{"id":1192,"date":"2025-11-27T12:09:07","date_gmt":"2025-11-27T05:09:07","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=1192"},"modified":"2025-12-02T10:51:17","modified_gmt":"2025-12-02T03:51:17","slug":"sarcoma-tu-cung-bieu-hien-lam-sang-va-dac-diem-mri","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/sarcoma-tu-cung-bieu-hien-lam-sang-va-dac-diem-mri\/","title":{"rendered":"Sarcoma t\u1eed cung: bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m MRI"},"content":{"rendered":"\n
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Sarcoma t\u1eed cung: bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m MRI<\/strong>
https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4463355\/<\/a><\/p>\n<\/blockquote>\n\n\n\n

T\u00f3m t\u1eaft<\/strong><\/h3>\n\n\n\n

Sarcoma t\u1eed cung l\u00e0 m\u1ed9t nh\u00f3m c\u00e1c kh\u1ed1i u hi\u1ebfm g\u1eb7p v\u00e0 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t c\u00f3 ngu\u1ed3n g\u1ed1c trung m\u00f4, chi\u1ebfm kho\u1ea3ng 8% c\u00e1c b\u1ec7nh l\u00fd \u00e1c t\u00ednh \u1edf t\u1eed cung. Ch\u00fang bao g\u1ed3m sarcoma c\u01a1 tr\u01a1n (leiomyosarcoma), sarcoma m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung (endometrial stromal sarcoma), sarcoma n\u1ed9i m\u1ea1c t\u1eed cung kh\u00f4ng bi\u1ec7t h\u00f3a (undifferentiated endometrial sarcoma) v\u00e0 sarcoma tuy\u1ebfn (adenosarcoma). So v\u1edbi ung th\u01b0 bi\u1ec3u m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung th\u01b0\u1eddng g\u1eb7p h\u01a1n, sarcoma t\u1eed cung c\u00f3 di\u1ec5n ti\u1ebfn \u00e1c t\u00ednh h\u01a1n v\u00e0 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng x\u1ea5u h\u01a1n. Do \u0111\u1eb7c \u0111i\u1ec3m sinh h\u1ecdc v\u00e0 l\u00e2m s\u00e0ng kh\u00e1c bi\u1ec7t, Li\u00ean \u0111o\u00e0n S\u1ea3n ph\u1ee5 khoa Qu\u1ed1c t\u1ebf (FIGO) \u0111\u00e3 \u0111\u01b0a ra m\u1ed9t h\u1ec7 th\u1ed1ng ph\u00e2n giai \u0111o\u1ea1n m\u1edbi cho sarcoma t\u1eed cung v\u00e0o n\u0103m 2009, ph\u00e2n lo\u1ea1i carcinosarcoma t\u1eed cung l\u00e0 m\u1ed9t bi\u1ebfn th\u1ec3 c\u1ee7a ung th\u01b0 bi\u1ec3u m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung, thay v\u00ec l\u00e0 m\u1ed9t sarcoma thu\u1ea7n t\u00fay. C\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) ng\u00e0y c\u00e0ng c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd \u00e1c t\u00ednh n\u00e0y. C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m nh\u01b0 v\u1ecb tr\u00ed<\/strong> kh\u1ed1i u, b\u1edd kh\u00f4ng \u0111\u1ec1u ho\u1eb7c d\u1ea1ng n\u1ed1t, ho\u1ea1i t\u1eed, ph\u00e1t tri\u1ec3n nhanh, ng\u1ea5m thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n m\u1ea1nh v\u00e0 h\u1ea1n ch\u1ebf khu\u1ebfch t\u00e1n<\/strong> tr\u00ean h\u00ecnh \u1ea3nh DWI c\u00f3 th\u1ec3 g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n v\u00e0 gi\u00fap ph\u00e2n bi\u1ec7t v\u1edbi nh\u00e2n x\u01a1 t\u1eed cung v\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung th\u01b0\u1eddng g\u1eb7p h\u01a1n. Do \u0111\u00f3, MRI c\u1ef1c k\u1ef3 h\u1eefu \u00edch trong vi\u1ec7c ph\u00e1t hi\u1ec7n v\u00e0 ph\u00e2n giai \u0111o\u1ea1n tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, v\u00e0 theo \u0111\u00f3 l\u00e0 x\u00e1c \u0111\u1ecbnh h\u01b0\u1edbng x\u1eed tr\u00ed th\u00edch h\u1ee3p<\/strong><\/em>. B\u00e0i t\u1ed5ng quan h\u00ecnh \u1ea3nh n\u00e0y nh\u1eb1m m\u1ee5c \u0111\u00edch th\u1ea3o lu\u1eadn v\u1ec1 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a sarcoma t\u1eed cung, c\u0169ng nh\u01b0 c\u00e1c bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m kh\u00e1c bi\u1ec7t c\u1ee7a ch\u00fang tr\u00ean MRI.<\/p>\n\n\n\n

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Sarcoma t\u1eed cung l\u00e0 m\u1ed9t nh\u00f3m c\u00e1c kh\u1ed1i u kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, hi\u1ebfm g\u1eb7p c\u00f3 ngu\u1ed3n g\u1ed1c trung m\u00f4, chi\u1ebfm kho\u1ea3ng 8% c\u00e1c b\u1ec7nh l\u00fd \u00e1c t\u00ednh \u1edf t\u1eed cung (1), m\u1eb7c d\u00f9 tr\u01b0\u1edbc \u0111\u00e2y ch\u00fang \u0111\u01b0\u1ee3c cho l\u00e0 ch\u1ec9 chi\u1ebfm 2% \u0111\u1ebfn 3% t\u1ea5t c\u1ea3 c\u00e1c kh\u1ed1i u t\u1eed cung (2). T\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh gia t\u0103ng n\u00e0y c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a vi\u1ec7c ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, c\u0169ng nh\u01b0 s\u1ef1 gia t\u0103ng th\u1ef1c s\u1ef1 trong d\u00e2n s\u1ed1 gi\u00e0 h\u00f3a (1).<\/p>\n\n\n\n

C\u00e1c b\u1ec7nh l\u00fd \u00e1c t\u00ednh n\u00e0y c\u00f3 th\u1ec3 b\u1eaft ngu\u1ed3n t\u1eeb c\u01a1 tr\u01a1n \u1edf l\u1edbp c\u01a1 t\u1eed cung (sarcoma c\u01a1 tr\u01a1n), t\u1eeb m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung (sarcoma m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung [ESS] v\u00e0 sarcoma n\u1ed9i m\u1ea1c t\u1eed cung kh\u00f4ng bi\u1ec7t h\u00f3a [UES]) ho\u1eb7c c\u1ea3 hai (sarcoma tuy\u1ebfn) (3). Theo T\u1ed5 ch\u1ee9 Ung th\u01b0 Ph\u1ee5 khoa (Gynecologic Oncology Group), sarcoma t\u1eed cung c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh hai lo\u1ea1i: kh\u00f4ng bi\u1ec3u m\u00f4 v\u00e0 h\u1ed7n h\u1ee3p bi\u1ec3u m\u00f4-kh\u00f4ng bi\u1ec3u m\u00f4, t\u00f9y thu\u1ed9c v\u00e0o lo\u1ea1i t\u1ebf b\u00e0o ung th\u01b0 v\u00e0 m\u00f4 ngu\u1ed3n g\u1ed1c \u0111\u01b0\u1ee3c gi\u1ea3 \u0111\u1ecbnh (4).<\/p>\n\n\n\n

Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a sarcoma t\u1eed cung l\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o ph\u00e2n nh\u00f3m m\u00f4 h\u1ecdc. \u0110i\u1ec3n h\u00ecnh, ch\u00fang bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng m\u1ed9t kh\u1ed1i u v\u00f9ng ch\u1eadu ph\u00e1t tri\u1ec3n nhanh, c\u00f3 th\u1ec3 k\u00e8m theo ch\u1ea3y m\u00e1u \u00e2m \u0111\u1ea1o v\u00e0 \u0111au b\u1ee5ng ho\u1eb7c \u0111au v\u00f9ng ch\u1eadu (1, 5).<\/p>\n\n\n\n

Sarcoma c\u01a1 tr\u01a1n (Leiomyosarcoma) <\/strong>l\u00e0 bi\u1ebfn th\u1ec3 m\u00f4 h\u1ecdc ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a sarcoma t\u1eed cung v\u00e0 \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t kh\u1ed1i u x\u00e2m l\u1ea5n c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u, v\u1edbi t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 5 n\u0103m dao \u0111\u1ed9ng t\u1eeb 18,8% \u0111\u1ebfn 68%. Sarcoma m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung (ESS<\/strong>) t\u01b0\u01a1ng \u0111\u1ed1i \u00edt \u00e1c t\u00ednh (indolent), c\u00f3 ti\u00ean l\u01b0\u1ee3ng s\u1ed1ng s\u00f3t l\u00e2u d\u00e0i, nh\u01b0ng \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00e1i ph\u00e1t mu\u1ed9n (14%\u201360% ph\u1ee5 n\u1eef). Ng\u01b0\u1ee3c l\u1ea1i, sarcoma n\u1ed9i m\u1ea1c t\u1eed cung kh\u00f4ng bi\u1ec7t h\u00f3a (UES)<\/strong> c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m r\u1ea5t x\u00e2m l\u1ea5n v\u00e0 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u, v\u1edbi t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 5 n\u0103m l\u00e0 25%\u201355%. Sarcoma tuy\u1ebfn (Adenosarcomas)<\/strong> l\u00e0 c\u00e1c kh\u1ed1i u h\u1ed7n h\u1ee3p hi\u1ebfm g\u1eb7p (ngu\u1ed3n g\u1ed1c tuy\u1ebfn v\u00e0 trung m\u00f4) v\u1edbi m\u1ee9c \u0111\u1ed9 \u00e1c t\u00ednh t\u01b0\u01a1ng \u0111\u1ed1i th\u1ea5p v\u00e0 ki\u1ec3u h\u00ecnh ph\u00e1t tri\u1ec3n ch\u1eadm, t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 5 n\u0103m tr\u00ean 80% (6).<\/p>\n\n\n\n

Vi\u1ec7c nh\u1eadn bi\u1ebft \u0111\u1eb7c \u0111i\u1ec3m sinh h\u1ecdc v\u00e0 l\u00e2m s\u00e0ng kh\u00e1c bi\u1ec7t c\u1ee7a ch\u00fang so v\u1edbi ung th\u01b0 bi\u1ec3u m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung (lo\u1ea1i ung th\u01b0 n\u00e0y c\u00f3 xu h\u01b0\u1edbng di\u1ec5n ti\u1ebfn \u00edt \u00e1c t\u00ednh h\u01a1n), \u0111\u00e3 khi\u1ebfn Li\u00ean \u0111o\u00e0n S\u1ea3n ph\u1ee5 khoa Qu\u1ed1c t\u1ebf (FIGO) ph\u00e1t tri\u1ec3n m\u1ed9t h\u1ec7 th\u1ed1ng ph\u00e2n giai \u0111o\u1ea1n m\u1edbi cho sarcoma t\u1eed cung v\u00e0o n\u0103m 2009 (B\u1ea3ng 1 v\u00e0 2). M\u1ed9t \u0111\u1eb7c \u0111i\u1ec3m quan tr\u1ecdng c\u1ee7a h\u1ec7 th\u1ed1ng ph\u00e2n giai \u0111o\u1ea1n m\u1edbi l\u00e0 carcinosarcoma (tr\u01b0\u1edbc \u0111\u00e2y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 “u h\u1ed7n h\u1ee3p M\u00fcller \u00e1c t\u00ednh”) kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a sarcoma t\u1eed cung, m\u00e0 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 m\u1ed9t d\u1ea1ng kh\u00f4ng bi\u1ec7t h\u00f3a ho\u1eb7c chuy\u1ec3n s\u1ea3n c\u1ee7a ung th\u01b0 bi\u1ec3u m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung (7).<\/p>\n\n\n\n

B\u1ea3ng 1 Giai \u0111o\u1ea1n Leiomyosarcoma <\/h4>\n\n\n\n
G\u0110<\/th>H\u00ecnh \u1ea3nh<\/th><\/tr><\/thead>
I<\/strong><\/td>U gi\u1edbi h\u1ea1n t\u1ea1i t\u1eed cung<\/strong><\/td><\/tr>
IA<\/td><5 cm<\/td><\/tr>
IB<\/td>>5 cm<\/td><\/tr>
II<\/strong><\/td>U lan ra ngo\u00e0i t\u1eed cung, n\u1eb1m trong v\u00f9ng ch\u1eadu<\/strong><\/td><\/tr>
IIA<\/td>X\u00e2m l\u1ea5n ph\u1ea7n ph\u1ee5<\/td><\/tr>
IIB<\/td>X\u00e2m l\u1ea5n c\u00e1c m\u00f4 kh\u00e1c trong v\u00f9ng ch\u1eadu<\/td><\/tr>
III<\/strong><\/td>U x\u00e2m l\u1ea5n c\u00e1c m\u00f4 trong \u1ed5 b\u1ee5ng (kh\u00f4ng ch\u1ec9 l\u1ed3i v\u00e0o trong \u1ed5 b\u1ee5ng)<\/strong><\/td><\/tr>
IIIA<\/td>M\u1ed9t v\u1ecb tr\u00ed<\/td><\/tr>
IIIB<\/td>Nhi\u1ec1u h\u01a1n m\u1ed9t v\u1ecb tr\u00ed<\/td><\/tr>
IIIC<\/td>Di c\u0103n h\u1ea1ch ch\u1eadu v\u00e0\/ho\u1eb7c h\u1ea1ch c\u1ea1nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/td><\/tr>
IV<\/strong><\/td><\/td><\/tr>
IVA<\/td>U x\u00e2m l\u1ea5n b\u00e0ng quang v\u00e0\/ho\u1eb7c tr\u1ef1c tr\u00e0ng<\/td><\/tr>
IVB<\/td>Di c\u0103n xa<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

B\u1ea3ng 2 Giai \u0111o\u1ea1n cho sarcoma m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung (endometrial stromal sarcoma – ESS) v\u00e0 sarcoma tuy\u1ebfn t\u1eed cung (adenosarcoma)<\/h4>\n\n\n\n
Giai \u0111o\u1ea1n<\/strong><\/td>\u0110\u1ecbnh ngh\u0129a<\/strong><\/td><\/tr><\/thead>
I<\/strong><\/td>U gi\u1edbi h\u1ea1n t\u1ea1i t\u1eed cung<\/strong><\/td><\/tr>
    IA<\/td>U gi\u1edbi h\u1ea1n t\u1ea1i n\u1ed9i m\u1ea1c t\u1eed cung\/trong c\u1ed5 t\u1eed cung, kh\u00f4ng x\u00e2m l\u1ea5n c\u01a1 t\u1eed cung<\/td><\/tr>
    IB<\/td>X\u00e2m l\u1ea5n d\u01b0\u1edbi m\u1ed9t n\u1eeda ho\u1eb7c m\u1ed9t n\u1eeda l\u1edbp c\u01a1 t\u1eed cung<\/td><\/tr>
    IC<\/td>X\u00e2m l\u1ea5n h\u01a1n m\u1ed9t n\u1eeda l\u1edbp c\u01a1 t\u1eed cung<\/td><\/tr>
II<\/strong><\/td>U lan ra ngo\u00e0i t\u1eed cung, n\u1eb1m trong v\u00f9ng ch\u1eadu<\/strong><\/td><\/tr>
    IIA<\/td>X\u00e2m l\u1ea5n ph\u1ea7n ph\u1ee5<\/td><\/tr>
    IIB<\/td>X\u00e2m l\u1ea5n c\u00e1c m\u00f4 kh\u00e1c trong v\u00f9ng ch\u1eadu<\/td><\/tr>
III<\/strong><\/td>U x\u00e2m l\u1ea5n c\u00e1c m\u00f4 trong \u1ed5 b\u1ee5ng (kh\u00f4ng ch\u1ec9 l\u1ed3i v\u00e0o trong \u1ed5 b\u1ee5ng)<\/strong><\/td><\/tr>
    IIIA<\/td>M\u1ed9t v\u1ecb tr\u00ed<\/td><\/tr>
    IIIB<\/td>Nhi\u1ec1u h\u01a1n m\u1ed9t v\u1ecb tr\u00ed<\/td><\/tr>
    IIIC<\/td>Di c\u0103n h\u1ea1ch ch\u1eadu v\u00e0\/ho\u1eb7c h\u1ea1ch c\u1ea1nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/td><\/tr>
IV<\/strong><\/td><\/td><\/tr>
    IVA<\/td>U x\u00e2m l\u1ea5n b\u00e0ng quang v\u00e0\/ho\u1eb7c tr\u1ef1c tr\u00e0ng<\/td><\/tr>
    IVB<\/td>Di c\u0103n xa<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Vi\u1ec7c ph\u00e2n bi\u1ec7t gi\u1eefa c\u00e1c ph\u00e2n nh\u00f3m sarcoma t\u1eed cung kh\u00e1c nhau v\u1edbi c\u00e1c kh\u1ed1i u t\u1eed cung kh\u00e1c (\u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u00e2n x\u01a1 t\u1eed cung v\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung) kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c ch\u1ec9 d\u1ef1a tr\u00ean c\u01a1 s\u1edf l\u00e2m s\u00e0ng. Do \u0111\u00f3, h\u00ecnh \u1ea3nh h\u1ecdc, \u0111\u1eb7c bi\u1ec7t l\u00e0 MRI, \u0111\u00f3ng vai tr\u00f2 ng\u00e0y c\u00e0ng quan tr\u1ecdng trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd \u00e1c t\u00ednh n\u00e0y, h\u1eefu \u00edch trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 c\u00e1c kh\u1ed1i u v\u00f9ng ch\u1eadu l\u00fac th\u0103m kh\u00e1m ban \u0111\u1ea7u, ph\u00e2n giai \u0111o\u1ea1n \u0111\u1ea7y \u0111\u1ee7 (\u0111\u00e1nh gi\u00e1 \u0111\u1ed9 s\u00e2u x\u00e2m l\u1ea5n, lan tr\u00e0n \u0111\u1ebfn c\u00e1c c\u01a1 quan l\u00e2n c\u1eadn v\u00e0 h\u1ea1ch b\u1ea1ch huy\u1ebft), v\u00e0 theo \u0111\u00f3 l\u00e0 x\u00e1c \u0111\u1ecbnh h\u01b0\u1edbng x\u1eed tr\u00ed th\u00edch h\u1ee3p.<\/p>\n\n\n\n

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Sarcoma c\u01a1 tr\u01a1n<\/strong><\/h3>\n\n\n\n

\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n

Sarcoma c\u01a1 tr\u01a1n (leiomyosarcoma) l\u00e0 ph\u00e2n nh\u00f3m m\u00f4 h\u1ecdc ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a sarcoma t\u1eed cung. \u0110\u1ea1i \u0111a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ph\u00e1t sinh m\u1edbi (de novo), nh\u01b0ng hi\u1ebfm khi (chi\u1ebfm 0,2% tr\u01b0\u1eddng h\u1ee3p) ch\u00fang c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 chuy\u1ec3n d\u1ea1ng sarcoma trong m\u1ed9t nh\u00e2n x\u01a1 l\u00e0nh t\u00ednh (2). B\u1ec7nh \u0111\u1eb7c tr\u01b0ng b\u1edfi h\u00e0nh vi x\u00e2m l\u1ea5n (ngay c\u1ea3 khi khu tr\u00fa t\u1ea1i t\u1eed cung), v\u1edbi t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 5 n\u0103m dao \u0111\u1ed9ng t\u1eeb 18,8% \u0111\u1ebfn 68%, thay \u0111\u1ed5i nhi\u1ec1u t\u00f9y theo c\u00e1c giai \u0111o\u1ea1n kh\u00e1c nhau. \u0110\u1ed9 m\u00f4 h\u1ecdc th\u1ea5p v\u00e0 s\u1ef1 x\u00e2m l\u1ea5n thanh m\u1ea1c d\u01b0\u1eddng nh\u01b0 l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng quan tr\u1ecdng. Nguy c\u01a1 t\u00e1i ph\u00e1t \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o thay \u0111\u1ed5i t\u1eeb 45% \u0111\u1ebfn 73%.<\/p>\n\n\n\n

H\u1ea7u h\u1ebft c\u00e1c sarcoma c\u01a1 tr\u01a1n x\u1ea3y ra \u1edf ph\u1ee5 n\u1eef tr\u00ean 40 tu\u1ed5i, v\u1edbi \u0111\u1ed9 tu\u1ed5i trung v\u1ecb l\u00e0 60 tu\u1ed5i. T\u1ef7 l\u1ec7 m\u1eafc sarcoma c\u01a1 tr\u01a1n \u1edf ph\u1ee5 n\u1eef M\u1ef9 g\u1ed1c Phi cao g\u1ea5p \u0111\u00f4i; vi\u1ec7c s\u1eed d\u1ee5ng tamoxifen d\u00e0i h\u1ea1n v\u00e0 x\u1ea1 tr\u1ecb v\u00f9ng ch\u1eadu tr\u01b0\u1edbc \u0111\u00f3 d\u01b0\u1eddng nh\u01b0 c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 gia t\u0103ng nh\u1ecf v\u1ec1 nguy c\u01a1 m\u1eafc b\u1ec7nh. C\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n \u1edf nh\u00e2n x\u01a1 t\u1eed cung, bao g\u1ed3m xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o b\u1ea5t th\u01b0\u1eddng<\/strong> (56%), s\u1edd th\u1ea5y kh\u1ed1i u v\u00f9ng ch\u1eadu<\/strong> (54%) v\u00e0 \u0111au v\u00f9ng ch\u1eadu<\/strong> (22%). \u00cdt g\u1eb7p h\u01a1n, ch\u00fang c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng tr\u00e0n m\u00e1u ph\u00fac m\u1ea1c (do v\u1ee1 kh\u1ed1i u), ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng do s\u1ef1 lan tr\u00e0n ra ngo\u00e0i t\u1eed cung ho\u1eb7c di c\u0103n. B\u00ean c\u1ea1nh \u0111\u00f3, m\u1eb7c d\u00f9 “s\u1ef1 ph\u00e1t tri\u1ec3n nhanh” c\u1ee7a m\u1ed9t kh\u1ed1i nh\u00e2n x\u01a1 t\u1eed cung \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u nghi ng\u1edd, nh\u01b0ng \u0111\u1ecbnh ngh\u0129a v\u1ec1 t\u00ecnh tr\u1ea1ng n\u00e0y v\u1eabn c\u00f2n g\u00e2y tranh c\u00e3i. Do \u0111\u00f3, vi\u1ec7c ph\u00e2n bi\u1ec7t tr\u01b0\u1edbc ph\u1eabu thu\u1eadt gi\u1eefa nh\u00e2n x\u01a1 t\u1eed cung l\u00e0nh t\u00ednh v\u00e0 sarcoma c\u01a1 tr\u01a1n \u00e1c t\u00ednh l\u00e0 r\u1ea5t kh\u00f3 kh\u0103n (n\u1ebfu kh\u00f4ng mu\u1ed1n n\u00f3i l\u00e0 kh\u00f4ng th\u1ec3) ch\u1ec9 d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, v\u00e0 v\u1eabn l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c \u0111\u1ed1i v\u1edbi c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng.<\/p>\n\n\n\n

\u0110\u1eb7c \u0111i\u1ec3m MRI<\/strong><\/p>\n\n\n\n

Sarcoma c\u01a1 tr\u01a1n th\u01b0\u1eddng kh\u00f3 ph\u00e2n bi\u1ec7t v\u1edbi nh\u00e2n x\u01a1 (kh\u1ed1i u c\u01a1 t\u1eed cung ph\u1ed5 bi\u1ebfn nh\u1ea5t), d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 th\u1eadm ch\u00ed c\u1ea3 sinh thi\u1ebft n\u1ed9i m\u1ea1c t\u1eed cung ho\u1eb7c nong v\u00e0 n\u1ea1o bu\u1ed3ng t\u1eed cung t\u1eebng ph\u1ea7n. H\u01a1n n\u1eefa, nh\u1eefng ti\u1ebfn b\u1ed9 g\u1ea7n \u0111\u00e2y trong vi\u1ec7c qu\u1ea3n l\u00fd nh\u00e2n x\u01a1 (t\u1ee9c l\u00e0 ph\u00e1t tri\u1ec3n c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n t\u1eed cung, nh\u01b0 c\u00e1c ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 hormone gi\u1ea3i ph\u00f3ng gonadotropin, thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch t\u1eed cung v\u00e0 ph\u1eabu thu\u1eadt si\u00eau \u00e2m ch\u1ecdn l\u1ecdc (focused ultrasound surgery) \u0111\u00e3 n\u00e2ng cao \u0111\u00e1ng k\u1ec3 t\u1ea7m quan tr\u1ecdng c\u1ee7a ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi sarcoma t\u1eed cung (3, 9, 10).<\/p>\n\n\n\n

Tr\u00ean MRI, sarcoma c\u01a1 tr\u01a1n th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng kh\u1ed1i u c\u01a1 t\u1eed cung l\u1edbn, c\u00f3 t\u00ednh ch\u1ea5t th\u00e2m nhi\u1ec5m<\/strong>, t\u00edn hi\u1ec7u th\u1ea5p kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t tr\u00ean T1W<\/strong>, v\u1edbi b\u1edd kh\u00f4ng \u0111\u1ec1u v\u00e0 gi\u1edbi h\u1ea1n kh\u00f4ng r\u00f5<\/strong>. Tr\u00ean T2W, ch\u00fang th\u01b0\u1eddng cho th\u1ea5y t\u00edn hi\u1ec7u trung b\u00ecnh \u0111\u1ebfn cao<\/strong>, v\u1edbi v\u00f9ng t\u0103ng t\u00edn hi\u1ec7u \u1edf trung t\u00e2m bi\u1ec3u th\u1ecb t\u00ecnh tr\u1ea1ng ho\u1ea1i t\u1eed lan r\u1ed9ng<\/strong> (hi\u1ec7n di\u1ec7n trong >50% c\u00e1c tr\u01b0\u1eddng h\u1ee3p) (H\u00ecnh 1a, 1b). Xu\u1ea5t huy\u1ebft l\u00e0 ph\u1ed5 bi\u1ebfn, v\u00e0 c\u00f3 th\u1ec3 c\u00f3 c\u00e1c n\u1ed1t v\u00f4i h\u00f3a<\/strong>. Sau khi ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n, ch\u00fang ng\u1ea5m thu\u1ed1c kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t \u1edf th\u00ec s\u1edbm<\/strong>, do c\u00e1c v\u00f9ng ho\u1ea1i t\u1eed v\u00e0 xu\u1ea5t huy\u1ebft \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean (H\u00ecnh 1c).<\/p>\n\n\n

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a\u2013c. Sarcoma c\u01a1 tr\u01a1n \u1edf m\u1ed9t ph\u1ee5 n\u1eef 52 tu\u1ed5i. H\u00ecnh \u1ea3nh T1W m\u1eb7t ph\u1eb3ng \u0111\u1ee9ng d\u1ecdc (a), h\u00ecnh \u1ea3nh T2W (b), v\u00e0 h\u00ecnh \u1ea3nh T1W x\u00f3a m\u1ee1 c\u00f3 ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n gadolinium (c) cho th\u1ea5y t\u1eed cung to r\u00f5 r\u1ec7t do m\u1ed9t kh\u1ed1i u c\u01a1 t\u1eed cung kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t. T\u1ed5n th\u01b0\u01a1ng bi\u1ec3u hi\u1ec7n t\u0103ng t\u00edn hi\u1ec7u \u1edf trung t\u00e2m tr\u00ean h\u00ecnh \u1ea3nh T1W (a) do xu\u1ea5t huy\u1ebft di\u1ec7n r\u1ed9ng, m\u1ed9t v\u00f9ng t\u00edn hi\u1ec7u cao \u1edf trung t\u00e2m tr\u00ean h\u00ecnh \u1ea3nh T2W (b) \u0111\u1ea1i di\u1ec7n cho ho\u1ea1i t\u1eed d\u1ea1ng nang, v\u00e0 ng\u1ea5m thu\u1ed1c m\u1ea1nh \u1edf th\u00ec s\u1edbm t\u1ea1i c\u00e1c v\u00f9ng \u0111\u1eb7c c\u1ee7a kh\u1ed1i u (c, m\u0169i t\u00ean), so v\u1edbi c\u01a1 t\u1eed cung b\u00ecnh th\u01b0\u1eddng. C\u00e1c v\u00f9ng trung t\u00e2m kh\u00f4ng \u0111\u1ec1u c\u00f3 t\u00edn hi\u1ec7u th\u1ea5p (d\u1ea5u sao) g\u1ee3i \u00fd ho\u1ea1i t\u1eed u lan r\u1ed9ng. Bu\u1ed3ng n\u1ed9i m\u1ea1c t\u1eed cung b\u1ecb kh\u1ed1i u \u0111\u1ea9y ra tr\u01b0\u1edbc (b, m\u0169i t\u00ean).<\/em><\/p>\n\n\n\n

Sarcoma c\u01a1 tr\u01a1n th\u01b0\u1eddng c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn h\u01a1n v\u00e0 ph\u00e1t tri\u1ec3n nhanh h\u01a1n so v\u1edbi nh\u00e2n x\u01a1 t\u1eed cung. M\u1eb7t kh\u00e1c, c\u00e1c nh\u00e2n x\u01a1 t\u1eed cung l\u00e0nh t\u00ednh th\u00f4ng th\u01b0\u1eddng c\u0169ng c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n c\u00e1c v\u00f9ng t\u0103ng t\u00edn hi\u1ec7u tr\u00ean h\u00ecnh \u1ea3nh T2W do c\u00e1c d\u1ea1ng tho\u00e1i h\u00f3a ho\u1eb7c c\u00e1c ph\u00e2n nh\u00f3m m\u00f4 h\u1ecdc t\u1ebf b\u00e0o kh\u00e1c nhau. M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 \u0111\u00e3 g\u1ee3i \u00fd r\u1eb1ng s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a b\u1edd kh\u00f4ng \u0111\u1ec1u, ho\u1ea1i t\u1eed v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n nhanh l\u00e0 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m g\u1ee3i \u00fd nh\u1ea5t v\u1ec1 t\u00ednh \u00e1c t\u00ednh.<\/p>\n\n\n\n

H\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb khu\u1ebfch t\u00e1n (DWI) c\u00f3 ti\u1ec1m n\u0103ng x\u00e1c \u0111\u1ecbnh c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u00e1c t\u00ednh d\u01b0\u1edbi d\u1ea1ng c\u00e1c v\u00f9ng t\u0103ng t\u00edn hi\u1ec7u v\u1edbi \u0111\u1ed9 t\u01b0\u01a1ng ph\u1ea3n m\u00f4 tuy\u1ec7t v\u1eddi, cung c\u1ea5p c\u00e1c ph\u00e9p \u0111o \u0111\u1ecbnh l\u01b0\u1ee3ng v\u1ec1 gi\u00e1 tr\u1ecb h\u1ec7 s\u1ed1 khu\u1ebfch t\u00e1n bi\u1ec3u ki\u1ebfn (ADC) (H\u00ecnh 2). Tamai v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 b\u00e1o c\u00e1o s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1ec1 gi\u00e1 tr\u1ecb ADC trung b\u00ecnh c\u1ee7a sarcoma c\u01a1 tr\u01a1n so v\u1edbi c\u01a1 t\u1eed cung b\u00ecnh th\u01b0\u1eddng v\u00e0 nh\u00e2n x\u01a1 tho\u00e1i h\u00f3a, m\u00e0 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 s\u1ef1 ch\u1ed3ng l\u1ea5p n\u00e0o. Namimoto v\u00e0 c\u1ed9ng s\u1ef1 (9) \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng s\u1ef1 ch\u1ed3ng l\u1ea5p v\u1ec1 gi\u00e1 tr\u1ecb ADC gi\u1eefa sarcoma c\u01a1 tr\u01a1n v\u00e0 u c\u01a1 tr\u01a1n th\u00f4ng th\u01b0\u1eddng (\u0111\u01b0\u1ee3c quy cho “hi\u1ec7u \u1ee9ng T2 blackout”, t\u1ee9c l\u00e0 t\u00edn hi\u1ec7u th\u1ea5p tr\u00ean DWI g\u00e2y ra b\u1edfi t\u00edn hi\u1ec7u th\u1ea5p tr\u00ean h\u00ecnh \u1ea3nh T2W) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft b\u1eb1ng vi\u1ec7c \u0111\u00e1nh gi\u00e1 t\u1ef7 l\u1ec7 t\u01b0\u01a1ng ph\u1ea3n u – c\u01a1 t\u1eed cung tr\u00ean h\u00ecnh \u1ea3nh T2W. Thomassin-Naggara v\u00e0 c\u1ed9ng s\u1ef1 b\u00e1o c\u00e1o r\u1eb1ng b\u1eb1ng c\u00e1ch k\u1ebft h\u1ee3p ph\u00e2n t\u00edch t\u00edn hi\u1ec7u T2, h\u00ecnh \u1ea3nh b1000 v\u00e0 b\u1ea3n \u0111\u1ed3 ADC, MRI \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 ch\u00ednh x\u00e1c 92,4% trong vi\u1ec7c ph\u00e2n bi\u1ec7t c\u00e1c u c\u01a1 t\u1eed cung l\u00e0nh t\u00ednh v\u1edbi c\u00e1c u kh\u00f4ng ch\u1eafc ch\u1eafn ho\u1eb7c \u00e1c t\u00ednh. Do \u0111\u00f3, h\u1ecd k\u1ebft lu\u1eadn r\u1eb1ng DWI c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf vi\u1ec7c ch\u1ea9n \u0111o\u00e1n nh\u1ea7m sarcoma t\u1eed cung th\u00e0nh u c\u01a1 tr\u01a1n l\u00e0nh t\u00ednh, v\u00e0 n\u00ean l\u00e0 ti\u00eau chu\u1ea9n \u0111\u1ea7u ti\u00ean \u0111\u1ec3 gi\u00fap c\u00e1c b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh x\u00e1c \u0111\u1ecbnh \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a m\u1ed9t kh\u1ed1i u t\u1eed cung \u0111\u01a1n \u0111\u1ed9c. D\u1ef1a tr\u00ean nh\u1eefng k\u1ebft qu\u1ea3 n\u00e0y, vi\u1ec7c s\u1eed d\u1ee5ng DWI c\u1ea7n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u01a1 t\u1eed cung, \u0111\u1eb7c bi\u1ec7t khi quan s\u00e1t th\u1ea5y t\u00edn hi\u1ec7u cao tr\u00ean h\u00ecnh \u1ea3nh T2W.<\/p>\n\n\n

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H\u00ecnh 2:<\/strong> a, b. Sarcoma c\u01a1 tr\u01a1n \u1edf m\u1ed9t ph\u1ee5 n\u1eef 54 tu\u1ed5i. H\u00ecnh \u1ea3nh DWI m\u1eb7t ph\u1eb3ng ngang v\u1edbi b1000 (a) cho th\u1ea5y m\u1ed9t kh\u1ed1i t\u0103ng t\u00edn hi\u1ec7u. Kh\u1ed1i n\u00e0y bi\u1ec3u hi\u1ec7n gi\u1ea3m t\u00edn hi\u1ec7u tr\u00ean b\u1ea3n \u0111\u1ed3 ADC (b, d\u1ea5u sao), v\u1edbi c\u01a1 t\u1eed cung b\u00ecnh th\u01b0\u1eddng \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y l\u00e0 m\u1ed9t v\u00f9ng t\u0103ng t\u00edn hi\u1ec7u (c\u00e1c m\u0169i t\u00ean).<\/em><\/p>\n\n\n\n

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Sarcoma m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung<\/h3>\n\n\n\n

\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n

Theo ph\u00e2n lo\u1ea1i c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi, u m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung bao g\u1ed3m c\u00e1c t\u1ebf b\u00e0o gi\u1ed1ng v\u1edbi c\u00e1c t\u1ebf b\u00e0o m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c c\u1ee7a n\u1ed9i m\u1ea1c t\u1eed cung giai \u0111o\u1ea1n t\u0103ng sinh. ESS (Sarcoma m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung) t\u01b0\u01a1ng \u1ee9ng v\u1edbi thu\u1eadt ng\u1eef c\u0169 l\u00e0 “ESS \u0111\u1ed9 th\u1ea5p”, v\u00e0 UES (Sarcoma n\u1ed9i m\u1ea1c t\u1eed cung kh\u00f4ng bi\u1ec7t h\u00f3a) thay th\u1ebf cho thu\u1eadt ng\u1eef “ESS \u0111\u1ed9 cao”. Ph\u00e2n lo\u1ea1i m\u1edbi n\u00e0y l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a vi\u1ec7c ghi nh\u1eadn c\u00e1c h\u00e0nh vi sinh h\u1ecdc v\u00e0 k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng r\u1ea5t kh\u00e1c bi\u1ec7t c\u1ee7a c\u00e1c kh\u1ed1i u n\u00e0y.<\/p>\n\n\n\n

ESS l\u00e0 m\u1ed9t kh\u1ed1i u hi\u1ebfm g\u1eb7p, chi\u1ebfm 0,2% t\u1ea5t c\u1ea3 c\u00e1c u \u00e1c t\u00ednh t\u1eed cung v\u00e0 10%\u201315% c\u00e1c b\u1ec7nh l\u00fd \u00e1c t\u00ednh t\u1eed cung c\u00f3 th\u00e0nh ph\u1ea7n trung m\u00f4. N\u00f3 \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t kh\u1ed1i u \u0111\u1ed9 th\u1ea5p, bi\u1ec7t h\u00f3a t\u1ed1t m\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 kh\u00f4ng \u0111i\u1ec3n h\u00ecnh \u0111\u00e1ng k\u1ec3 v\u1ec1 t\u1ebf b\u00e0o. Do \u0111\u00f3, ESS l\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u01b0\u01a1ng \u0111\u1ed1i \u00edt \u00e1c t\u00ednh (indolent), nh\u00ecn chung c\u00f3 ti\u00ean l\u01b0\u1ee3ng thu\u1eadn l\u1ee3i, v\u1edbi t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 5 n\u0103m v\u00e0 10 n\u0103m l\u1ea7n l\u01b0\u1ee3t l\u00e0 98% v\u00e0 89% \u0111\u1ed1i v\u1edbi giai \u0111o\u1ea1n I, t\u01b0\u01a1ng \u1ee9ng v\u1edbi \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n \u1edf th\u1eddi \u0111i\u1ec3m ph\u00e1t hi\u1ec7n b\u1ec7nh. Tuy nhi\u00ean, k\u1ebft c\u1ee5c ph\u1ee5 thu\u1ed9c ph\u1ea7n l\u1edbn v\u00e0o m\u1ee9c \u0111\u1ed9 lan r\u1ed9ng c\u1ee7a kh\u1ed1i u t\u1ea1i th\u1eddi \u0111i\u1ec3m ph\u00e1t hi\u1ec7n, v\u00e0 giai \u0111o\u1ea1n b\u1ec7nh d\u01b0\u1eddng nh\u01b0 l\u00e0 ch\u1ec9 s\u1ed1 quan tr\u1ecdng nh\u1ea5t \u0111\u1ed1i v\u1edbi s\u1ef1 s\u1ed1ng c\u00f2n. \u0110\u1ed1i v\u1edbi giai \u0111o\u1ea1n II v\u00e0 III, t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 5 n\u0103m gi\u1ea3m \u0111\u00e1ng k\u1ec3 xu\u1ed1ng c\u00f2n l\u1ea7n l\u01b0\u1ee3t l\u00e0 50% v\u00e0 65%. ESS c\u0169ng \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 t\u00e1i ph\u00e1t mu\u1ed9n (14%\u201360% b\u1ec7nh nh\u00e2n), ngay c\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh giai \u0111o\u1ea1n I. Do \u0111\u00f3, vi\u1ec7c theo d\u00f5i d\u00e0i h\u1ea1n l\u00e0 b\u1eaft bu\u1ed9c.<\/p>\n\n\n\n

ESS x\u1ea3y ra ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i t\u1eeb 40 \u0111\u1ebfn 55. \u0110\u00e3 c\u00f3 b\u00e1o c\u00e1o v\u1ec1 m\u1ed1i li\u00ean quan v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng tamoxifen v\u00e0 estrogen, m\u1eb7c d\u00f9 d\u1eef li\u1ec7u c\u00f2n h\u1ea1n ch\u1ebf. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n ch\u1ea3y m\u00e1u \u00e2m \u0111\u1ea1o b\u1ea5t th\u01b0\u1eddng, \u0111au v\u00f9ng ch\u1eadu v\u00e0 th\u1ed1ng kinh; tuy nhi\u00ean, c\u00f3 t\u1edbi 25% b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/p>\n\n\n\n

Theo h\u1ec7 th\u1ed1ng ph\u00e2n giai \u0111o\u1ea1n FIGO m\u1edbi cho sarcoma t\u1eed cung, ESS \u0111\u01b0\u1ee3c ph\u00e2n giai \u0111o\u1ea1n theo c\u00e1ch t\u01b0\u01a1ng t\u1ef1 nh\u01b0 sarcoma tuy\u1ebfn (B\u1ea3ng 2)<\/a>.<\/p>\n\n\n\n

\u0110\u1eb7c \u0111i\u1ec3m MRI<\/strong><\/p>\n\n\n\n

H\u00ecnh \u1ea3nh h\u1ecdc (v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 MRI) c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 m\u1ea1nh m\u1ebd trong vi\u1ec7c qu\u1ea3n l\u00fd c\u00e1c kh\u1ed1i u n\u00e0y, cho ph\u00e9p x\u00e1c \u0111\u1ecbnh \u0111\u1eb7c \u0111i\u1ec3m giai \u0111o\u1ea1n ban \u0111\u1ea7u v\u00e0 c\u0169ng gi\u00fap ph\u00e2n bi\u1ec7t v\u1edbi ung th\u01b0 bi\u1ec3u m\u00f4 (carcinoma) n\u1ed9i m\u1ea1c t\u1eed cung th\u01b0\u1eddng g\u1eb7p h\u01a1n.<\/p>\n\n\n\n

ESS th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng kh\u1ed1i n\u1ed9i m\u1ea1c t\u1eed cung d\u1ea1ng polyp<\/strong>, v\u1edbi t\u00edn hi\u1ec7u th\u1ea5p tr\u00ean h\u00ecnh \u1ea3nh T1W v\u00e0 t\u00edn hi\u1ec7u cao kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t tr\u00ean T2<\/strong>. U th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n x\u00e2m l\u1ea5n c\u01a1 t\u1eed cung, c\u00f3 th\u1ec3 c\u00f3 ranh gi\u1edbi r\u00f5 n\u00e9t ho\u1eb7c theo ki\u1ec3u lan t\u1ecfa v\u00e0 ph\u00e1 h\u1ee7y h\u01a1n (ki\u1ec3u sau ph\u1ed5 bi\u1ebfn h\u01a1n nhi\u1ec1u \u1edf UES) (H\u00ecnh 3a). Nh\u1eefng kh\u1ed1i u n\u00e0y c\u00f3 xu h\u01b0\u1edbng x\u00e2m l\u1ea5n m\u1ea1ch m\u00e1u v\u00e0 m\u1ea1ch b\u1ea1ch huy\u1ebft, hi\u1ec3n th\u1ecb c\u00e1c d\u1ea3i lan r\u1ed9ng gi\u1ed1ng nh\u01b0 b\u00fai giun c\u00f3 t\u00edn hi\u1ec7u th\u1ea5p b\u00ean trong c\u00e1c v\u00f9ng x\u00e2m l\u1ea5n c\u01a1 t\u1eed cung tr\u00ean h\u00ecnh \u1ea3nh T2W (“d\u1ea5u hi\u1ec7u c\u00e1c b\u00fai giun – bag of worms\u201d), t\u01b0\u01a1ng \u1ee9ng v\u1edbi c\u00e1c b\u00f3 c\u01a1 t\u1eed cung c\u00f2n \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n (H\u00ecnh 4). Sau khi ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n, ng\u1ea5m thu\u1ed1c m\u1ee9c \u0111\u1ed9 trung b\u00ecnh v\u00e0 th\u01b0\u1eddng kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t (H\u00ecnh 3b)<\/p>\n\n\n

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H\u00ecnh 3:<\/strong> a, b. Sarcoma m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung \u1edf m\u1ed9t ph\u1ee5 n\u1eef 82 tu\u1ed5i. H\u00ecnh \u1ea3nh T2W m\u1eb7t ph\u1eb3ng \u0111\u1ee9ng d\u1ecdc (a) v\u00e0 h\u00ecnh \u1ea3nh T1W x\u00f3a m\u1ee1 m\u1eb7t ph\u1eb3ng \u0111\u1ee9ng d\u1ecdc, sau khi ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n (b) cho th\u1ea5y m\u1ed9t t\u1ed5n th\u01b0\u01a1ng r\u1ea5t l\u1edbn c\u00f3 t\u00e2m t\u1ea1i v\u00f9ng c\u1ed5 t\u1eed cung, th\u00e2m nhi\u1ec5m l\u00ean ph\u00eda tr\u00ean v\u00e0o th\u00e2n t\u1eed cung v\u00e0 xu\u1ed1ng ph\u00eda d\u01b0\u1edbi v\u00e0o n\u1eeda tr\u00ean c\u1ee7a \u00e2m \u0111\u1ea1o. Kh\u1ed1i u cho th\u1ea5y nhi\u1ec1u \u1ed5 t\u0103ng t\u00edn hi\u1ec7u tr\u00ean h\u00ecnh \u1ea3nh T2W do ho\u1ea1i t\u1eed di\u1ec7n r\u1ed9ng, c\u0169ng nh\u01b0 ng\u1ea5m thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n m\u1ee9c \u0111\u1ed9 trung b\u00ecnh v\u00e0 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t nh\u1eb9.<\/em><\/p>\n\n\n

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H\u00ecnh 4: <\/strong>a, b. H\u00ecnh \u1ea3nh T2W m\u1eb7t ph\u1eb3ng \u0111\u1ee9ng d\u1ecdc (a) v\u00e0 m\u1eb7t ph\u1eb3ng ngang (b) cho th\u1ea5y sarcoma m\u00f4 \u0111\u1ec7m n\u1ed9i m\u1ea1c t\u1eed cung \u1edf m\u1ed9t ph\u1ee5 n\u1eef 64 tu\u1ed5i. T\u1ed5n th\u01b0\u01a1ng c\u00f3 t\u00edn hi\u1ec7u kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u1edbi s\u1ef1 x\u00e2m l\u1ea5n d\u1ea1ng n\u1ed1t lan r\u1ed9ng v\u00e0o c\u01a1 t\u1eed cung, b\u1edd kh\u00f4ng \u0111\u1ec1u v\u00e0 t\u1ea1o n\u1ed1t r\u00f5 r\u1ec7t (do s\u1ef1 lan tr\u00e0n c\u1ee7a kh\u1ed1i u d\u1ecdc theo c\u00e1c m\u1ea1ch m\u00e1u v\u00e0 m\u1ea1ch b\u1ea1ch huy\u1ebft).<\/em><\/p>\n\n\n\n

So v\u1edbi ung th\u01b0 bi\u1ec3u m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung, ESS th\u01b0\u1eddng c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn h\u01a1n, ng\u1ea5m thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n m\u1ea1nh h\u01a1n, b\u1edd kh\u00f4ng \u0111\u1ec1u, lan tr\u00e0n d\u1ea1ng n\u1ed1t v\u00e0o c\u01a1 t\u1eed cung, v\u00e0 b\u1edd t\u1ea1o n\u1ed1t do u lan tr\u00e0n d\u1ecdc theo c\u00e1c m\u1ea1ch m\u00e1u v\u00e0 m\u1ea1ch b\u1ea1ch huy\u1ebft.<\/p>\n\n\n\n

Hi\u1ebfm g\u1eb7p h\u01a1n, ESS c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n nh\u01b0 m\u1ed9t kh\u1ed1i u gi\u1ed1ng nh\u00e2n x\u01a1 t\u1eed cung tho\u00e1i h\u00f3a nang. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y, ESS trong c\u01a1 t\u1eed cung c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n bi\u1ec7t d\u1ef1a tr\u00ean s\u1ef1 ph\u00e1t tri\u1ec3n nhanh v\u00e0 x\u00e2m l\u1ea5n,<\/strong> m\u1ee9c \u0111\u1ed9 ng\u1ea5m thu\u1ed1c th\u1ea5p h\u01a1n<\/strong>, x\u00e2m l\u1ea5n m\u1ea1ch b\u1ea1ch huy\u1ebft v\u00e0 m\u1ea1ch m\u00e1u<\/strong>, t\u1ef7 l\u1ec7 ho\u1ea1i t\u1eed cao h\u01a1n, vi\u1ec1n t\u00edn hi\u1ec7u th\u1ea5p ngo\u1ea1i vi tr\u00ean h\u00ecnh \u1ea3nh T2W, v\u00e0 b\u1edd kh\u00f4ng \u0111\u1ec1u<\/strong>.<\/p>\n\n\n\n

Di c\u0103n h\u1ea1ch b\u1ea1ch huy\u1ebft g\u1eb7p \u1edf 10% b\u1ec7nh nh\u00e2n, th\u01b0\u1eddng g\u1eb7p h\u01a1n t\u1ea1i ch\u1ed7 trong v\u00f9ng ch\u1eadu ho\u1eb7c \u00e2m \u0111\u1ea1o, ti\u1ebfp theo l\u00e0 nhu m\u00f4 ph\u1ed5i.<\/p>\n\n\n\n

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C\u00f3 th\u1ec3 c\u00f3 ESS trong c\u01a1 d\u00f9 hi\u1ebfm g\u1eb7p
ESS trong c\u01a1 c\u00f3 th\u1ec3 nh\u1ea7m v\u1edbi nh\u00e2n x\u01a1 t\u1eed cung tho\u00e1i h\u00f3a nang
Ph\u00e2n bi\u1ec7t:<\/em><\/p>\n\n\n\n