Tap chl Tai Mui Hpng Vijt Nam - Voiume (58-14). N°2 - Apr., 2013
DOI CHIEU MO BENH UpC VA H O A M 6 MIEN DICH Vpl LAM SANG TRONG CHAN DOAN UNG THlT MUI XOANG
Nguyen Dinh Phiic , Phung Quang Tuan Le Cong Dinh-, Le Trung Thg*, Phgm Kien Huru *'*
T6M TAT
Ung thu mUi xoang co nhieu phdn logi ve mo b^nh hQC cho phep quyet dinh phuang phdp dieu tri va tien lir^g tren Idm sang. Myc tieu: 1) Chdn dodn MBH vd HMMD 2) Ddi chieu vai idm sang. Doi ttrgrng ,P Le Cong Dinh*, PNC; Nghien cuu tirng truang hop tren 38 UTMX(2007-2009). Chdn dodn Idm sdng. CT, MBH, HMMD. Ket qui Typ UTBMV hoc lo tat cd cdc trieu chimg co ndng (50% din 80% ) . Hinh thdi siii (14/23= 60,08%), siii kem polyp (12/13= 82,3%) co bdn chdt Id UTBMvdy. UTBM khong biet hoa gap hinh thdi siii Id chu yeu ( 3/4=75%). Typ UTBM khong bi?t hoa cd 4 truang h(/p deu gdy bien dgng mat.
UTBMV il gap a tdng duai, bieu mo khong biet hoa, dgng luyen nuac bgt vd u lympho ac tinh khong Hodgkin gap a cd 2 tdng tren vd Idng giira hodc dudi, bieu mo tuyen vdy chi gap a tdng giua. Ket lugn Gap 5 typ UTBM vdy, HMMD gidp chdn dodn dudi typ va phdn bi^t.
Tif khoa: Ung thu mui xoang, mo benh hgc, hog mo mien dich.
SUMMARY
Diggnoslic cancer nasosinusal is based TNM, the histologics to detect a tumor, provide information, help plan treatment Ojective : The description a lesion on histopathologics of HE, PAS and immuno-histopathologic Materials and Methods: Case study of 38 patients operateds at Hospital ENT central (2007-2009). Diagnostic histopathologics of HE, PAS and immuno-histopathologic with 8 marques. Results and discussions; The lyps SCC are 50% - 80% of the symptom functional, 60.08% the form of vegetation.The UCNT of SCC are 75% of the form of vegetation . and 100% of the deformation.. UTBMV it gap a The typs SCC arise the inferior floor. The typ lymphomalin non Hodgkin and, UCNT of SCC arise the inferior and middl floor The typ adenoma ariseonly the inferior floor . Conclusion there is different the clinical formes and sub typs of histopathologics.
Key words: sinusonasal Carcinoma. Histopathologics. Immuno-histopathologic 1. DAT VAN DE hay da bien dang vimg mat thi Ijenh nhan
Ung thu mui chi chi6m khoang 0,2-0,8% • " * * " ^ ^ ™ * ^ ^°^ ''"''c. khi lan t6ng s6 cac ung thu, va Ichoang 3% cac ung ^^ '™ '*?>' ^^ phai co chan doan_ hinh anh thu viing diu c6 [7], Trieu chung lam sang """, '=° *« ™ ' ' l ' * '^•"'* ''*<=• ^ f "8"' kin , thim Iang, bj che day nhu cac viem '^'""' " ^ ''?'''' ^"f' ''* (""^ ™" " ' ™ *!''' mui xoang tliong thucmg, it di can hach c6. ^"^ '""" *^"S •''"''g «''»'' ^o^" ""g *."•
Chi a giai doan da lan rong vao h6c mui •""' ^"""S" co 2 muc tieu sau : 1) Chdn . '• ' dodn MBH vd HMMD 2) Boi chieu ton [Truong DHY Hi noi rAifOTig tren mo benh hgc. HMMD vdi dgc
BV Vinh phuc. ^.s ,.
- Dai hoc Y Duoc TP. H6 Chl Minh *^"' '"'" ™"S- Nhan ngSy 25.2 Duyet in 10.3.2013
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Tgp chf Tai MQi Hong Vifet Nam - V o l u m e (58-14), N ° 2 - A p r , 2013
2. BOI TlTONG VA PHlTOfNG PHAP NGHIEN ClTU
2.1. G6m 38 bgnh n h ^ gap tai BVTMH TU"
tu 2007-2009, CO cli^ doan xac dinh boi mo benh hoc, hoa mo mien dich.
2.2. Phuorng phap mo ta trnig ca, can thiep.
2.3. Su dung noi soi va tham kham lam sang mo ta hinh thai t6n thuong. Su dung may chup CLVT xo5n 6c (Siemens Somatom Emotison) de chup 2 tu the cat ngang, diing ngang va dung hinh dumg dpc vdi dp day 3mm de danh gia ton thuong. Xet nghiem mo benh hpc thuang qui nhupm HE, va hoa mo mien dich vol 8 dau an de dinh typ va chan doan phan biet, va doi chieu voi lam sang.
1. KET QUA 3.1. Ve tuoi va gioi
Bang 1. Ve tuoi N t i o m
t u 6 l n
%
3 - 2 0 1 2 , 6 3
2 1 - 4 0 9 2 3 , 6 8
4 1 - 6 0 2 1 5 6 , 2 7
6 1 - 7 4 7 1 8 , 4 2
T o n g s o 3 8 1 0 0
Tuoi tre nhat 3, gia nhat 74, nhom gap nhilu nhit laf41-60 ( 55,27%)
Ve gidi: Nam: 23=60,5%, nu 15- 39,5%
3.2. Ddi chieu chan doaD MBH va hinh thai lam sang
3.2.1. Bdi chiiu chin dodn MBH vd hinh thdi lam sdng,npi soi
Bdng 4 . S o s d n h c h a n d o d n MBH va h i n h t h a i l a m s a n g , n d i s o i H i n h
t h a i Sill (n=23)
K e m p o l v p : 1 3
T h a m n h i e m :2
U T B M v a y
1 4 1 2
U T B M l y m p h o
1 U T B M Ithong B H
3
1 UTBtuI t u y I n N B
1 L M N H
1 1
Hinh thai siii (14/23= 60,08%), siii kem polyp (12/13= 82,3%) co ban chit la UTBM vay. UTBM khong biet hoa gap hinh thai sui la chii y^u (3/4=75%). UTBM tuyen nude bpt co hinh thai gidng polyp, LMNH thi a tlil tham nhilm.(p=0,004) 3.2.2. Boi chieu MBH vd hinh thdi biin dgng viing mgt
Bang 5. B6\ chieu MBH v^ hinh thdi bi^n dang vung mSt
B i e u h i ^ n
Bien d g n g mgt Bieu h i f n m i t B i l u h i ^ n t h a n kinh C o h a c h c6
UTBM Vciy
2 1
15
2 0
1 UTBM lympho
1
1 UTBM kh6ng BH
4
3
4
2 UTBM tuy^n NB
1
1 LMNH
1
1 UTBM t u y l n vay
1
1
Bang doi chieu tren cho thay UTBM vay va khong biet hoa gay ra bien dang, mat va than kinh so gan 100%.
3.2.3. B6i chiiu MBH vd phan tang ton thirffng tren lam sdng
Bang 6. So sdnh MBH va phdn tang ton thu-o-ng tr&n lam sang
V i t r l
T a n g t r § n T a n g g l i j a T a n g 6uit\
Hai t i n g
U T B M v a y
2
7
17 U T B M l y m p h o
1 U T B M k h o n g B H
1
1
2 U T B M t u y e n NB
2
3 L M N H
1 U T B M t u y e n v a y
1
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Tap chl Tai Mui Hgng Vi$t Nam - Volume (58-14). N°2 - Apr, 2013
3.2.4. Boi chiiu MBH vd chdn dodn giai dognTtren Idm sdng
Bang 7.D6i chi^u MBH vd chSn dodn giai dognT trfen Idm sdng Giai
dogn CT) T l T2 T3 T4
UTBM Veiy
6 20
UTBM lympho
1 UTBM khdng BH
1 3
UTBM tuy^n NB
2 3
LMNH
1 UTBM tuy^n vSy
1
4. BAN LUAN DOI CHIEU T 6 N THU^ONG LAM SANG VOl MBH 4.1. Doi chieu voi hinh rhais lam sang
Trong nghien cuu ciia chung toi, typ ung thu bieu mo chiem 97,37%, trong do typ UTBMV chi6m da s6 (68,45%), boi vay hau nhu cac bieu hien trieu chumg lam sang deu Hen quan den ung thu bieu mo noi chung va ung thu bieu mo vay noi rieng.
Dau hieu chay mau miii gap a tat ca cac typ ung thu bieu mo, chiing toi chi khong gap trong u lympho ac tinh khong Hodgkin.
Tuy nhien, neu benh nhan bi u lympho ac tinh o giai doan muon thi ciing co the xuat hien chay mau tuy nguyen nhan khac nhau.
Chay mau trong ung thu sang ham chu y8u do su pha huy cua mo u va/hoac hoai tu con chay mau trong u lympho ac tinh thucmg do roi loan ve huyet hpc. Dau hieu chay mui cung gap 6 tit ca cac u theo chiing toi co le do niem mac bj kich thich bai nhiing ton thuang tai cho nen gay tang
tiet v^ vi th^ ddu hieu nay khong dac hieu.
Cac dau hi?u ngat tdc miii ciia typ UTBMV cung chilm ty 1? rat cao do UTBMV co xu hudng phdt trien loi len thanh kh6i siii gay chen 6p vd b?nh nhan co bieu hien tac mui.
Co 5 trucmg hpp mh ngui xult hi?n a 4 typ MBH ciia cac UTBM. Trieu chiing mat ngiii chi xuat hi?n khi u phd hiiy than kinh khuu giac n§n it phu thupc vao typ mo b?nh ma Hen quan toi do Ion, dp xam lin cua mo u [8]. Trieu chiing dau nhiic viing ma va song mui ciing xuat hien 6 4 typ UTBM va CO 16 ciing giong nhu trieu chung mIt ngiii, miic dp ciia ton thuang nay lien quan nhieu tai dp lan, dp xam lan cua mo u hon la typ mo benh. Tuy nhien, chi co typ UTBMV la CO bieu hien day dii ciia ca 5 bieu hien ca nSng: chay mau, chay mui, ngat tac miii, mat ngiri va dau nhiic vimg ma va song mui, cac typ mo benh khac hoc 16 cac trieu chung tren it day dii han.
4.2. Doi chieu vol bien dang vung m^t Trong nghien cuu nay, chiing toi nhan thay rang cac ung thu bieu mo khong biet hoa c6 kha nang gay bien dang mdt nhieu ban (4/4 truang hop). Diiu nay co le do cac ung thu khong bi?t hoa co dp ac tinh cao nen kha nang xam lan va pha hiiy viing mo ke can nhanh va du doi hem cac typ img thu khac va vi the bieu hien gay bien dang mat a typ mo benh nay the hi?n som va ro hon [8,9,10].
4.3. Doi chieu voi lan tran va ph^n tang ciia ton thinmg
Chiing toi cung tim thiy 57,7% cac truong hap UTBMV, 75% cac truong hpp
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Tgp chl Tai MQi Hpng Vi6t Nam - Volume (58-14) N°2 - A p r , 2013
UTBM khong bi$t hoa va 1/1 truong hprp ULPATKH c6 bieu hien tri$u chung a m5t.
Dau hieu nay dugc coi nhu mot bing chiing ve su lan tran ciia ung thu nen theo chiing toi no it CO moi lien quan tdi typ mo b?nh ma chu yeu Hen quan toi thai gian mic benh, giai doan ciia benh.
Mot trong cac ton thuong do ung thu bieu mo noi chung la su xam nhap, pha buy mo than kinh, dac biet cac soi than kinh tai viing mo u. Cac u co thai gian nhan doi u cang ngan, cang co xu huong xam nhap pha hiiy than kinh som, bdi vay d nghien cmi nay co tdi 100% cac trudng hap UTBM khdng biet hda co bieu hien ciia trieu chiing than kinh.
4.4. Doi chieu vdi phan loai giai doan va di can.
Di can theo dudng hach lympho la mpt trong nhiing con dudng di can chu yeu ciia moi loai ung thu bieu mo, trong do co ung thu bieu md sang ham. Cac hach di can sdm nhat la hach vimg sau do mdi tdi cac h^ch xa hon. Tuy nhien, viec phat hien cac di can hach tren tham kham lam sang co the bd qua vi kich thudc hach nhd, khd sd thay, diic biet vdi nhirng ngudi beo. Theo mpt so tac gia, kich thudc hach < 1 cm dudng kinh cd the coi la hach phan ling, hach co kich thudc >lcm luon dugc nghi ngd vdi miic dp canh giac cao cua mpt di can ung thu. Mac dii vay, ngudi ta da nhan ra rang, ke ca cac hach nhd, dugc sinh thiet va chan doan tren cac tieu ban nhugm HE thong thudng khong tim thiy di can ung thu nhung nhung 6 td bao ung thu cue nho (vi di can)
da dugc xdc nhan tren cdc tieu ban nhupm HMMD vdi cdc dau an phii hgp. Thi du: dl tim di can UTBMV chi cin nhupm CK chung la du, de tim vi di cSn UTBMT cin nhupm CK7 va CK20... Bdi vay, theo chiing toi, tat ca cac ung thu sang ham d giai doan T3, T4 co the va can dupe nao vet hach, va nen nhupm them HMMD vdi nhiing hach lay dugc trong khi mo de chin doan do la hach qua san phan ung, hay hach da bi di can se giiip cho dieu tri phoi hgp sau phau thuat dat ket qua toi uu.
5. KET LUAN
1. Ung thu sang ham gap nhieu d nhiing ngudi >40 60 tu6i (55,27%), ty le nam/nu la 1,52/1.
2. Typ UTBMV bpc Ip tat ca cac trieu chiing ca nang vdi ty le tir 50% den 80% cac trudng hgp. Typ UTBM khong biet hoa ca 4 trudng hgp deu gay bien dang mat.
3. UTBMV it gap d tang dudi, dang myen nude bpt va u lympho ac tinh khong Hodgkin hien dien d ca 2 tang, loai bieu md khong biet hda gap d ca 2 tang tren va ting giiia, bieu mo tuyen vay chi gap d tang giiia.
TAI LIEU THAM KHAO
1. Le Van Bich, Pham Khanh Hoa (1969),
" Nghien cuu tren 60 u ac tinh sang ham gap tai khoa TMH benh vien Bach mai tir 1960-1968", Npi san TMH, s61- 2. trang 73-79.
Tgp chi Tai Mui Hpng Vi^t Nam - Volume (58-14). N°2 - Apr. 2013
. Nguyen Manh Cudng (1978), " Nhung bieu hi?n lam sang, to chuc b?nh hpc, di?n quang cua 52 trudng hgp tmg thu bieu mo khoi s^ng hdm", Lugn vdn lot nghiep CK 11 chuyen ngdnhTMH, Dgi hpc Y Hd npi.
. Pham van Hau (2004)," Nghien cuu dac diem hinh anh chup cit Idp vi tinh trong chan doan ung thu sang ham ", Ludn vdn tdt nghi^pthac sy Y hpc, chuyen ngdnh chdn dodn hinh dnh . Dai hpc Y Hd npi.
. Tran Thi Hgp (1996), " Gdp phin chin doan va dieu tri ung thu sang ham . Nhan xet qua 174 ca ung thu sang ham tai BV TMH va benh vien K ha ngi tir
', Ludn vdn tot nghiep CK II chuyen ngdnh Ung thu, Dgi hpc Y Hd npi.
. Ngo Ngpc Lien (2002)"Tinh hinh ung thu sang ham tai Vien Tai Mui Hpng trong 15 nam 1986-2001", tap chi y hpc thuc hanh, sd 431, tr 299-305.
6. Anton N (1984), " CT of tumor and tumor - like conditions of the paransal sinus" Radiologic clinics of North Americ.,Vol22,Nol,pl9-30.
7. Barnes L, Everson J, Reichart P ( 2005), World Health Organization classification of tumors: pathology and genetics head and neck tumors. Lyon, IA RC, Press.
8. Bouijat P. and al,(1993), "Tomoden simetrie cervicofacial", Masson,p 42- 47.
9. Cerilli L, Hoist V, and al.(2003),
"Sinonasal undifferanciated carcinoma profie and genetics head and lack of EBV association. Am J Surg Pathol, 25,156-163.
10. Popovic D. (2004), Malignant tumors of the maxillary sinus. A ten years experience", Med. And Biology, Vol 11, No l , p 31-34.
