{"id":10434,"date":"2022-09-12T18:56:36","date_gmt":"2022-09-12T11:56:36","guid":{"rendered":"https:\/\/easymed.vn\/?p=10434"},"modified":"2022-09-12T18:56:36","modified_gmt":"2022-09-12T11:56:36","slug":"giai-phau-benh-hoc-u-phan-mem-soft-tissue-tumors","status":"publish","type":"post","link":"https:\/\/easymed.vn\/en\/giai-phau-benh-hoc-u-phan-mem-soft-tissue-tumors\/","title":{"rendered":"GI\u1ea2I PH\u1eaaU B\u1ec6NH H\u1eccC: U PH\u1ea6N M\u1ec0M (SOFT TISSUE TUMORS)"},"content":{"rendered":"

Ph\u1ea7n m\u1ec1m (soft tissue) bao g\u1ed3m t\u1ea5t c\u1ea3 c\u00e1c m\u00f4 li\u00ean k\u1ebft trong c\u01a1 th\u1ec3 m\u00e0 kh\u00f4ng thu\u1ed9c v\u1ec1 h\u1ec7 th\u1ed1ng x\u01b0\u01a1ng, kh\u1edbp, th\u1ea7n kinh trung \u01b0\u01a1ng, m\u00f4 t\u1ea1o huy\u1ebft v\u00e0 m\u00f4 lympho. U ph\u1ea7n m\u1ec1m c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf b\u1ea5t k\u1ef3 n\u01a1i n\u00e0o trong c\u01a1 th\u1ec3, nh\u01b0ng th\u01b0\u1eddng nh\u1ea5t l\u00e0 \u1edf c\u00e1c chi.<\/span><\/p>\n

Theo di\u1ec5n ti\u1ebfn sinh h\u1ecdc, ph\u00e2n bi\u1ec7t 3 lo\u1ea1i u ph\u1ea7n m\u1ec1m:<\/span><\/p>\n

U ph\u1ea7n m\u1ec1m l\u00e0nh t\u00ednh<\/strong>, chi\u1ebfm \u0111\u1ea1i \u0111a s\u1ed1 (t\u1ec9 l\u1ec7 l\u00e0nh\/\u00e1c: 100\/1); u d\u1ea1ng c\u1ee5c, th\u01b0\u1eddng n\u1eb1m n\u00f4ng, k\u00edch th\u01b0\u1edbc nh\u1ecf (95% nh\u1ecf h\u01a1n 5cm), gi\u1edbi h\u1ea1n r\u00f5, c\u00f3 v\u1ecf bao. C\u1ea5u t\u1ea1o vi th\u1ec3 y h\u1ec7t m\u00f4 b\u00ecnh th\u01b0\u1eddng. \u0110i\u1ec1u tr\u1ecb kh\u1ecfi h\u1eb3n b\u1eb1ng ph\u1eabu thu\u1eadt.<\/span><\/p>\n

U ph\u1ea7n m\u1ec1m \u00e1c t\u00ednh<\/strong>, c\u00f2n g\u1ecdi l\u00e0 sarcoma ph\u1ea7n m\u1ec1m, ch\u1ec9 chi\u1ebfm 0,9% c\u00e1c ung th\u01b0 \u1edf ng\u01b0\u1eddi (ghi nh\u1eadn t\u1ea1i BV. Ung b\u01b0\u1edbu Tp. HCM, 2003). U l\u1edbn nhanh, th\u01b0\u1eddng c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn (> 5cm), n\u1eb1m s\u00e2u, gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5 v\u00e0 kh\u00f4ng c\u00f3 v\u1ecf bao. U c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf b\u1ea5t k\u1ef3 v\u1ecb tr\u00ed n\u00e0o tr\u00ean c\u01a1 th\u1ec3, nh\u01b0ng 75% tr\u01b0\u1eddng h\u1ee3p l\u00e0 \u1edf c\u00e1c chi (nh\u1ea5t l\u00e0 \u0111\u00f9i), 10% \u1edf th\u00e2n v\u00e0 v\u00f9ng<\/span> sau <\/span>ph\u00fac m\u1ea1c. Xu\u1ea5t \u0111\u1ed9 sarcoma ph\u1ea7n m\u1ec1m t\u0103ng d\u1ea7n theo tu\u1ed5i t\u00e1c, tu\u1ed5i trung b\u00ecnh l\u00e0 65 (tuy nhi\u00ean \u1edf tr\u1ebb em c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p u ph\u1ea7n m\u1ec1m \u00e1c t\u00ednh, th\u00ed d\u1ee5 sarcom c\u01a1 v\u00e2n). C\u00e1c lo\u1ea1i u \u00e1c th\u01b0\u1eddng g\u1eb7p nh\u1ea5t theo th\u1ee9 t\u1ef1 gi\u1ea3m d\u1ea7n l\u00e0 sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 t\u1ebf b\u00e0o \u0111a d\u1ea1ng, sarcoma m\u1ee1, sarcoma c\u01a1 v\u00e2n, sarcoma c\u01a1 tr\u01a1n, sarcoma m\u00e0ng kh\u1edbp, u v\u1ecf bao th\u1ea7n kinh \u00e1c v\u00e0 sarcoma s\u1ee3i.<\/span><\/p>\n

Sarcoma ph\u1ea7n m\u1ec1m c\u00f3 th\u1ec3 di c\u0103n theo \u0111\u01b0\u1eddng m\u00e1u \u0111\u1ebfn ph\u1ed5i v\u00e0 gan; r\u1ea5t hi\u1ebfm khi cho di c\u0103n h\u1ea1ch (ngo\u1ea1i tr\u1eeb sarcoma c\u01a1 v\u00e2n, sarcoma d\u1ea1ng bi\u1ec3u m\u00f4, sarcoma ho\u1ea1t m\u1ea1c, sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 t\u1ebf b\u00e0o \u0111a d\u1ea1ng). \u0110i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu b\u1eb1ng ph\u1eabu thu\u1eadt, nh\u01b0ng ph\u1ea3i ph\u1ed1i h\u1ee3p th\u00eam x\u1ea1 tr\u1ecb v\u00e0 ho\u00e1 tr\u1ecb \u0111\u1ed1i v\u1edbi c\u00e1c u \u00e1c c\u00f3 grad m\u00f4 h\u1ecdc cao. Ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u1ef1a theo grad m\u00f4 h\u1ecdc c\u1ee7a u v\u00e0 giai \u0111o\u1ea1n l\u00e2m s\u00e0ng .<\/span><\/p>\n

H\u1ec7 th\u1ed1ng x\u1ebfp Grad m\u00f4 h\u1ecdc sarcoma ph\u1ea7n m\u1ec1m theo Hi\u1ec7p h\u1ed9i c\u00e1c Trung t\u00e2m Ph\u00f2ng ch\u1ed1ng Ung th\u01b0<\/span> Ph\u00e1p <\/span>qu\u1ed1c (FNCLCC: F\u00e9d\u00e9ration Nationale de Centres de Lutte Contre le Cancer)<\/span><\/p>\n

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U ph\u1ea7n m\u1ec1m gi\u00e1p bi\u00ean \u00e1c: l\u00e0 c\u00e1c u c\u00f3 di\u1ec5n ti\u1ebfn sinh h\u1ecdc n\u1eb1m trung gian gi\u1eefa 2 lo\u1ea1i tr\u00ean. U x\u00e2m nh\u1eadp t\u1ea1i ch\u1ed7, d\u1ec5 t\u00e1i ph\u00e1t<\/span> sau <\/span>ph\u1eabu thu\u1eadt nh\u01b0ng hi\u1ebfm khi cho di c\u0103n.<\/span><\/p>\n

Nguy\u00ean nh\u00e2n g\u00e2y ra u ph\u1ea7n m\u1ec1m v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c r\u00f5; m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 \u0111\u00e3 n\u00eau l\u00ean vai tr\u00f2 c\u1ee7a y\u1ebfu t\u1ed1 di truy\u1ec1n, m\u00f4i tr\u01b0\u1eddng, b\u1ee9c x\u1ea1 ion ho\u00e1, vir\u00fat,<\/span> s\u1eb9o <\/span>c\u0169, v.v. nh\u01b0ng c\u00f3 v\u1ebb nh\u01b0 \u0111\u1ea1i \u0111a s\u1ed1 u ph\u1ea7n m\u1ec1m \u0111\u1ec1u l\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t hi\u1ec7n t\u1ef1 ph\u00e1t m\u1edbi (de novo).<\/span><\/p>\n

Theo quan \u0111i\u1ec3m hi\u1ec7n nay, u ph\u1ea7n m\u1ec1m xu\u1ea5t ph\u00e1t t\u1eeb c\u00e1c t\u1ebf b\u00e0o trung m\u00f4 \u0111a ti\u1ec1m n\u0103ng c\u00f3 s\u1eb5n trong ph\u1ea7n m\u1ec1m ho\u1eb7c t\u1eeb t\u1ee7y x\u01b0\u01a1ng chuy\u1ec3n \u0111\u1ebfn; khi t\u1ebf b\u00e0o n\u00e0y chuy\u1ec3n d\u1ea1ng th\u00e0nh t\u1ebf b\u00e0o u, c\u00f3 th\u1ec3 t\u0103ng sinh v\u00e0 bi\u1ec7t ho\u00e1 theo nhi\u1ec1u h\u01b0\u1edbng kh\u00e1c nhau \u0111\u1ec3 t\u1ea1o ra u s\u1ee3i, u m\u1ee1, u c\u01a1, u m\u1ea1ch m\u00e1u… ho\u1eb7c m\u1ed9t u ch\u1eb3ng c\u00f3 h\u01b0\u1edbng bi\u1ec7t ho\u00e1 n\u00e0o r\u00f5 r\u1ec7t. V\u00ec v\u1eady, u ph\u1ea7n m\u1ec1m r\u1ea5t \u0111a d\u1ea1ng, vi\u1ec7c ph\u00e2n lo\u1ea1i kh\u00f3 kh\u0103n v\u00e0 s\u1ebd c\u00f2n ti\u1ebfp t\u1ee5c thay \u0111\u1ed5i do kh\u00f4ng ng\u1eebng \u0111\u01b0\u1ee3c b\u1ed5 sung nh\u1eefng hi\u1ec3u bi\u1ebft m\u1edbi v\u1ec1 ho\u00e1 m\u00f4 mi\u1ec5n d\u1ecbch, di truy\u1ec1n h\u1ecdc t\u1ebf b\u00e0o v\u00e0 sinh h\u1ecdc ph\u00e2n t\u1eed. B\u1ea3ng ph\u00e2n lo\u1ea1i u ph\u1ea7n m\u1ec1m m\u1edbi nh\u1ea5t do T\u1ed5 ch\u1ee9c Y t\u1ebf th\u1ebf gi\u1edbi \u0111\u01b0a ra n\u0103m 2013 li\u1ec7t k\u00ea 11 nh\u00f3m u ph\u1ea7n m\u1ec1m, g\u1ed3m kho\u1ea3ng 100 lo\u1ea1i kh\u00e1c nhau, trong \u0111\u00f3 50 lo\u1ea1i l\u00e0 sarcoma.<\/span><\/p>\n

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U M\u1ee0 (LIPOMATOUS TUMORS):<\/span><\/h3>\n

U m\u1ee1 l\u00e0nh (lipoma):<\/span><\/h4>\n

L\u00e0 lo\u1ea1i u ph\u1ea7n m\u1ec1m l\u00e0nh t\u00ednh th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, x\u1ea3y ra \u1edf ng\u01b0\u1eddi l\u1edbn t\u1eeb 40 – 60 tu\u1ed5i. U m\u00e0u v\u00e0ng, gi\u1edbi h\u1ea1n r\u00f5, c\u00f3 v\u1ecf bao; k\u00edch th\u01b0\u1edbc trung b\u00ecnh kho\u1ea3ng 3 cm. U hay g\u1eb7p \u1edf v\u00f9ng c\u1ed5, l\u01b0ng, vai, b\u1ee5ng. Tr\u00ean vi th\u1ec3, u c\u1ea5u t\u1ea1o nh\u01b0 m\u00f4 m\u1ee1 b\u00ecnh th\u01b0\u1eddng. (H\u00ecnh 30)<\/span><\/p>\n

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H\u00ecnh 30: U m\u1ee1 l\u00e0nh c\u00f3 m\u00e0u v\u00e0ng, gi\u1edbi h\u1ea1n r\u00f5, c\u00f3 v\u1ecf bao (A); Vi th\u1ec3 gi\u1ed1ng m\u00f4 m\u1ee1 b\u00ecnh th\u01b0\u1eddng (B)<\/span><\/em><\/p>\n

Sarcoma m\u1ee1 (liposarcoma)<\/span><\/h4>\n

C\u0169ng l\u00e0 m\u1ed9t lo\u1ea1i u th\u01b0\u1eddng g\u1eb7p; ch\u1ec9 \u0111\u1ee9ng<\/span> sau <\/span>sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 t\u1ebf b\u00e0o \u0111a d\u1ea1ng. U x\u1ea3y ra \u1edf ng\u01b0\u1eddi l\u1edbn t\u1eeb 40 – 70 tu\u1ed5i. U c\u00f3 th\u1ec3 \u0111\u1ea1t k\u00edch th\u01b0\u1edbc r\u1ea5t l\u1edbn (tr\u00ean 10 cm), hay th\u1ea5y \u1edf v\u00f9ng \u0111\u00f9i v\u00e0<\/span> sau <\/span>ph\u00fac m\u1ea1c. U x\u00e2m nh\u1eadp t\u1ea1i ch\u1ed7, hay t\u00e1i ph\u00e1t<\/span> sau <\/span>ph\u1eabu thu\u1eadt, di c\u0103n theo \u0111\u01b0\u1eddng m\u00e1u \u0111\u1ebfn ph\u1ed5i. Tr\u00ean vi th\u1ec3, u c\u1ea5u t\u1ea1o b\u1edfi c\u00e1c t\u1ebf b\u00e0o m\u1ee1 \u00edt nhi\u1ec1u gi\u1ed1ng t\u1ebf b\u00e0o m\u1ee1 b\u00ecnh th\u01b0\u1eddng, tuy nhi\u00ean lu\u00f4n c\u00f3 c\u00e1c nguy\u00ean b\u00e0o m\u1ee1 (lipoblast), l\u00e0 \u0111i\u1ec1u ki\u1ec7n ti\u00ean quy\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n sarcoma m\u1ee1. (H\u00ecnh 31)<\/span><\/p>\n

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H\u00ecnh 31: Sarcoma m\u1ee1 c\u00f3 k\u00edch th\u01b0\u1edbc tr\u00ean 10 cm (A), t\u1ebf b\u00e0o u gi\u1ed1ng t\u1ebf b\u00e0o m\u1ee1 b\u00ecnh th\u01b0\u1eddng nh\u01b0ng lu\u00f4n c\u00f3 nguy\u00ean b\u00e0o m\u1ee1 (m\u0169i t\u00ean, B), nguy\u00ean b\u00e0o m\u1ee1 ch\u1ee9a nhi\u1ec1u kh\u00f4ng b\u00e0o m\u1ee1 trong b\u00e0o t\u01b0\u01a1ng, \u1ea5n l\u00f5m nh\u00e2n (C)<\/span><\/em><\/p>\n

U S\u1ee2I ( FIBROUS TISSUE TUMORS)<\/span><\/h3>\n

U s\u1ee3i l\u00e0nh c\u1ee7a m\u00e0ng g\u00e2n (fibroma of tendon sheath):<\/span><\/h4>\n

L\u00e0 u l\u00e0nh t\u00ednh, th\u01b0\u1eddng g\u1eb7p \u1edf gi\u1edbi nam t\u1eeb 30 – 50 tu\u1ed5i. U c\u00f3 d\u1ea1ng c\u1ee5c, gi\u1edbi h\u1ea1n r\u00f5, \u1edf ng\u00f3n tay ho\u1eb7c b\u00e0n ch\u00e2n, d\u00ednh v\u00e0o m\u00e0ng g\u00e2n. C\u1ea5u t\u1ea1o vi th\u1ec3 l\u00e0 m\u1ed9t m\u00f4 s\u1ee3i collagen \u0111\u1eb7c, v\u1edbi c\u00e1c nguy\u00ean b\u00e0o s\u1ee3i n\u1eb1m r\u1ea3i r\u00e1c. (H\u00ecnh 32)<\/span><\/p>\n

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H\u00ecnh 32: U s\u1ee3i c\u1ee7a m\u00e0ng g\u00e2n \u1edf ng\u00f3n 3 (A); c\u1ea5u t\u1ea1o vi th\u1ec3 (B)<\/span><\/em><\/p>\n

Sarcoma s\u1ee3i (fibrosarcoma):<\/span><\/h4>\n

X\u1ea3y ra ch\u1ee7 y\u1ebfu \u1edf ng\u01b0\u1eddi l\u1edbn t\u1eeb 30 – 60 tu\u1ed5i. U n\u1eb1m s\u00e2u, d\u1ea1ng c\u1ee5c, gi\u1edbi h\u1ea1n r\u00f5 nh\u01b0ng kh\u00f4ng c\u00f3 v\u1ecf bao, k\u00edch th\u01b0\u1edbc t\u1eeb 3 – 8 cm, m\u1eadt \u0111\u1ed9 ch\u1eafc; v\u1ecb tr\u00ed th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 \u1edf chi d\u01b0\u1edbi. Tr\u00ean vi th\u1ec3, c\u00e1c t\u1ebf b\u00e0o u h\u00ecnh thoi gi\u1ed1ng nguy\u00ean b\u00e0o s\u1ee3i, x\u1ebfp th\u00e0nh b\u00f3 b\u1eaft ch\u00e9o nhau nh\u01b0 x\u01b0\u01a1ng c\u00e1, t\u1ec9 l\u1ec7 ph\u00e2n b\u00e0o cao. (H\u00ecnh 33)<\/span><\/p>\n

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H\u00ecnh 33: Sarcoma s\u1ee3i \u1edf ph\u1ea7n<\/span> sau <\/span>\u0111\u00f9i, gi\u1edbi h\u1ea1n r\u1ecd, n\u1eb1m gi\u1eefa kh\u1ed1i c\u01a1 v\u00e2n (A); c\u1ea5u t\u1ea1o vi th\u1ec3, t\u1ebf b\u00e0o h\u00ecnh thoi x\u1ebfp b\u00f3 b\u1eaft ch\u00e9o nhau, nhi\u1ec1u ph\u00e2n b\u00e0o (m\u0169i t\u00ean, B).<\/span><\/em><\/p>\n

U M\u00d4 B\u00c0O S\u1ee2I (FIBROHISTIOCYTIC TUMORS):<\/span><\/h3>\n

U m\u00f4 b\u00e0o s\u1ee3i l\u00e0nh (fibrous histiocytoma):<\/span><\/h4>\n

U x\u1ea3y ra \u1edf ng\u01b0\u1eddi l\u1edbn t\u1eeb 20-40 tu\u1ed5i. U d\u1ea1ng c\u1ee5c kh\u00f4ng \u0111au, n\u1eb1m n\u00f4ng trong l\u1edbp b\u00ec v\u00e0 m\u00f4 d\u01b0\u1edbi da ho\u1eb7c n\u1eb1m s\u00e2u b\u00ean trong c\u00e1c b\u00f3 c\u01a1 c\u1ee7a chi, h\u1ea7u h\u1ebft c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf h\u01a1n 3cm; Tr\u00ean vi th\u1ec3, c\u00e1c t\u1ebf b\u00e0o u c\u00f3 nh\u00e2n h\u00ecnh thoi gi\u1ed1ng nguy\u00ean b\u00e0o s\u1ee3i ho\u1eb7c h\u00ecnh b\u1ea7u d\u1ee5c gi\u1ed1ng m\u00f4 b\u00e0o, x\u1ebfp th\u00e0nh b\u00f3 ph\u00e2n b\u1ed1 ki\u1ec3u xo\u00e1y l\u1ed1c (storiform), tr\u1ed9n l\u1eabn v\u1edbi c\u00e1c t\u1ebf b\u00e0o b\u1ecdt v\u00e0 \u0111\u1ea1i b\u00e0o Touton. (H\u00ecnh 34)<\/span><\/p>\n

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H\u00ecnh 34 : U d\u1ea1ng c\u1ee5c trong l\u1edbp b\u00ec da (A) ; C\u00e1c t\u1ebf b\u00e0o u h\u00ecnh thoi x\u1ebfp b\u00f3 xo\u00e1y l\u1ed1c v\u00e0 \u0111\u1ea1i b\u00e0o Touton (B).<\/span><\/em><\/p>\n

U C\u01a0 TR\u01a0N ( SMOOTH MUSCLE TUMORS)<\/span><\/h3>\n

U c\u01a1 tr\u01a1n l\u00e0nh (leiomyoma):<\/span><\/h4>\n

Th\u01b0\u1eddng x\u1ea3y ra \u1edf ng\u01b0\u1eddi tr\u1ebb 15 – 25 tu\u1ed5i, u n\u1eb1m trong da, c\u00f3 d\u1ea1ng m\u1ed9t c\u1ee5c \u0111\u01a1n \u0111\u1ed9c hay nhi\u1ec1u c\u1ee5c, \u0111\u01b0\u1eddng k\u00ednh 1- 2 cm, gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5. Tr\u00ean vi th\u1ec3, u t\u1ea1o b\u1edfi c\u00e1c b\u00f3 t\u1ebf b\u00e0o c\u01a1 tr\u01a1n gi\u1ed1ng c\u01a1 tr\u01a1n b\u00ecnh th\u01b0\u1eddng; kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh ph\u00e2n b\u00e0o. (H\u00ecnh 35)<\/span><\/p>\n

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H\u00ecnh 35: U c\u00f3 d\u1ea1ng nhi\u1ec1u c\u1ee5c tr\u00ean da (A); vi th\u1ec3, t\u1ebf b\u00e0o u t\u1ea1o b\u00f3 gi\u1ed1ng b\u00f3 c\u01a1 tr\u01a1n b\u00ecnh th\u01b0\u1eddng (B)<\/span><\/em><\/p>\n

Sarcoma c\u01a1 tr\u01a1n (leiomyosarcoma):<\/span><\/h4>\n

X\u1ea3y ra \u1edf gi\u1edbi n\u1eef nhi\u1ec1u h\u01a1n gi\u1edbi nam, tu\u1ed5i trung b\u00ecnh l\u00e0 60.<\/span><\/p>\n

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H\u00ecnh 36: Sarcoma c\u01a1 tr\u01a1n<\/span> sau <\/span>ph\u00fac m\u1ea1c k\u00edch th\u01b0\u1edbc l\u1edbn, m\u1eb7t c\u1eaft \u0111\u1eb7c ch\u1eafc nh\u01b0 th\u1ecbt, c\u00f3 ch\u1ed7 xu\u1ea5t huy\u1ebft ho\u1ea1i t\u1eed (A); vi th\u1ec3 g\u1ed3m t\u1ebf b\u00e0o h\u00ecnh thoi d\u1ecb d\u1ea1ng, x\u1ebfp b\u00f3, c\u00f3 nhi\u1ec1u ph\u00e2n b\u00e0o (m\u0169i t\u00ean,B)<\/span><\/em><\/p>\n

U th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n trong v\u00f9ng<\/span> sau <\/span>ph\u00fac m\u1ea1c v\u00e0 trong \u1ed5 b\u1ee5ng. U c\u00f3 k\u00edch th\u01b0\u1edbc r\u1ea5t l\u1edbn (trung b\u00ecnh kho\u1ea3ng 16cm), m\u1eb7t c\u1eaft m\u00e0u tr\u1eafng x\u00e1m, xen l\u1eabn nh\u1eefng v\u00f9ng ho\u1ea1i t\u1eed, xu\u1ea5t huy\u1ebft v\u00e0 tho\u00e1i ho\u00e1 b\u1ecdc. Tr\u00ean vi th\u1ec3, u t\u1ea1o b\u1edfi c\u00e1c t\u1ebf b\u00e0o c\u00f3 nh\u00e2n h\u00ecnh thoi gi\u1ed1ng t\u1ebf b\u00e0o c\u01a1 tr\u01a1n b\u00ecnh th\u01b0\u1eddng (nh\u00e2n h\u00ecnh \u0111i\u1ebfu x\u00ec g\u00e0), xen l\u1eabn v\u1edbi c\u00e1c t\u1ebf b\u00e0o d\u1ecb d\u1ea1ng, x\u1ebfp th\u00e0nh b\u00f3; t\u1ec9 l\u1ec7 ph\u00e2n b\u00e0o cao. (H\u00ecnh 36)<\/span><\/p>\n

U C\u01a0 V\u00c2N (SKELETAL MUSCLE TUMORS):<\/span><\/h3>\n

U c\u01a1 v\u00e2n l\u00e0nh (rhabdomyoma):<\/span><\/h4>\n

C\u00f3 th\u1ec3 x\u1ea3y ra \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i, th\u01b0\u1eddng g\u1eb7p \u1edf v\u00f9ng \u0111\u1ea7u c\u1ed5. U c\u00f3 d\u1ea1ng c\u1ee5c, gi\u1edbi h\u1ea1n r\u00f5 nh\u01b0ng kh\u00f4ng c\u00f3 v\u1ecf bao, k\u00edch th\u01b0\u1edbc trung b\u00ecnh kho\u1ea3ng 3cm, m\u1eb7t c\u1eaft d\u1ea1ng h\u1ea1t m\u1ecbn, m\u00e0u n\u00e2u \u0111\u1ecf. Tr\u00ean vi th\u1ec3, u t\u1ea1o b\u1edfi c\u00e1c t\u1ebf b\u00e0o \u0111a di\u1ec7n, nh\u00e2n nh\u1ecf l\u1ec7ch b\u00ean v\u00e0 b\u00e0o t\u01b0\u01a1ng r\u1ea5t \u00e1i toan, c\u00f3 th\u1ec3 c\u00f3 kh\u00f4ng b\u00e0o. (H\u00ecnh 37)\u00a0\u00a0<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 37: U c\u01a1 v\u00e2n l\u00e0nh v\u00f9ng c\u1ed5, m\u1eb7t c\u1eaft \u0111\u1ecf m\u1ecbn nh\u01b0 th\u1ecbt (A); Vi th\u1ec3 t\u1ebf b\u00e0o c\u00f3 nh\u00e2n l\u1ec7ch, b\u00e0o t\u01b0\u01a1ng \u00e1i toan, c\u00f3 kh\u00f4ng b\u00e0o (B).<\/span><\/em><\/p>\n

Sarcoma c\u01a1 v\u00e2n (rhabdomyosarcoma):<\/span><\/h4>\n

L\u00e0 lo\u1ea1i u ph\u1ea7n m\u1ec1m \u00e1c t\u00ednh hay g\u1eb7p nh\u1ea5t \u1edf tr\u1ebb em, v\u1ecb tr\u00ed th\u01b0\u1eddng th\u1ea5y l\u00e0 \u1edf v\u00f9ng ph\u1ea7n m\u1ec1m c\u1ea1nh tinh ho\u00e0n, \u00e2m \u0111\u1ea1o v\u00e0 v\u00f9ng \u0111\u1ea7u c\u1ed5. U c\u00f3 k\u00edch th\u01b0\u1edbc trung b\u00ecnh 3 – 4cm, gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5, m\u1eadt \u0111\u1ed9 ch\u1eafc, m\u1eb7t c\u1eaft d\u1ea1ng h\u1ea1t m\u1ecbn, m\u00e0u n\u00e2u \u0111\u1ecf, c\u00f3 xen l\u1eabn nh\u1eefng v\u00f9ng xu\u1ea5t huy\u1ebft ho\u1ea1i t\u1eed. C\u1ea5u t\u1ea1o vi th\u1ec3 \u0111a d\u1ea1ng, v\u1edbi c\u00e1c t\u1ebf b\u00e0o u h\u00ecnh tr\u00f2n, h\u00ecnh thoi ho\u1eb7c \u0111a di\u1ec7n, nh\u00e2n t\u0103ng s\u1eafc, b\u00e0o t\u01b0\u01a1ng \u00e1i toan c\u00f3 ch\u1ee9a c\u00e1c v\u00e2n c\u01a1 gi\u1ed1ng c\u00e1c nguy\u00ean b\u00e0o c\u01a1 v\u00e2n (rhabdomyoblast); t\u1ec9 l\u1ec7 ph\u00e2n b\u00e0o t\u0103ng. Sarcoma c\u01a1 v\u00e2n l\u00e0 lo\u1ea1i u c\u00f3 \u0111\u1ed9 \u00e1c t\u00ednh cao, ph\u00e1t tri\u1ec3n nhanh, di c\u0103n theo \u0111\u01b0\u1eddng m\u00e1u \u0111\u1ebfn ph\u1ed5i, t\u1ee7y x\u01b0\u01a1ng v\u00e0 c\u00f3 th\u1ec3 cho di c\u0103n h\u1ea1ch. (H\u00ecnh 38)<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 38: Sarcoma c\u01a1 v\u00e2n n\u1eb1m s\u00e2u trong ph\u1ea7n m\u1ec1m \u0111\u00f9i, m\u1eb7t c\u1eaft m\u00e0u \u0111\u1ecf, c\u00f3 \u1ed5 xu\u1ea5t huy\u1ebft v\u00e0 ho\u1ea1i t\u1eed(A); Vi th\u1ec3 t\u1ebf b\u00e0o u gi\u1ed1ng nguy\u00ean b\u00e0o c\u01a1 v\u00e2n, nh\u00e2n t\u0103ng s\u1eafc, b\u00e0o t\u01b0\u01a1ng \u00e1i toan, c\u00f3 ch\u1ee9a v\u00e2n c\u01a1 (B,C,D).<\/span><\/em><\/p>\n

U M\u1ea0CH M\u00c1U (TUMORS OF BLOOD VESSELS)<\/span><\/h3>\n

G\u1ed3m c\u00f3 u m\u1ea1ch m\u00e1u l\u00e0nh (hemangioma) v\u00e0 sarcoma m\u1ea1ch m\u00e1u (angiosarcoma), \u0111\u00e3 \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong ch\u01b0\u01a1ng b\u1ec7nh l\u00fd tim v\u00e0 m\u1ea1ch m\u00e1u.<\/span><\/p>\n

U C\u00d3 H\u01af\u1edaNG BI\u1ec6T H\u00d3A KH\u00d4NG R\u00d5 R\u1ec6T (TUMORS OF UNCERTAIN DIFFERENTIATION)<\/span><\/h3>\n

L\u00e0 1 nh\u00f3m g\u1ed3m nhi\u1ec1u lo\u1ea1i u ph\u1ea7n m\u1ec1m kh\u00e1c nhau, c\u00f3 th\u1ec3 l\u00e0nh t\u00ednh, gi\u00e1p bi\u00ean \u00e1c ho\u1eb7c \u00e1c t\u00ednh. U c\u00f3 h\u00ecnh \u1ea3nh vi th\u1ec3 \u0111\u1eb7c tr\u01b0ng nh\u01b0ng h\u01b0\u1edbng bi\u1ec7t h\u00f3a l\u1ea1i kh\u00f4ng r\u00f5 r\u00e0ng, th\u00ed d\u1ee5 sarcoma m\u00e0ng kh\u1edbp.<\/span><\/p>\n

Sarcoma m\u00e0ng kh\u1edbp (Synovial sarcoma):<\/span><\/h4>\n

L\u00e0 1 u ph\u1ea7n m\u1ec1m kh\u00f4ng r\u00f5 h\u01b0\u1edbng bi\u1ec7t h\u00f3a, v\u00ec tuy c\u00f3 t\u00ean g\u1ecdi l\u00e0 sarcoma m\u00e0ng kh\u1edbp nh\u01b0ng kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y t\u1ebf b\u00e0o u bi\u1ec7t ho\u00e1 theo h\u01b0\u1edbng m\u00e0ng kh\u1edbp. U x\u1ea3y ra \u1edf ng\u01b0\u1eddi tr\u1ebb t\u1eeb 15 – 40 tu\u1ed5i, th\u01b0\u1eddng th\u1ea5y \u1edf ph\u1ea7n m\u1ec1m g\u1ea7n kh\u1edbp; k\u00edch th\u01b0\u1edbc t\u1eeb 3 – 5 cm, gi\u1edbi h\u1ea1n r\u00f5 nh\u01b0ng kh\u00f4ng c\u00f3 v\u1ecf bao, m\u1eb7t c\u1eaft tr\u1eafng, c\u00f3 v\u00f9ng tho\u00e1i ho\u00e1 b\u1ecdc. C\u1ea5u t\u1ea1o vi th\u1ec3 \u0111\u1eb7c tr\u01b0ng g\u1ed3m 2 pha v\u1edbi nh\u1eefng t\u1ebf b\u00e0o u h\u00ecnh thoi, x\u1ebfp th\u00e0nh b\u00f3, n\u1eb1m chen gi\u1eefa c\u00e1c c\u1ea5u tr\u00fac gi\u1ea3 tuy\u1ebfn, c\u0169ng do t\u1ebf b\u00e0o u t\u1ea1o n\u00ean. U c\u00f3 \u0111\u1ed9 \u00e1c t\u00ednh cao, c\u00f3 th\u1ec3 cho di c\u0103n theo \u0111\u01b0\u1eddng m\u00e1u \u0111\u1ebfn ph\u1ed5i v\u00e0 di c\u0103n h\u1ea1ch. (H\u00ecnh 39)<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 39: Sarcoma m\u00e0ng kh\u1edbp n\u1eb1m trong kh\u1ed1i c\u01a1 quanh x\u01b0\u01a1ng ch\u00e0y v\u00e0 x\u01b0\u01a1ng m\u00e1c (*), u gi\u1edbi h\u1ea1n r\u00f5, m\u1eb7t c\u1eaft tr\u1eafng, c\u00f3 v\u00f9ng tho\u00e1i ho\u00e1 b\u1ecdc (A); t\u1ebf b\u00e0o u h\u00ecnh thoi x\u1ebfp b\u00f3 (1), chen gi\u1eefa c\u00e1c c\u1ea5u tr\u00fac d\u1ea1ng tuy\u1ebfn (2, B).<\/span><\/em><\/p>\n

SARCOMA KH\u00d4NG BI\u1ec6T HO\u00c1 \/ KH\u00d4NG X\u00c1C \u0110\u1ecaNH LO\u1ea0I (UNDIFFERENTIATED\/<\/span><\/h3>\n

Unclassified sarcoma)<\/span><\/h4>\n

L\u00e0 nh\u00f3m u m\u1edbi \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o trong b\u1ea3ng ph\u00e2n lo\u1ea1i u ph\u1ea7n m\u1ec1m 2013 c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf th\u1ebf gi\u1edbi, nh\u01b0ng l\u1ea1i chi\u1ebfm t\u1eeb 10 \u0111\u1ebfn 20% sarcoma ph\u1ea7n m\u1ec1m. U kh\u00f4ng cho th\u1ea5y 1 h\u01b0\u1edbng bi\u1ec7t h\u00f3a n\u00e0o r\u00f5 r\u1ec7t \u0111\u1ec3 x\u1ebfp v\u00e0o trong c\u00e1c nh\u00f3m ph\u00e2n lo\u1ea1i \u0111\u00e3 c\u00f3; \u0111\u1ebfn m\u1ee9c m\u00e0 th\u1ea7y<\/span> thu\u1ed1c <\/span>gi\u1ea3i ph\u1eabu b\u1ec7nh \u0111\u00e0nh ph\u1ea3i s\u1eed d\u1ee5ng h\u00ecnh d\u1ea1ng t\u1ebf b\u00e0o u \u0111\u1ec3 \u0111\u1eb7t t\u00ean cho ch\u1ea9n \u0111o\u00e1n, th\u00ed d\u1ee5 nh\u01b0 sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 t\u1ebf b\u00e0o h\u00ecnh thoi, sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 t\u1ebf b\u00e0o tr\u00f2n, sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 t\u1ebf b\u00e0o d\u1ea1ng bi\u1ec3u m\u00f4, sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 t\u1ebf b\u00e0o \u0111a d\u1ea1ng… \u0110\u00e1ng<\/span> ch\u00fa <\/span>\u00fd nh\u1ea5t l\u00e0 lo\u1ea1i<\/span> sau <\/span>c\u00f9ng, b\u1edfi n\u00f3 c\u0169ng l\u00e0 lo\u1ea1i sarcom ph\u1ea7n m\u1ec1m th\u01b0\u1eddng g\u1eb7p nh\u1ea5t.<\/span><\/p>\n

Sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 t\u1ebf b\u00e0o \u0111a d\u1ea1ng ( Undifferentiated pleomorphic sarcoma)<\/span><\/h4>\n

L\u00e0 lo\u1ea1i sarcoma ph\u1ea7n m\u1ec1m th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ng\u01b0\u1eddi tr\u00ean 50 tu\u1ed5i. U th\u01b0\u1eddng n\u1eb1m s\u00e2u trong ph\u1ea7n m\u1ec1m chi d\u01b0\u1edbi ho\u1eb7c trong v\u00f9ng<\/span> sau <\/span>ph\u00fac m\u1ea1c; k\u00edch th\u01b0\u1edbc 5 – 10cm, gi\u1edbi h\u1ea1n r\u00f5 nh\u01b0ng kh\u00f4ng c\u00f3 v\u1ecf bao, m\u1eb7t c\u1eaft m\u00e0u tr\u1eafng x\u00e1m, c\u00f3 nh\u1eefng v\u00f9ng ho\u1ea1i t\u1eed xu\u1ea5t huy\u1ebft. Tr\u00ean vi th\u1ec3, c\u00e1c t\u1ebf b\u00e0o u h\u00ecnh thoi ho\u1eb7c \u0111a di\u1ec7n, nh\u00e2n \u0111a d\u1ea1ng v\u00e0 d\u1ecb d\u1ea1ng, t\u1ec9 l\u1ec7 ph\u00e2n b\u00e0o cao v\u00e0 c\u00f3 nhi\u1ec1u ph\u00e2n b\u00e0o b\u1ea5t th\u01b0\u1eddng, c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 nhi\u1ec1u nh\u00e2n. Sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 \u0111a d\u1ea1ng c\u00f3 \u0111\u1ed9 \u00e1c t\u00ednh cao, u l\u1edbn nhanh, x\u00e2m nh\u1eadp t\u1ea1i ch\u1ed7 v\u00e0 cho di c\u0103n xa \u0111\u1ebfn ph\u1ed5i v\u00e0 gan, 1 s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 cho di c\u0103n h\u1ea1ch; t\u1ec9 l\u1ec7 s\u1ed1ng c\u00f2n 5 n\u0103m<\/span> sau <\/span>\u0111i\u1ec1u tr\u1ecb ch\u1ec9 v\u00e0o kho\u1ea3ng 50%. (H\u00ecnh 40)<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 40: Sarcoma kh\u00f4ng bi\u1ec7t ho\u00e1 \u0111a d\u1ea1ng, n\u1eb1m s\u00e2u, gi\u1edbi h\u1ea1n r\u00f5, kh\u00f4ng v\u1ecf bao, m\u1eb7t c\u1eaft nhi\u1ec1u \u1ed5 ho\u1ea1i t\u1eed v\u00e0 xu\u1ea5t huy\u1ebft, g\u00e2y lo\u00e9t da b\u1ec1 m\u1eb7t (m\u0169i t\u00ean, A). T\u1ebf b\u00e0o u h\u00ecnh thoi, nh\u00e2n \u0111a d\u1ea1ng v\u00e0 d\u1ecb d\u1ea1ng, ph\u00e2n b\u00e0o b\u1ea5t th\u01b0\u1eddng (m\u0169i t\u00ean), c\u00f3 t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 nhi\u1ec1u nh\u00e2n (B)\u2026<\/span><\/em><\/p>\n

 <\/p>","protected":false},"excerpt":{"rendered":"

Ph\u1ea7n m\u1ec1m (soft tissue) bao g\u1ed3m t\u1ea5t c\u1ea3 c\u00e1c m\u00f4 li\u00ean k\u1ebft trong c\u01a1 th\u1ec3 m\u00e0 kh\u00f4ng thu\u1ed9c<\/p>","protected":false},"author":21,"featured_media":10437,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-10434","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-giai-phau"],"_links":{"self":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/10434","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/comments?post=10434"}],"version-history":[{"count":1,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/10434\/revisions"}],"predecessor-version":[{"id":10448,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/10434\/revisions\/10448"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/media\/10437"}],"wp:attachment":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/media?parent=10434"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/categories?post=10434"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/tags?post=10434"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}