10 trudng hgp).

TAI LIEU T H A M KHAO

/. Arnold, Odom, James. Andrew's Diseases of the skm Clinical Dermatology - Eighth edition.

2. Civatte (J) Histopathologie cutanee 2e edition

3. Christopher J, Mc Cormack, MBB5, John W.Kelly, MDBS, Fael. Dlfferrences in age and body site distribution of the histological sybtypes of basal cell Carcinoma. Arch Dermatol/vol 133, May 1997.

4. Degos (Robert). Dermatologie tome II mise a jour 1976.

5. Fitzpatrick (Thomas) Dermatology in general medicine vol I Fifth Edition.

6. Geoffrey M.Struton. Pathological variants of basal cell carcinome, Australian Journal of Dermatology (1997) 38 (SupppI) S31 - S35.

7. Lever (W) Hispathology of the skin Eighth Edition.

8. La vie medical - Janvier/1986.

9, Howord K.Kola, MD, MPH, Alan C.Geller, RN, MPH. Donald R,Mitler, 5c D. ted A, Grossbart, PhD.

Robert A, Lew PhD, Prevention and Early Detection Strategies for melanoma and skin cancer Arch dermatol/vol 132 April 1996.

10 Hd Van Phifdc Doi chieu Idm sdng gida gidi phSu binh 110 tri/dng hgp tgi B^nh Vi^n Da Liiu sinh boat khoa hoc klthudt Binh Viin Da Liiu quy 2 /1998.

11 Hd Van Phiidc, Carcinome Verruqueux trin nen Id ddo qua nhdn xit 12 trudng hgp tai phong Ben Sdn vd Binh Viin Da Hiu, Sinh hogt khoa hoc ki thudt Binh Vidn Da Lieu quy 3/2000

12 JHRichardus and April 1996, Squamous cell Carcinoma in chronic ulcers in leprosy A review of 38 consecutive cases Leps Rew (1991) 62,387-388

13. Kevin Imrie: Primary Skin lymphomas 14 N BB Reddy. TS Rinivasan, Sar Krishman,

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NGHIEN COtJ KHOA HQC

SR Bhusnurnath. Malignancy In chronic ulcers In leprosy: a report of 5 cases from Northern Nigeria, LeprRew (1985) 56.249-253

15. Nguyen Ch6n HOng. Ung thUhqcldm sdng tap II, 1986

16. Nguyin Sdo Trung, Nguyin Ch6n HOng, B^nh hoc ung budu ca bdn Trung tdm ddo tao vd bdi dudng cdn bd y te 1992.

17. Nhd xuSt bdn y hoc 1991. Ung thU hoc Idm sdng.

18. Robin Marks. Epidermiology of non-

melanoma skin cancer and solar keratoses in Australia: A tale of self- immolation in ^ysian Helds. Australian Journal ofDermatdogy (1997)3S (supple) s26 s29

19. RNF Leury and OVA opromolla 20. Carcinome In plantar ulcers In Leprosy 21. Leps Rew (1984) 55,369-378 22. Robert T, J.Friedman: cancer of the skir\

1991:319-331

23 Reinhard Dummer Diagnosis and therapeutic standard In Dermatologlcal oncology.

MACRO AND MICRO CHARACTERISTICS OF 317 SKIN CANCER CASES TREATED AT HO CHI MINH CITY HOSPITAL OF DERMATO-VENEREOLOGY (1986-2005) Introduction: Skin cancer is one of c o m m o n cancers. Vietnam is a tropical country, therefore skin cancer is frequent The study of macro and micro characteristics of c o m m o n skin cancer categories was carried out vi/ith t h e expectation of contribution t o t h e clinicians'early diagnosis and timely treatment of malignant cancers.

Objects and methods: This is a transversal descriptive retrospective study using t h e data from the clinical records of skin cancer cases treated at Ho Chi M i n h City Hospital of Dermato-Venereology during t h e p e n o d 1986-2005.

Results: The majority of cases are basocellular carcinoma (215/317) t h e n squamous cell carcinoma (85/317).

II. Basocellular carcinoma IS mostly observed at t h e head-face-neck area, w/hilesquamous cell carcinoma at t h e four limbs.

III. Basocellular carcmoma's c o m m o n clinical feature is ulcerated t u m o u r and histological feature is mainly of solid type

IV. Clinical feature of squamous cell carcinoma is mostly ulcerated verruca.

V No basocellular carcmoma metastasis is recorded, w/hile 6% of squamous cell carcinoma suffer metastasis

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