NGHIEN CCfU MO BENH HOC LAM SANG 1118
TRLTONGHOP UNG THI/ BIEU MO TUYEN GIAP
Tran Ngoc Dung*, Le Dinh Roanh**;
Nguyen Van Chii***, Nguyin Manh Hung****|
TOM TAT
Nghien ciiu phan loai mo benh hoc 1118 benh nhan (BN) ung thu bieu mo tuyen giap (UTBMTG) duoc phau thuat tai Benh vien Noi tiet Trung uong va duoc xet nghiem mo benh hoc tai Trung tam nghien ciiu va phat hien sdm ung thu (CREDCA) tii 26/10/2005 den 26/03/2010, ket qua nhu sau:
-Nam 127 BN (11,36%), nLr991 BN (88,64%).
- Tudi thap nhat la 08, cao nha't la 85, nhieu nhat d Ilia tudi 30 - 49 (514 BN = 45,97%), tudi trung binh:
41,3±1
- Phan bd typ mo hoc: the nhu 993 BN (88,82%), thi nang 70 BN (6,26%), the kem biet hoa 22 BN (1,97%), the khong biet hoa 12 (1,07%), the tuy 20 BN (1,79%), the te bao vay 01 BN (0,09%).
* Tdkhds. Tuyen giap; Ung thu bieu mo tuyen giap.
SUMMARY
STUDY OF HISTOPATHOLOGICAL AND CLINICAL IN 1118 CASES OF THYROID CARCINOMA Study of histopathological in 1118 patients with thyroid carcinoma, who were operated in National Hospital of Endocrinology and histopathological tested in Center research and early detection of cancer (CREDCA) (from Oct/2005 to Mar/2010), the results showed that:
- Male: 127 cases (11,36%), female 991 cases (88,64%). ,, , , .^ ^ ._
- Age: range from 08 to 85 years old.
- The most common age ranged from 30 - 49
years old (514 cases = 45,97%), the mean age: 41,3 I - The major subtypes of thyroid carcinoma and j
their relative frequencies include: •'•'\
+ Papillary carcinoma 993 cases (88,82%). j + Follicular carcinoma 70 cases (6,26%). | + Poorly differentiated carcinoma 22 cases;
(1,97%). ;
•-" + Undifferentiated (anaplastic) carcinoma 12!
cases (1,07%) \ + Medullary thynDid carcinoma 20 cases (1,79%). \
+ Squamous cell carcinoma 01 cases (0,09%). ;
*Key words. Thyroid; Thyroid carcinoma. | I. OAT V A N O E
Ung thu bieu md tuyen giap la loai ung thu hiem gap, chiem 1 % cac khdi u ac tinh, nii gap nhieu ban nam. Tuy nhien, UTBMTG ; la benh ac tinh thudng gap nha't ciia he thdng '.
ndi tiet va dugc su quan tam Idn ciia cac nha | giai phSu benh, cac nha ngoai khoa va ung i budu. Benh cd the gap d mgi liia tuoi, nhung ; hay gap d ngudi tre va trung tudi vdi khoang i 122.000 trudng hgp mdi mac mdi nam trSn j the gidi. Trong cac UTBIVI, ung thu ciia cac t6l bao nang tuyen thudng gap ban nhieu so vdi;
ung thu cua cac te bao C va cd tien lugng j thuan lgi ban. Benb sinh cua UTBMTG co i lien quan tdi cac yeu td mdi trudng (lugng | iode cd trong thiic an, cac yeu td phdng xa j gay nhilm ddc gen), di truyen va ndi tiet (y6'u' td gia dinh vdi nhidu khdi u ndi ti^). i
* Benh vien 103 ** Trung tdm nghien citu vdphdt hien sdm ung thir
*** Benh vien K Trung uang **** Benh vien Ngi tiei Trung uang
Y HOC VIET NAM THANG 12 - SO 2/2010
UTBMTG the nbii la loai hay gap nhat, cd lien quan mat thiet vdi biic xa, dac biet nhay cam vdi tre nhd. UTBMTG dugc phat hien bang xet nghien mo benb hgc, vi vay viec nghien ciiu md benb hgc cac the UTBMTG CO y nghia quan trgng trong tien lugng va theo ddi BN sau phau thuat. Tren co sd dd, chiing tdi tien hanh nghien ciiu phan loai mo benh hoc cac the UTBM tuyen giap nham xac dinh tan suat, ty le cac typ mo hoc UTBMTG va mot sd yeu td vi tuoi, gidi, vi tri khdi u gap dugc tai Viet Nam.
II. oo'l TUdNG VA PHUONG PHAP NGHIEN COU 1. Ddi tugng nghien ciifu.
1118 BN UTBMTG dugc phSu thuat tai Benh vien Ndi tiet Trung uang tir 26/10/2005
den 26/3/2010, 127 BN nam va 991 BN nii, tit 0 8 - 8 5 tudi. .-:- .
2. Phuong phap nghien ciiru.
- Mo ta cat ngang.
- Nghien ciiu cac phieu yeu cau xet nghiem mo benh hoc, ghi nhan thdng tin ve tuoi, gidi, vi tri khdi u.
- Pha benb pham, mo ta dai the, lay mSu d vung nghi ngd tdn thuong, viing giap ranh giua tdn thuong va vung lanh (lay viing vd u), cat nhuom, lam tieu ban mo benh hgc thong thudng (nhuom tieu ban bang phuong phap nhudm hematoxylin - eosin, H.E). Dgc va bgi chan tieu ban tren kinh bien vi quang hoc vdi do phdng dai 40 - 400 lan. Xac dinh cac the md benh hgc UTBMTG theo phan loai ciia Td chiic Y te The gidi (WHO, 2004).
I. KET Q U A N G H I E N COU VA BAN LUAN 3.1. Tuoi, gidi.
Bdng I:
^^~~^^^^^^ Gidi Tudi ^ ^ - ^ ^ ^
<10 10-19 20-29 30-39 40-49 50-59 60-69
>70 Tdng(%)
Nam 1 11 25 20 19
. . : . . • • , , . M ...<•>• . . . .
19 10 127(11,36%)
NO' 1 41 187 246 229 195 66 26 991 (88,64%)
Tdng (%) 2(0,18%) 52 (4,65%) 212(18,96%) 266 (23,80%) 248(22,18%) 217(1941%) 85 (7,60%) 36 (3,22%)
1118
Ty le nam - nii = 1/8. Tudi thap nhat 08, cao nhat 85, trung binh 41,3! '1 tudi, hay gap nha't 30-49 tudi (45,97%). Cd 2 BN dudi 10 tudi va 4 BN tren 80 tuoi.
Cd 281 BN da phat hien cddi can bach bach huyet, chiem 25,13%. ' ' .- - •
173
3.2. Vj tri khdi u Bdng 2
— 1 Vj tri
Ben phai Ben trai Eo tuyen Xam lan > 2 thuy
Tdng
So luong
189 159 19 751 1118
Ty le (%) 16,91%
14,22%
1,70%
67,17%
100 (%)
— 1
Xac dinh duoc 367 vi tri nguyen phat cua khoi u, trong do gap nhieu a vi tri ben phai, co I 19 TH vi tri nguyen phat o thuy eo tuyen giap. Cd 751 TH xam lan > 2 thiiy, nhiing trudng ]
hgp nay khong xac dinh dugc vi tri xuat phat ban dau ciia khdi ung thu. \ 3.3. Ket qua phan loai mo benh hoc.
- Tiiy tirng trud'ng hgp cd the thay nhiing hinh anh ac tinh khac nhau:
+ Te bao cd hinh dang bat thudng, nhidu nhan chia, nhan va bao tuong thay ddi.
+ Hinh anb xam lan vd bao va mach mau.
-I- Hinh anh hoai hi, xuat huyet, cau canxi v.v.
- Cd 992 trudng hgp cd hinh anh te bao bieu md tao thanh hinh cac nhii ldi vao trong long nang, cd noi, nhii cd true lien ke't-huye't quan, dugc xac dinh la UTBMTG the nhii va cac bien the cua nd, trong dd:
-h Bien the nang: 23 trud'ng hgp (2,32%).
-I- Bien thd te bao ua axit: 04 trudng hgp (0,40%). :
-I- Bien the te bao ua axit: 06 trudng hgp ; (8,57%). ' i -t- Bien the te bao sang: 01 trudng hop I (1,43%). ' I - Cd 22 trudng hgp khdng rd hinh anh'i be, dai bay nang tuyen, cac te bao hop thanh dam lan tda, mdt sd cd hoai tii, xua't huy6't,, khong tha'y md sun, xuong, mdt sd cd hinh anh xam nhap vd bao va mach mau, dugc chan doan la UTBMTG the kem biet hda. Ddi vdi the nay sd lugng BN ciia hai gidi la bang nhau.
- Cd 12 trudng hgp ca'u triic va thanh phan u da dang, dugc chan doan la ung thu bieu mo the khdng bidt boa.
Cd 20 trudng hgp trdn tieu ban tha'y co + Vi ung thu bieu md nhii: 35 trudng hgp te bao binh trdn, da didn hay hinh thoi xd'p (3,53%).
+ Bie'n the te bao tru: 01 trudng hgp (0,10%).
+ Cdn lai la cac trudng hgp UTBM the nhu kinh dien, 929 trudng hgp (93,65%)
- Cd 70 trudng bgp, ca'u triic u cd binh nang tuye'n vdi chat keo thay ddi, tinh chat ac tinh the hien d xam nhap te bao u vao vd bao va mach mau, chain doan la ung thu bieu mo
thanh day, cd the tha'y chat dem dang tinh \ bgt, dugc chan doan la UTBMTG the tiiy. |
- Cd 1 trudng hgp te bao u dang bi, di i kem cau triic nang hoac be, dugc xac dinh la j
UTBMTG the te bao vay. ij Ke't qua phan loai m6 benh hoc ung thiT •
bieu mo tuyen giap: The nhii 993 BN \ (88,82%), the nang 70 BN (6,26%), the kem biet boa 22 BN (1,97%), the khdng biet hoa tuye'n giap the nang (63 trudng hgp, chie'm 12 BN (1,07%), the tiiy 20 BN (1,79%), thi 90%) va cac bie'n the ciia nd: tebao vay 1 BN (0,09%).
Y HOC VIET NAM THANG 12 - SO 2/2010
Bdng 3: Lien quan giua gidi tinh va the loai UTBMTG The loai UTBMTG
The nhu The nang The kem biet hoa The khong biet hoa The tuy
The vay
Nam 95 11 11 1 8 1
NOT 898
59 11 11 12 0
6 nu, UTBMTG the nhii bay gap nhat, cd 898/991 trudng hgp (90,60%) va chie'm 80,32%
tdng sd benh nhan.
Bdng 4: Tan xuat cac the UTBMTG thudng gap theo m6t sd tac gia
^^~~--~..,^.^^^ Nguon TheUT ^ ^ " ^ " " - - - ^ UTBMTG
the nhu UTBM [hi nang UTBM th^tu'^
UTBM kem bi§t hoa (thuy dao)
UTBMTG khSng biet hoa
Theo y van The gidi
60-80%
5-25 % 5-10%
1-10%
4-10%
SGPGIMS Lucknow, An Do
64%
20%
7%
5%
4%
Nghien ciiu cOa chung toi
88,82%
6,26%
1,79%
1,97%
1,07%
- Trong nghien ciiu ciia chiing tdi, UTBMTG the nhii chie'm 88,82%, cao ban so vdi cac nghien cim trudc dd. UTBMTG the nang, the kem biet boa phu bgp vdi sd lieu cua y van the gidi va tha'p ban nghien ciiu ciia Lucknow, cdn the tuy va the khong biet boa tha'p ban so vdi cac nghien cihi trudc dd.
Nhimg khac biet ndi tren cd the lien quan tdi ye'u td dia ly ciia mdi vung nghien ciiu.
- UTBMTG chii ye'u gap d nu gidi (88,73%), tuy nhien ty le nam/nu cd xu hudng ngang nhau d the kem biet hoa va the
tuy. Benh cd the' gap d mgi liia tuoi, cd 2 BN dudi 10 tuoi va 4 BN tren 80 tudi.
- Vi tri khdi u nguyen phat: 189 TH thuy phai (16,91%), 159 TH thuy trai (14,22%),
19 TH thuy eo (1,70%), nhung cd tdi 751 TH khong xac dinh dugc vi tri tri khdi u (67,17%).
- Nhieu nha't la UTBMTG the nhii (88,82%), trong dd nii gidi chiem tdi 90,62%, ke't qua nay cao ban nhieu so vdi cac nghidn ciiu trudc day.
- Co nhieu the UTBMTG theo phan loai cua WHO, 2004, chiing toi khong gap dugc nbu: the' nhay, the xa ciing bi vdi bach cau ai toan, the biet hda dang tuyen lic v.v..
- Tudi trung binh cua BN UTBMTG la 41,3 va tan suat cao nhat d liia tudi 30-49.
Nhu vay BN cd xu hudng ngay cang tre boa.
IV. KET LUAN
Qua nghien ciiu 1118 BN UTBMTG dugc pbSu thuat tai Benh vien Noi tiet Trung uong va dugc tien hanh xet nghiem mo benh hoc tai Trung tam nghien ciiu va phat hien sd-m ung thu (CREDCA), chiing toi nhan thay:
- UTBMTG gap nhieu nhat d lira tudi 30 - 49 (45,97%), tudi trung binh 41,3±1 (d ca hai gidi), ty le nam/nir = 1/8.
- Vi tri khdi u nguyen phat: gap d ca thuy phai, thuy trai va eo tuye'n, tuy nhien cd tdi 67,17% khdi u da xam lan it nha't 2 thuy, khong xac dinh dugc vi tri u nguyen phat, dieu dd chiing td benh nhan den vdi cac co sd y te' khi khdi u da cd xam lan manh tai chd.
- Ty le phan bd the benb trong UTBMTG:
-t- UTBMTG the nhii cd tien lugng tdt nhai, chie'm ty le 88,82%. Vdi cac bien the' gap dugc nbu sau: bien the nang 23 trudng hgp, bie'n the te bao ua axit 04 trudng hgp, vi ung thu bieu md nhu 35 trud'ng hgp, bie'n the te bao tru 01 trudng hgp.
+ The nang chiem 6,26%, trong dd bie'n the te bao ua axit 6 trudng hgp, bie'n the te' bao sang 01 trudng hgp.
-I- UTBMTG the kem biet hda cd do ac tinh cao chie'm 1,97%.
-I- UTBMTG the khong biet boa chie'm ty le thap (1,07%) ' • : /
+ UTBMTG the tuy: 1,79%.
-f UTBMTG the te bao vay: 0,09%.
1 - Cac the khac cua UTBMTG theo phan I loai cua W H O (2004), chiing tdi khdng gap ]
dugc trong qua trinh nghien ciiu. j - Cd 281 BN da phat hien di can hachi
lympho vung (25,13%). \ Viec xac dinh typ mo benh hoc ;
UTBMTG cd y nghTa quan trgng trong tien '^
lugng benh. i TAI LIEU THAM KHAO ^
1. Moller L, Sailer B, Quadbeck B, et al. i Thyroid carcinoma, diagnosis - nonoperative \ - after care. MMW - Fortschr - Med. Jan, 11. | 2001. P 2 6 - 3 1 .
2. Robbin. Pathology. 6 edition, Saunder. 1999, p. 1140-47.
3. Staunton MD, Bourne H. Thyroid cancer in the 1980 - a decade of change. Ann - Acad - Med. jun, 1993, 22 (A), p. 613 - 6.
4. Kirillov V.A, Yuschenko Y.P, Paplevka A.A, Demichik E.P. "Thyroid carcinoma diagnosis based on a set of karyometric parameters of follicular cells". Cancer. Oct 1.
2001. 92 (7), p. 1818-27.
5. Chan JKC. Tumours of the thyroid and parathyroid glands. 'Diagnostic Histopathology of Tumours', vol. 2, Fletcher CDM (Ed.). Churchill Livingstone, Edinburgh, 1995, pp. 705-764.
6. Hedinger C, Williams ED, Sobin LH.
"Histological typing of thyroid tumours".
Second edition. No. 11 in: International Histological Classification of Tumours, World Health Organization. Springer-Verlag, Berlin, 1988.
7. Hedinger C, Williams ED, Sobin LH. "The WHO histological classification of thyroid tumours", A commentary on the second edition. Cancer 1989;63:908-911.
8. Rosai J, Carcangiu ML, Delellis RA.
"Tumours of the thyroid gland". Atlas of
Y HOC VIET NAM THANG 12 - SO 2/2010 Tumour Pathology, third series. Armed
Forces Institute of Pathology, Washington DC, 1992.
9. Sobrinho-Simoes M, Fonseca E. "Recently described tumours of thyroid". Recent Advances in Histopathology no. 16, Anthony PP and Macsween RNM (Eds.). Churchill Livingstone, Edinburgh, 1994, pp 213-229.
10. Zubair W. Baloch, MD, PhD; Susan Mandel, MD; Virginia A. Livolsi, MD.
"Combined tall cell carcinoma and Hyrthle cell carcinoma (collision tumor) of the thyroid" Arch Pathol Lab Med. Apr 2001 ;Vol. 125, pp.541-543.
11. Alessndro Lugli, MD; Maria Terracciano, MD; Martin Oberholzer, MD; Lulas Bubendori, MD; Lugi Tomillo,MD.
"Macro follicular variant of papillary carcinoma of the thyroid" Arch Pathol Lab Med. Jan 2004;Vol.l28, pp.54-58.
12. Saul Suster, MD. "Thyroid tumor with a follicular growth pattern problems in differential diagnosis" Arch Pathol Lab Med.
July 2006;Vol.l30, pp,984-988.
13. Nabeel Albrahim, MD; Sylvia L. Asa MD, PhD. "Papillary thyroid carcinoma an overview" Arch Pathol Lab Med. July 2006;Vol 130, pp. 1057-1062.
14. Heitham Gheriani, MD. "Update on epidermiology classification and management of thyroid cancer" Libyan j . Med, AO?:0605M.
15. Sebastiano Filetti. PhD. "Anaplastic thyroid carcinoma" Oiphanet encyclopedia. Mar
2004. ^ ^.iv.:.
16. Bukhari. U; Sadiq. S. " Histopathological audit of goiter: a study of 998 thyroid lesions" Pak J.Med-Sci. 2008, Vol. 24 (3):
442-446.
17. Steven. T. Rosen, MD, (ed). "Molecular basis of thyroid cancer". Editor by Nadir. R.
Farid. 2005; ISBN 1-4020-8106-5.Biersack.
H. J; Grynwald; (eds). "Thyroid cancer" 2'"' editon, 2005.
18. Jonh. K.C.Chan. "Diagnostic histopathology of tumors" 3'"' editon, (2), 2007, pp. 997-1081.
, : •
v r ; i;i.
,/.;;•
; ) ( i (•••;, : - . '
- . ? • ' . . • • - ; I
y^mm-iz .'•
• i
• • ) • ' ;
<_>••''J
; : ! ' • , " • ' "
'''-' :
• : • ! : . i i i • i :
>. "<l\ i •.•'':
' ' " i f i '
> 6 .
r';';ts':
:$•"•''
-3\
• '^
/ K a
,fi'n"':,-
•• k i l l ' iC,
-.-,.
:".:r •;
^'
••v: • '
