KHOA HOC KY THUAT THU Y TAP XXIV SO 8 - 2017
NGHIEN CUfU DAC DIEM DENH LY MOT 8 0 LOAI U TUYEN VU THUilNG GAP THEN CHO TAI HA NOI
Nguyen Vu San', Nguyen Hihi Nam', Biii Trdn Anh Bdo', Nguyin Thi Lan', Biii Thi Td Nga', Bdo Duy Tung', Nguyin Thi Huang Giang'
TOM TAT
Nghign cijru dupc tign hanh trgn sau con chd cd khdi u tuydn vii tgi mpt sd phdng kham thu y tai Ha Ndi. Cac khdi u ran, kich thudc tii 1 - 5 cm cd hidn tupng sung, chay mau, hinh thanh vgt loet,...
c i u hiic dai the ciia khdi u rat da dgng vdi cac d hogi tir, nang trdng chiia dich nhiy hay hmh thanh td chiic xuang, sun. Quan sat cac tdn thuong vi thg cho thiy cac tan bao trong khdi u h§n tuydn va u da dgng linh tinh la su tang sinh ciia tg bao co bidu md va td bao ldp bieu md ciing lupng ldn xa d^m.
Nhan te bio cd hinh dang khi ddng ddu. Khdi u lanh tinh cd ranh gidi ro vdi md bio xung quanh.
Cac d hogi tir nhd dupc binh thinh, khdng cd hien tupng xam lin mgch lympho hay di can tdi hach lympho. (5 khdi u don tuyen vi hon tuydn ic tinh, hinh thai te bao ung thu phong phu, di biet vdi cic d hoai tu ldn va lan rpng. Td bao u xam lan mgch lympho xung quanh va di can tdi hach lympho Ian can. Hien tupng phan bao giin phan (Mitosis) thudng dupc quan sit thiy trong khdi u ac tuih.
Tie khoa: chd, u tuy^n vii, bdnh ly, linh tinh, ic tinh
Pathological characterization of some canine mammary gland tumor types in Ha Noi
S U M M A R Y
Canine mammary gland tumors were found in six female dogs in some veterinary clinics in Ha Noi. The tumors wfere hard with size ranging from 1 to 5 cm, swollen, hemorrhage or/and ulceration. The gross structure of tumors was multiple types with the necrosis spots, mucous cysts or bone, cartilage formation. Study on histological lesions indicated that, the neoplasm of complex adenoma and benign in tumor had both epithelial and myoepithelial proliferation with variable amounts of fibrous stroma. The benign mammary gland tumor cells possessed monomorphic nuclei, well circumscribed with central necrosis, no lymphatic or vascular invasion, no lymph node metastasis. In simple carcinoma and complex carcinoma, the neoplastic cells possessed pleomorphic nuclei, with multifocal necrosis, possible lymphatic or vascular invasion, lymph node metastasis. Mitotic figures were frequently found in malignant canine mammary gland tumors.
Keyword: dog, mammary gland tumor, histopathology, benign, malignant
I. D A T V A N D E Trong do, su tang sinh khdng hgn chg, vupt qua - , , . 3 „ - -T 1 /1/M A\ ranli gicfi ciia ciu tnic giii phlu la dac tnmg Theo Nguyen Huu Nam vi cs (2014), ung , < . , , , , , , , £ . %^, A- , „ J V ^ . - Z
*u I- -.if- 1, ' J ^-.i--- , .,.- nhat cua benh do khoi u. Khdi ucd tilg phit sinh thu la mpt benh xay ra do dpt bien gen va CO hen ^, . / , , , ^, i ,- ~. 4-- UA
.*- 1.-- A- j - ^ >• r.- L-! i-'- ' tu mpi mo bio trong co thg dpng vat. Tren chd, quan den su bien ddi dl trayen. Cac bien doi nay , , ;- J - ,. , • , . - , J;. . ,, ., j j . i ^ , . , , „ , . khoi u tuyen vu la logi u thuang gap nhat o con lam tbay doi cau trac va chuc nang cua gen, tu , . , . . . ,; . , i i i
». , , . , ^i, , . . . , . , . i , cai chua tnet san vdi su da dgng ve nguon goc do cho phep cac te bio khong chiu sir kiem soat , i , , , , , . " , , , . , ' , ,7, T irtm\
^u-^i- i,A**_:^ -. ji\uK.^. ' te bio khdi phit, do ic tinh cao (Moe, L., 2001).
cua CO the de phit men mpt cich bat thudng. ^. ^ V ' , , ^ /-inii\ - *'• <no/
^ Theo Sorenmo,K.U. vacs (2011), CO toi 50%
tdng sd ca u vii tren chd dupc chan doin la ung
; Khoa Tlm y, H,c vi^n N6„8 „^i«p Viet Nam thu vu ac tmh. U tuyIn vu thutag gap 4 tren cho
^ Phong kham thu y Samyang Ho Chl Minh •' e e - r
KHOA HQC KY THUAT THU Y TAP XXIV S6 8 - 2017
gii hi 7 d^n 13 nam hidi (Goldschmidt, M. va cs, 2001). Tuy nhign, dp tudi mic khdi u se thay ddi tuy thudc theo gidng, kfch co tdi da ciia chd vi rit nhigu yen to khic. Cac tiiudc npi tiqtjjtdng hpp cd thinh phan nhu progestin va estrogen la ygu td lim tang kha nang u tuyen vu d cdc chd dudi 7 nam tudi (Stovring, M. va cs, 1997).
Trong khi dd, triet sin sdm giiip lam giam ding ke nguy co xuat hien cac khdi u tuygn vu trgn chd (Schneider R v i cs, 1969). U tuygn vu xay rd"^
chu ygu trgn chd cii, nhung ciing cd nhirng bao cio tren chd due do su rdi logn sin sinh hormon sinh due cai la Estrogen va Progesterone (Saba, CF. va cs, 2007; Soon, C.K. v i cs, 2017). Ngoai ra, bdi s\i tuong ddng cao giiia ung thu vii trgn chd vi hdn ngudi vg dac diem lam sang, dac digm td chiic hpc, sioh benh hpc vi cip dp phan hi, khoi u tuyen vii tren chd ciing dupc ghi nhin nhu Ii md hinh nghien cuu quan trpng trong ung thu vd d ngudi (Sorenmo, K.U. v i cs, 2009).
Dil rat thudng gap, nhimg a nude ta nhiing b?nh khoi u tren thu cung ndi chung va khdi u tuyen vii tren chd ndi rigng Men chua dupc nghign cijru va thdng tin diy du. Muc tieu ciia nghign cuu niy li cung cap them dii lieu ve trieu chiing lam sang, tdn thuang dgi the v i vi thg, phin loai chi tiet hon ve do lanh tinh, ac tinh ciia khdi u tuyen vu d cho, giup cic bac sy thii cinh, chii thii cung cd hudng xir ly, quan tam vi cham sdc chinh xic, phu hop hon; ddng thdi giup phit trign benh ly hpc so sanh vdi ung thu vii trgn ngudi nham hd trp viec dieu tri nhin y dgt hi?u qui cao ban.
II. V^T LIEU VA PHlTOfNG PHAP NGHIEN CUti
2.1. V|t lifu
Mlu benh phim la cac khdi u, hach ben cua 6 chd mic u ti^en vu dupc thu thip tir mot sd phdng kham tiui y tgi Ha Ndi.
2.2. Phinrag phip nghien ciru
2.2.L Phuongphap quan sdt, khdm ldm sdng Trieu chirng lam sing ciia chd mac u tuyen
vii dupc xac djnh qua theo ddi, ghi chep khi chd cd nhung bigu hien dau tign. Ddng thdi, kdt hpp vdi vi^c tong hpp thdng tin lam sang hi chu nudi chd vg gi6ng, gidi tinh, dp tudi va vide tham khim lim sang vg vi tri, sd lupng ciing nhu kich thudc ciia kh6i u dg giiip chan doan chinh xic.
2.2.2. Quan sdt ton thuang d^i thi Tuy thudc vio v; tri, sd lupng va kich thudc ciia cac khdi u, chd cd khdi u se dupc chi dinh phau thuat cat bd khdi u hoac cat bd toan bd tuygn vu ciia chd cd khdi u cimg hach ben. Ciu tnic, tinh chat bg mat, miu sac ciia khdi u se dupc kiem tra sau dd.
2.2.3. Phuang phdp ldm tieu bdn vi the Cic khdi u tuygn vii, hach lympho dupc cd dinh trong dung dich formoi trung tinh 10%.
Vdi cic khdi u cd kich thudc ldn, mau se dupc liy d nhidu vi tri khac tihau nhu: vung tdn thuong nghiSm trpng, trung tam khdi u, vung tiep giap vdi td chuc lanh dg dim bio tinh toin dien. Sau dd, cic miu khdi u dupc lim tidu ban vi thd theo quy trinh tim due bang parafiin, cat tigu bin (dd diy 2 - 4pm), nhudm bang Hematoxylin - Eosm (HE) vi cac tdn thuang vi the dupc quan sat dudi kinh hign vi quang hoc (Prophet and Pathology, 1992).
2.2.4. Phdn locii khoi u tuyen vu Kgt qui chin doin vi the tigu ban nhudm HE ciia khdi u tuyen vii se dupc dinh gii ddc lap bdi hai chuygn gia benh ly de dua ra kgt qui chin doan cuoi ciing. De phin loai ciing nhu danh gia cic khdi u tuygn vii trong nghign curu, chung tdi sii dung He thdng phan loai u mygn vu tren chd, mdo chinh thiic cua WHO (1999).
IH, K E T Q U A V A T H A O L U A N 3.1. Trieu chung lam sing cua chd cd kh6i u tuyen vu
Qua trinh theo doi trieu chiing lam sang cua cac chd bi khdi u tuydn vii bat dau tii khi mang dgn kham tai mot sd phdng khim thii y trgn dja bin H i Npi. Kgt qui tham kham, theo ddi va thdng tin tu chii thii cimg cung cap dupc tdng hpp d bing 1.
KHOA HQC KY THUAT THU Y TAP XXIV 6U 8 - 2017
Bang 1. Thong tin vd tri§u chirng iann sang cua cho bj khoi u tuyen vii
TT Giong cho Tu6i Tri^t san Tri^u chu'ng ISm sang So liFong
khoi u German
Shepherds Chihuahua
8 tudi 7tu6i
Khdng Khong
Miniature Pinscher
Cd
Khdng Khdng Khdng
Khoi u kich thu'de 1 - 1,5cm, dku vil co hien tu'ong chay mau
Thd khd, khoi u 1,5cm a bau vu thi> 2 bdn phai, mot khoi u d b^u vii 5 ben tr^i, kfch thu'de tang nhanh bit thu'dng Dau vii su'ng dd, hai khdi u Idn a bau vii 4,5 ben trii, phan xung quanh vO 3 so thay cyc cdng, hach b§n surg
Nhieu khdi u nhd, cii'ng xullt hidn du'di cic bau vu 5 va 6, thii bd an
Khoi u ldn tgi blu vd thij 2 loet, hoai tu', ndi hach iympho thdnh ngirc
2 khoi u nhd xuit hi#n gan dau vu 4, cd hign tu'ong thd khd
Ket qui d bing 1 cho thay tat ci chd cd khdi u tuygn vii trong nghign cim deu li gidng cii, cd dp tudi tCr 6 - 10 nam tudi. Chd cd khdi u thudc cic gidng dupc nudi phd biln d nude ta nhu Bee gid Dirc, chd Phdc huau, chd Nhit, chd lai... nhung phin Idn la nhung gidng chd cd kich thudc tradng thinh nhd. Kdt qui nay ciing tuong ddng vdi mdt sd nghign ciiu trudc day khi tic gii Moe, L. (2001) cho ring u tuydn vu xiy ra chu ygu d chd trudng thinh hoac gia va cd xu hudng thudng gap ban d gi6ng chd vdc nhd. Trong sd 6 chd dupc theo ddi, chi CO hai chd cd 1 khdi u, cac chd cdn lai deu cd tir 2 khdi u tuygn vii trd ldn tai ciing hoac khic bau vu vdi kich thudc khdi u da dang, tir I - 5 cm. Dac biet, 5 trong 6 chd cd khdi u chua dupc triet sin.
Vigc trigt sin sdm d chd khdng cd muc dich sinh sin giup giim tdi 99,5% nguy co khdi u tuydn vu so vdi cic chd khdng triet san. Tuy nhien, nguy ca se tang dan neu triet sin mudn ban vi khdng cdn 5' nghla nlu trigt sin sau 4 nam tuoi (Schneider R vi cs, 1969). Tradng hpp tri^t sin mudn d chd cii, hormon do budng trirng tiet ra la nhan to quan trpng inh hudng tdi su hlnh thinh kb^i u tuyen vu (Stovring, M. vi cs, 1997). Phan ldn chd cd khdi u tuygn vii khdng bigu bi^n cic trieu chimg lam sing rd ring. Ngu co hign tupng di can trong khdi u ac tinh, chd cd cic bigu bifn giim can ngng va ddi luc khd thd. Vimg khdi u cd hign tupng ttr Cling rin, sung, dd, chiy miu tdi hinh thanh vgt
loet, hogi tOr (hinh 1). Cic viing da hi anh hudng CO the hi phii, ndng va chd cd bigu hign dau khi bi cham vio.
3.2. Ton thinmg blnh ly cua chd mac kboi u tuyen vu
Ton thirang dai thi
Cic khdi u tuydn vu sau khi dupc phiu thuat dupc cit kidm tra bi mat khdi u vi c6 dinh trong dung dich formoi trung tinh 10%. Khdi u cd ciu true chia thinh cic 6 nhd xep chat che vdi nhau.
Tuy thupc vio su phat trien cda khdi u mi thanh pbin ciia khdi u lgi rit khic nhau, cd the Ii cic d hoai td ldn, xuit huylt hoac hinh thinh nang Udng chiia diy dich nhiy. Mdt sd khdi u cd xuat Iii?n md xuong, sun cd ciu true ran chac nam xen Ian cic md mem (hinh 2). Vi vgy, rit khd de phan Io?i khdi u dua tren tinh chit bl mat ciing nhu miu sac cua khdi u. Mot sd hach ben sung to, miu sac tiiay ddi bit thudng, hi dd tdi tim den. Trong dd, cic kh6i u cd kich thudc ldn hon 3,5 cm cd ciu tnic phiic tap, ldn xgn, cd xu hudng ic tinh hon so vdi cic khdi u nhd. Cic khdi u ldn niy tiiudng cd tien lupng rit xiu (Kuirman ID, Gilbertson SR, 1986).
Tuy nhidn, tit ca cac khdi u mygn vii, bit ke ldn, nhd dgu cin dupc lam tieu bin, quan sit vi the de dinh gii li ic tinh hay lanh tinh (Goldschmidt, M va cpng su, 2016).
KHOA HQC KY THUAT THTJ Y TAP XXIV S6 8 - 2017
Hinh L Khoi u tuyin vu cd hiin tuang loet, hoai tu nghiim trgng Ton thuang vi thi
U tuyIn vu tren chd rit da dang vdi rat nhigu cich phin loai khac nhau. Chiing c6 the dupc phin nhdm dua trgn su khic biet ve binh thii cau tnic vi till khdi u hay phan loai theo sy bigt hoi cua loai tg bio tuygn. Vdi su da dang dd, cd rit nbieu he thdng khac nhau duoc ip dung trong chin doin vi thi khdi u tuyen vu, nhung dgu chia thinh hai nhdm Ii u linh tinh va u ic tinh. Trong nghien cmi niy, he thdng phan logi u tuyen vu tren chd, meo chinh fliuc ciia WHO (1999) dupc chiing tdi su dung.
Cic khdi u tuydn vii sau khi quan sat tdn thuang dai thg dupc cd dinh, lira tidu bin, nhudm HE de quan sat tdn thuong vi thd. Kit qui dupc trinh biy d hinh 3, 4 vi bing 2.
Uldnh tinh
Tdn thuong vi thd cua cic khdi u cd sir phat triln cua ci bai logi te bio bieu md li tg bio co bilu md vi td bio ldp bilu md thanh cic ciu tnic die tnmg cho hai nhom te bao cimg te bio md dem dang xa. Cic tl bao ldp bidu md hinh tru hay hinh hpp cd td bio chat bat miu ai toan xgp lai vdi nhau hinh thinh nen cic ciu tnic dng. Nhan cd dgng tir trdn tdi d-van vdi vign ro net vdi mpt hach nhan bit mau ai toan. Cic te bao co bigu md cd dgng thoi dii vdi ming tl bao md nhat, it tl
Hinh 2. Tuyen vu xuat hien nhiiu khoi u v&i kich thu^, mau sac va tinh chat da dang bio chit. Nhan cd dang ttdn hay thon dii vdi mdt bach nhin. Chung kgt hpp dich nhiy hinh thinh nen cic bd bat miu ii kiem (hinh 3b). Cic khdi u nay cd ranh gidi tich biet vdi cac md linh xung quanh (hinh 3a). Ldp vd bpc dupc hinh thinh bdi cic tg bio dem vi td chdc nen. Hien tugng hoai tii tl bao xuit hien it vdi kich thudc cac o hoai tii nhd, nim trong ldng cic Ing tuyen (hinh 3c).
Khdng quan sit thiy tdn thuong vi thg d bach lympho (hinh 3d). Phan bio giin phin it xuat hien tten cac vi trudng quan sat. Cic die diem niy phu hpp vdi md ti cda khdi u hdn tuyen linh tinh (Complex adenoma) theo he thdng phin loai cua WHO (1999).
Mpt sd khdi u khic ciing cd tl bio ldp bilu md va tl bao co bilu md cimg tang sinh. Ngoai ra, cac tg bao trung md biet boa thanh tl bio xuong hogc tl bio sun cdng xuit hien tai nhilu vi tri trong khdi u. Cic tl bao ldp va co bilu md cd ciu tnic vi hinh thai tuong hr khdi u hdn tuyIn linh tinh dupc md ti d tten. Dac trung cua khdi u li cic ciu true md sun, md xuong vi md md vdi kich thudc ldn nhd khic nhau xuit hien rigng re hogc ddng thdi (hinh 3e,f). Hgch lympho cua nhiing chd cd ciu true binh thudng, khdng cd mat tg bao ung tiiu di cin. Cic khdi u niy dupc xip vao khdi u da dgng linh tinh (Benign mixed tumor).
KHOA HQC KY THUAT THU Y TAP XXIY SO 8 - 2017
Hinh 3. a. U hon tuyen lanh tinh co vo bpc tdch biet, khong xdm ldn mgch mdu, lympho vd mo bdo Idnh xung quanh (HE 4X), b. U hon tuyen lanh tinh. Te bdo lop bieu mo hinh thdnh cdu triic ong ddc trung, te bdo ca bieu mo cuon lgi hinh thdnh cdc bo (hoa thi) (HE lOX), c. U hon tuyen lanh tinh.
Cdc bo te bdo ca bieu mo bdt mdu di toan (hoa thi); O hogi tir trung tdm nho vai so lu^g it (ddu mui ten); Mitosis hiim khi bdt gap (HE lOX), d. Hgch lympho khong co te bao ung thu di can trong khoi u lanh tinh (HE lOX), e. Uda dgng lanh tinh. Cdc ddo sun tang sinh (ddu mUi ten) ndm xen ldn cdu tnic ong tuyin do te bdo lap bieu mo tdng sinh (HE 4X), f. Mo sun vd mo xuong (hoa th}) trong khoi u tuyen vu da dgng lanh tinh (HE 4X).
Udc tinh
Tdn thuong vi the vdi chi duy nhit mpt loai tg bio ldp bigu md phit trien khdng kilm soat.
Chung hinh thinh cic vgt loet tten khdi u vdi sd lupng ldn tl bio viem tbim nhilm, chu yeu li
bach ciu da nhin trung tinh. Cic te bio ldp bigu rad sap xep thinh cau true dang dng die trung vdi luang Idn cic tl bio xo di kgm bao quanh, ttong ldng dng chiia diy hoai tii chit. Cic d hoai tir ldn, hinh tbii da dang (hlnh 4a). Thinh dng thudng
KHOA HOC KY THUAT THO Y TAP XXIV SO 8 - 2017
Hinh 4. a. U dem tuyen dc tinh tdng sinh ti bdo lap bieu mo hinh thdnh cdc cdu trdc ong tuyen ddc tnmg bao quanh cdc 6 hogi tu te bdo lan, da hinh (hoa thi) (HE 4X), b. U dan tuyen dc tinh. Te bdo lap bieu mo co hinh thii di biet xip thdnh cdc ong tuyin to nho khac nhau, gidn phdn (mitosis) thircmg xuyin duoc quan sdt thdy (ddu mUi ten)(HE 20X), c. U tuyen vu dc tinh xdm ldn hi thong lympho vd di cdn tai cdc mo xunh quanh (HE 4X), d. Hgch lympho mat cdu true do te bdo ung thu di cdn trong khoi u dc tinh (HE lOX), e. U hon tuyen dc tinh vai stf tdng sinh cua cdc ti bdo biiu mo tgo ra vung hogi turgng (hoa thi)(HE 10X).f. Cdc bo ti bdo ca bieu mo bdt mdu di toan (hoa thi) tdng sinh cung cdc ti bdo lap biiu mo da hinh thu; gidn phdn (mitosis) xudt hi$n v&i mat dg ddy (HE 2OX).
dupc tgo nen tii 1 - 2 ldp te bio bieu md da hmh thii. Nhin khdng diln hinh, di dgng, hgch nhin dgng dan, kich thudc rat ldn hogc nhilu nhan con.
Nguyen smh chit thudng rpng, bit raiu ii toan.
Hien tupng giin phan (Mitosis) xuit hien vdi sd
lupng ldn ttgn vi tradng quan sit (hinh 4b). Chi sd MI (Mitotic Index) cao, thay ddi tir 10 - 1 8 mitosis dudi do phdng dgi 100 lan (10 High power field).
Dac biet, cic td bao ung thu xim Iin vi xuit hien ttong long he thdng lympho va mao mach xung
KMUArtQUKY IHUAl IHU Y TAP XXIV SO 8 - 2017
quanh (hinh 4c). Hgch lympho bi di can vdi tdn thucmg nghiem ttpng. Cac te bao lympho bi tbay thg mdt phin bay hoin toan bdi cau true dang dng (hinh 4d). Cic te bio di can co die diem hinh thai vi thg tuong tu vdi kbdi u tuyen vii. Theo hg thdng phan logi u tuyen vii tten cho, meo cua WHO, day li die tnmg cua khdi u don tuygn ac tinh (Simple carcinoma) tten chd.
Khdi u cd su tang sinh khdng kiem soit cua ca hai loai td bio bigu md tuygn. Chung hinh thinh cac ciu tnic bign dpng, khdng cd ranh gidi ro ring, xam lan cac md bao td chirc xung quanh.
Nhdm te bao Idp bieu md tao nen ciu tnic dang
td, dng bat thudng bing mpt hay nhieu ldp tl bio. Cac tl bio ldp bilu md da dgng vg hinh thii vdi nhan khdng didn hinh bat miu dim nhat khdng ddng nhat. Trong khdi u hinh thinh nen cic d hogi tu Idn vdi mit dp gian phan (mitosis) xuat hien khi cao (binh 4e). Nhdm tg bao co bieu md hinh thoi dii khi tich biet, sap xep thinh cic bd tg bao, kgt hpp vdi gian bio xa bit miu ai kiem. Ming te bao md nhgt khien chiing nhu khdng cd gidi han. Nhan te bio ca bilu md bit thudng, tir ttdn tdi det vdi mdt nhan con nim d trang tam (hinh 4f). Hai ttong ba hach lympho xuat hien te bao khdi u. Day la khoj u hdn tuyin ic tinh d chd (Complex carcinoma).
Bang 2. Ton thu'O'ng vi the cua cho mac khoi u tuyen vu
Ton thipang vi the
Hon tuyen Da dang Do'n tuyen Hdn tuyen Hoai tii te bao
Tham nhiem t4 b^o viem
Ranh gidi khdng ro rang, xam I3n md bio Xam l§n m^ch quan, lympho xung quanh Dl can hgch lympho
Chu thich: (+) co ton thucmg vi the(-) khong co ton thucmg vi the(+/-) thtccmg co ton thuang vi the Ket qua d bang 2 cho thay cic tdn thuang vi
the cua nhdm cic khdi u linh tinh vi ic tinh ddu cd hien tupng hogi tir te bio vi tham nhiem te bio vigm. Tuy nhign, d khdi u ic tinh, hien tupng hoai tir xiy ra ttgn dien rdng vdi cac d hoai tir ldn, thay thg cic ciu tnic md tuygn vii do sir tang sinh va xim Iin cua cic te bio tan tao. Vdi khdi u linh tinh, hien tupng hoai tii gidi ban ttong cac dng mygn vdi cac d hoai td nhd cd the do su suy giam cua cic mao mach, khign luong mau cung cap hi thieu hut. Cic te bio viem tham nhilm ciing rat da dang nhu tuong bao, bach cau da nhin trung tinh, nhung chu ylu li dai thuc bao vi bach ciu lympho. Die trung cua cac khdi u ic tinh li ranh gidi khdng ro ring, cd su xim lan md bao xung quanh va cac tl bio ung tiiu thudng dupc tim thay ttong long mgch quan, mach lympho lin cin. Hien tupng di can tdi bach lympho gap kha tiiudng xuygn d khdi u tuyin vii ac tmh ttdn cic chd ttong nghien ciiu. Tuy nhign, cung tuy thudc
vio cic giai doan phit ttiln cua khli u mi hach lympho khdng hoac cd te bao ic tinh thay the mdt pbin hay toin bd cau true bach (Sorenmo, K.U.
va cs, 2011). Ngoii ra, hinh thii nhan td bao va chi sd mitosis (Mitotic Index - MI) cung li mpt yeu td quan ttpng de phin biet sy lanh tinh va ac tinh ciia cic khdi u tuydn vu. Vdi khoi u ac tinh, nhin te bio rat da dgng vi khic biet; chi sd mitosis hiang ddi cao, MI tu 10 - 18 [10 HPF],Ci khdi u linh tinh, nhin tg bio tuang ddi ddng dang vi chi sd MI tii 2 - 3 [10 HPF], tiiip hon nhilu so vdi khdi u ac tinh.
Ngoai cic loai u thudng gap d tten, u tuygn vii tten chd cdn mdt sd dgng linh tinh it ggp khac (u xo tuyen, u don tuygn, u nhu dng siia,...) hay cic dang ic tinh khic (u dng tuyin tgi chd, u dang xa, u dgng xuong, u dgng dgc biet, bilu mo viy,...) (MisdorpW va cs, 1999). Cung vdi su da dang, khdi u tuyin vii cdn cd diln biln va tdc dp phat triln rit thit thudng, do dd, viec chin doin vi
KHOA HQC KY THUAT THU Y TAP XXIV S6 8 - 2017
phin loai khoi u sdra dac bift quan ttpng ttong dilu tri vi tien luong khli u. Hien nay, dii cic phuang phap iing dung sinh hgc phan tu dang rit phat trien, nhung phuang phip chin doin b§nh ly vi the van dupc coi la "tieu chuin ving" dg dinh gii tinh ttgng, phin loai vi tign lupng ttong khdi u tuyen vu (^Rasotto, R. va cs, 2012). Cac logi u niy dgu cd thg chan doan vi phin logi dua ttgn kit qui quan sit, dinh gii tdn thuong vi the.
IV. KET L U ^
Dua vio trigu chimg lim sing, tdn thuong dgi thi vi tdn thuong vi tiig, nghign cim da chin doin vi phin loai mdt sd khdi u tuygn vu thudng gap tren chd d khu vuc Hi Ndi. Cic khdi u xuat hien tten nhigu gidng chd khac nhau chua trigt sin vdi dp tudi tii 5 - 10 tudi. U tuygn vii h khi xuat hign don Ie, chiing thudng gdm nhieu khdi u cung ha^
khic loai phat trign ddng thdi. Tdn thuong vi thg rit da dang vdi sy tang sinh cua tg bio ldp bidu md vi CO bigu md, cung su gdp mat cua te bio trung md sun, xuong hogc md. Khli u ic tinh cd hinh thu te bio rit da dang, vdi su xim lan mgnh me tdi md bio, mgch quin, lympho xung quanh, di cin tdi cic hgch lan cin. Tg bao u lanh tinh ddng deu, ranh gidi ro rang vdi cic d hoai tu nhd. Chi sd MI d khdi u lanh tinh thip hon rat nhieu so vdi khdi u ac tinh.
Loi cdm an: Nhdm tie gia xin chin thinh cim on he thdng phdng khim thii y Hanoi Vet Clinic, phdng khim thu y Hanvet da tgo dieu kieu cho sinh vign bd mdn Bgnh Iy thu y cd mdi trudng thuc tap, tiiu thap mlu va lam vide ttong thdi gian qua.
TAI LIEU THAM KHAO 1. Nguydn Huu Nam, Nguygn Thi Lan, Bui Trin
Anh Dao (2014), Giao tiinh benh ly tiiu y I, Nhd xudt bdn Dgi hoc Nong nghiep, 192.
2. Goldschmidt, M., Shofer, F.S., and Smelstoys, J. A. (2001) Neoplastic lesions of the mammary gland. Pathobiology of the Aging Dog. Iowa State University Press, Ames, IA, 168-178.
3. Kurzman ID, Gilbertson SR (1986) Prognostic factors in canine mammary tumors. Semin Vet Med Surg. 1:25-32.
4. MisdorpW,ElseRW,HellmenE,Lipscomb Tp (1999) Histologic Classification of Mammary
Tumors of the Dog and the Cat, 2nd, vol. 7.
Armed Force Institute of Pathology and World Health Organization, Washington, DC.
5. Moe, L. (2001) Population-based incidence of mammary tumours in some dog breeds. / Reprod Fertil Suppl. 57:439-443.
6. Prophet, E.B. and A.F.I.O. Pattiology.(1992).
Laboratory methods in histotechnology, American Registiy of Pathology.
7. Rasotto, R., Zappulli, V., Castagnaro, M., and Goldschmidt, M.H. (2012) A retiospective study of the histopathologic parameters predictive of invasion of the lymphatic system by canine mammary carcinomas. Vet Pathol.
49:330-340.
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(2007) Mammary gland tumors in male dogs.
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9. Schneider R, Dom CR, Taylor Don. (1969) Factors influencing canine mammary cancer development and postsurgical survival-/ Natl Cancer Inst. 43:1249-1261.
lO.Soon C.K., Dae Y.Y., Mmho K., Kwon Y.L, Ho H.K, hi CR, In K.H., Jung H.C, Jm Y.C.
(2017) Mammary gland tumors m a male Cocker Spaniel, ^c/o Vet Scand 59:20-25.
11. Sorenmo, K.U., Kristiansen, V.M., Cofone, M.A., et al. (2009) Canine mammary gland tumours; a histological continuum fi-om benign to malignant; clinical and histopathological evidence. Vet Comp Oncol. 7.162-172.
12.Sorenmo, K.U., Rasotto R., ZappuIH V, et al. (2011) Development, anatomy, histology, lymphatic drainage, clinical features, and cell differentiation markers of canine mammary gland neoplasms. Vet Pathol. 48:85-97.
U.Stovring M. Moe L, Glattre E. (1997) A population-based case-conttol study of canine mammary tumours and clinical use of medroxyprogesterone acetate. APMIS.
105:590-596 Nhin ngiy 10-7-2017 Phin bi?n ngay 25-8-2017
