{"id":33089,"date":"2022-06-29T05:18:42","date_gmt":"2022-06-28T22:18:42","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=33089"},"modified":"2022-06-29T05:18:42","modified_gmt":"2022-06-28T22:18:42","slug":"sarcoma-ewing-thanh-nguc-ewing-sarcoma-chest-wall","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/sarcoma-ewing-thanh-nguc-ewing-sarcoma-chest-wall\/","title":{"rendered":"Sarcoma Ewing (th\u00e0nh ng\u1ef1c)- Ewing sarcoma (chest wall)"},"content":{"rendered":"

T\u1ea3i file PDF b\u00e0i vi\u1ebft Sarcoma Ewing (th\u00e0nh ng\u1ef1c)- Ewing sarcoma (chest wall)<\/strong>\u00a0<\/b>t\u1ea1i \u0111\u00e2y<\/a><\/p>\n

B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c d\u1ecbch b\u1edfi Tr\u1ea7n Th\u1ecb Thu, Dr. L\u00ea V\u0169 Duy<\/p>\n

\u0110\u1ea1i c\u01b0\u01a1ng<\/h2>\n
Kh\u1ed1i u sarcoma Ewing gia \u0111\u00ecnh (Ewing sarcoma family of tumors (ESFT)) hay c\u00f2n g\u1ecdi l\u00e0 sarcoma Ewing th\u00e0nh ng\u1ef1c, l\u00e0 kh\u1ed1i u \u00e1c t\u00ednh \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi tr\u1ebb, xu\u1ea5t ph\u00e1t t\u1eeb x\u01b0\u01a1ng ho\u1eb7c m\u00f4 m\u1ec1m th\u00e0nh ng\u1ef1c.<\/p>\n
Tr\u00ean h\u00ecnh \u1ea3nh, \u0111\u1eb7c tr\u01b0ng l\u00e0 m\u1ed9t kh\u1ed1i m\u00f4 m\u1ec1m l\u1edbn, \u0111\u1eadm \u0111\u1ed9 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t do ch\u1ea3y m\u00e1u, ho\u1ea1i t\u1eed ho\u1eb7c tho\u00e1i h\u00f3a d\u1ea1ng nang. Kh\u1ed1i u c\u00f3 t\u00ednh ch\u1ea5t ng\u1ea5m thu\u1ed1c v\u00e0 t\u0103ng h\u1ea5p thu \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1. V\u00f4i h\u00f3a hi\u1ebfm g\u1eb7p, th\u01b0\u1eddng c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i l\u01b0\u1ee3ng \u00edt.<\/p>\n
Thu\u1eadt ng\u1eef<\/h2>\n
Ban \u0111\u1ea7u, c\u00e1c kh\u1ed1i u t\u1ebf b\u00e0o tr\u00f2n, nh\u1ecf, m\u00e0u xanh c\u1ee7a m\u00f4 m\u1ec1m \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 u Askin hay kh\u1ed1i u bi\u1ec3u b\u00ec th\u1ea7n kinh nguy\u00ean th\u1ee7y ngo\u1ea1i vi (peripheral primitive neuroectodermal tumor (pPNET)). C\u00e1c thu\u1eadt ng\u1eef n\u00e0y hi\u1ec7n nay \u0111\u01b0\u1ee3c g\u1ecdi chung l\u00e0 Ewing sarcoma family of tumors (ESFT).<\/p>\n
D\u1ecbch t\u1ec5 h\u1ecdc<\/h2>\n
\u0110\u1ed9 tu\u1ed5i c\u1ee7a kh\u1ed1i u n\u00e0y gi\u1ed1ng v\u1edbi sarcoma Ewing \u1edf v\u1ecb tr\u00ed kh\u00e1c, th\u01b0\u1eddng \u1edf ng\u01b0\u1eddi tr\u1ebb v\u00e0 tr\u1ebb em. Sarcoma Ewing chi\u1ebfm kho\u1ea3ng 10-15% c\u00e1c kh\u1ed1i u nguy\u00ean ph\u00e1t \u1edf th\u00e0nh ng\u1ef1c.<\/p>\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/h2>\n
C\u00e1c kh\u1ed1i u n\u00e0y xu\u1ea5t ph\u00e1t t\u1eeb c\u1ea5u tr\u00fac x\u01b0\u01a1ng c\u1ee7a th\u00e0nh ng\u1ef1c (x\u01b0\u01a1ng s\u01b0\u1eddn, x\u01b0\u01a1ng b\u1ea3 vai, \u0111\u1ea7u trong x\u01b0\u01a1ng \u0111\u00f2n) v\u00e0 \u00edt g\u1eb7p \u1edf m\u00f4 m\u1ec1m th\u00e0nh ng\u1ef1c (c\u00e1c kh\u1ed1i u n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 Askin tumors\/pPNET). \u00a0Ch\u00fang c\u00f3 th\u1ec3 \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c nhi\u1ec1u kh\u1ed1i, ph\u00e1t tri\u1ec3n nhanh, g\u00e2y \u0111au ph\u1ea7n m\u1ec1m.<\/p>\n
B\u1ec7nh l\u00fd h\u1ecdc<\/h2>\n
C\u00f3 t\u00ednh ch\u1ea5t di truy\u1ec1n. Do \u0111\u1ed9t bi\u1ebfn chuy\u1ec3n \u0111o\u1ea1n t(11;22)(q24;q12), t\u1ea1o ra gen h\u1ed7n h\u1ee3p EWS-ETS v\u1edbi c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. Giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n, c\u00f3 th\u1ec3 c\u00f3 tho\u00e1i h\u00f3a d\u1ea1ng nang.<\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh<\/h2>\n
M\u1eb7c d\u00f9 c\u00f3 t\u00ednh ch\u1ea5t x\u00e2m l\u1ea5n, nh\u1eefng kh\u1ed1i u n\u00e0y c\u00f3 xu h\u01b0\u1edbng \u0111\u1ea9y l\u1ec7ch c\u00e1c c\u1ea5u tr\u00fac nh\u01b0 ph\u1ed5i ho\u1eb7c c\u01a1 ho\u00e0nh. Kh\u1ed1i u l\u1edbn c\u00f3 th\u1ec3 x\u00e2m l\u1ea5n tr\u1ef1c ti\u1ebfp. C\u00f3 th\u1ec3 g\u00e2y ph\u00e1 h\u1ee7y x\u01b0\u01a1ng s\u01b0\u1eddn.<\/p>\n
CT<\/h3>\n
C\u00e1c kh\u1ed1i u n\u00e0y c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m \u0111i\u1ec3n h\u00ecnh tr\u00ean CT l\u00e0 kh\u00f4ng r\u00f5 ranh gi\u1edbi, kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u1edbi nhi\u1ec1u v\u00f9ng tho\u00e1i h\u00f3a d\u1ea1ng nang. Th\u00e0nh ph\u1ea7n \u0111\u1eb7c ng\u1ea5m thu\u1ed1c sau ti\u00eam. Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i th\u01b0\u1eddng g\u1eb7p nh\u01b0ng th\u01b0\u1eddng l\u01b0\u1ee3ng \u00edt. Th\u01b0\u1eddng kh\u00f4ng c\u00f3 v\u00f4i h\u00f3a. C\u00e1c kh\u1ed1i u xu\u1ea5t ph\u00e1t t\u1eeb x\u01b0\u01a1ng c\u00f3 th\u1ec3 c\u00f3 ph\u1ea3n \u1ee9ng m\u00e0ng x\u01b0\u01a1ng d\u1ea1ng v\u1ecf h\u00e0nh.<\/p>\n
MRI<\/h3>\n
Kh\u1ed1i kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u1edbi c\u00e1c v\u00f9ng ho\u1ea1i t\u1eed, tho\u00e1i h\u00f3a d\u1ea1ng nang, ch\u1ea3y m\u00e1u. Kh\u1ed1i u nh\u1ecf c\u00f3 th\u1ec3 \u0111\u1ed3ng nh\u1ea5t.<\/p>\n
\n
T1: \u0111\u1ed3ng ho\u1eb7c t\u0103ng t\u00edn hi\u1ec7u so v\u1edbi c\u01a1<\/li>\n
T2: t\u00edn hi\u1ec7u cao kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t<\/li>\n
T1 C+ (Gd): ng\u1ea5m thu\u1ed1c kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t.<\/li>\n<\/ul>\n
\u0110i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng<\/h2>\n
\n
\u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt v\u00e0 h\u00f3a ch\u1ea5t +\/- x\u1ea1 tr\u1ecb.<\/li>\n
Ti\u00ean l\u01b0\u1ee3ng ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ed5n th\u01b0\u01a1ng t\u1ea1i ch\u1ed7 v\u00e0 di c\u0103n xa.<\/li>\n
T\u1ef7 l\u1ec7 s\u1ed1ng sau 5 n\u0103m l\u00e0 15-48%.<\/li>\n<\/ul>\n
Chu\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h2>\n
Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t bao g\u1ed3m c\u00e1c kh\u1ed1i u kh\u00e1c \u1edf th\u00e0nh ng\u1ef1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng sarcomas kh\u00e1c.<\/p>\n
\n
Osteosarcoma:\n
\n
C\u00f3 ma tr\u1eadn x\u01b0\u01a1ng\/s\u1ee5n.<\/li>\n
V\u1ecb tr\u00ed \u1edf ng\u1ef1c kh\u00f4ng th\u01b0\u1eddng g\u1eb7p.<\/li>\n<\/ul>\n<\/li>\n
Di c\u0103n th\u00e0nh ng\u1ef1c v\u00e0 m\u00e0ng ph\u1ed5i: ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 t\u1eeb c\u00e1c kh\u1ed1i u nguy\u00ean ph\u00e1t \u1edf ng\u1ef1c nh\u01b0 ung th\u01b0 ph\u1ed5i, ung th\u01b0 v\u00fa.<\/li>\n
U lympho: \u0111\u1ed3ng nh\u1ea5t, ng\u1ea5m thu\u1ed1c r\u00f5 r\u00e0ng v\u00e0 kh\u00f4ng ph\u00e1 h\u1ee7y x\u01b0\u01a1ng s\u01b0\u1eddn.<\/li>\n
Kh\u1ed1i u x\u01a1 m\u00e0ng ph\u1ed5i: r\u1ea5t hi\u1ebfm g\u1eb7p<\/li>\n
Sarcoma t\u1ebf b\u00e0o c\u01a1 v\u00e2n: hi\u1ebfm g\u1eb7p \u1edf th\u00e0nh ng\u1ef1c, th\u01b0\u1eddng kh\u00f3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c.<\/li>\n<\/ul>\n
C\u00e1c v\u00ed d\u1ee5<\/h2>\n
V\u00ed d\u1ee5 1<\/h3>\n
B\u1ec7nh nh\u00e2n nam, 19 tu\u1ed5i, \u0111au b\u00ean ng\u1ef1c ph\u1ea3i. H\u00ecnh \u1ea3nh x-quang cho th\u1ea5y kh\u1ed1i c\u00f3 \u0111\u1eadm \u0111\u1ed9 m\u00f4 m\u1ec1m \u1edf th\u00e0nh ng\u1ef1c ph\u1ea3i v\u00e0 ph\u00e1 h\u1ee7y x\u01b0\u01a1ng s\u01b0\u1eddn 6 b\u00ean ph\u1ea3i.<\/p>\n
<\/p>\n
$\"\"$ <\/p>\n
H\u00ecnh \u1ea3nh CT cho th\u1ea5y kh\u1ed1i ph\u00e1 h\u1ee7y x\u01b0\u01a1ng s\u01b0\u1eddn 6 b\u00ean ph\u1ea3i. Nhi\u1ec1u n\u1ed1t hai ph\u1ed5i<\/p>\n
$\"\"$ $\"\"$ $\"\"$ <\/p>\n
H\u00ecnh \u1ea3nh nhu\u1ed9m HE: nhi\u1ec1u t\u1ebf b\u00e0o tr\u00f2n nh\u1ecf, m\u00e0u xanh, \u0111\u1ed3ng nh\u1ea5t. (+) v\u1edbi CD 99 v\u00e0 (\u2013) v\u1edbi Cytokeratin. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 sarcoma Ewing th\u00e0nh ng\u1ef1c.<\/p>\n
$\"\"$ <\/p>\n
V\u00ed d\u1ee5 2<\/h3>\n
B\u1ec7nh nh\u00e2n n\u1eef, 15 tu\u1ed5i, ho khan, kh\u00f3 th\u1edf v\u00e0 s\u00fat c\u00e2n 2 th\u00e1ng nay, kh\u00f4ng s\u1ed1t. Phim x-quang cho th\u1ea5y h\u00ecnh m\u1edd to\u00e0n b\u1ed9 l\u1ed3ng ng\u1ef1c tr\u00e1i, \u0111\u00e8 \u0111\u1ea9y trung th\u1ea5t sang ph\u1ea3i.<\/p>\n
$\"\"$ <\/p>\n
CT cho th\u1ea5y m\u1ed9t kh\u1ed1i r\u1ea5t l\u1edbn, m\u1ea5t l\u1edbp m\u1ee1 ngo\u00e0i m\u00e0ng ph\u1ed5i. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 sarcoma Ewing th\u00e0nh ng\u1ef1c hay u Askin.<\/p>\n
$\"\"$ <\/p>\n
V\u00ed d\u1ee5 3<\/h3>\n
B\u1ec7nh nh\u00e2n nam, 16 tu\u1ed5i. H\u00ecnh \u1ea3nh x-quang cho th\u1ea5y m\u1ed9t kh\u1ed1i l\u1edbn ph\u00e1 h\u1ee7y ph\u1ea7n m\u1ec1m xu\u1ea5t ph\u00e1t t\u1eeb th\u00e0nh ng\u1ef1c tr\u00e1i.<\/p>\n
$\"\"$ <\/p>\n
H\u00ecnh \u1ea3nh CT cho th\u1ea5y ph\u00e1 h\u1ee7y x\u01b0\u01a1ng s\u01b0\u1eddn 4 b\u00ean tr\u00e1i, gi\u00e3n c\u00e1c m\u1ea1ch m\u00e1u ph\u00eda tr\u01b0\u1edbc b\u00ean th\u00e0nh ng\u1ef1c, kh\u1ed1i ng\u1ea5m thu\u1ed1c kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t.<\/p>\n
$\"\"$ $\"\"$ <\/p>\n
Tr\u00ean MRI, kh\u1ed1i c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m t\u01b0\u01a1ng t\u1ef1 nh\u01b0 CT. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 u Askin.<\/p>\n
$\"\"$ <\/p>\n
V\u00ed d\u1ee5 4<\/h3>\n
B\u1ec7nh nh\u00e2n nam, 25 tu\u1ed5i, \u0111au ng\u1ef1c. X-quang cho th\u1ea5y kh\u1ed1i ph\u00e2n th\u00f9y t\u1ef1a l\u00ean \u0111\u1ec9nh ph\u1ed5i tr\u00e1i.<\/p>\n
$\"\"$ <\/p>\n
CT: kh\u1ed1i \u0111\u1eadm \u0111\u1ed9 m\u00f4 m\u1ec1m, ng\u1ea5m thu\u1ed1c kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t \u1edf v\u00f9ng \u0111\u1ec9nh ph\u1ed5i tr\u00e1i.<\/p>\n
$\"\"$ <\/p>\n
PET-CT: kh\u1ed1i t\u0103ng h\u1ea5p thu FDG.<\/p>\n
$\"\"$ <\/p>\n
Sinh thi\u1ebft d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m cho ch\u1ea9n \u0111o\u00e1n l\u00e0 Sarcoma Ewing.<\/p>\n
$\"\"$ <\/p>\n
V\u00ed d\u1ee5 5<\/h3>\n
B\u1ec7nh nh\u00e2n nam, 16 tu\u1ed5i, v\u1edbi kh\u1ed1i \u1edf th\u00e0nh ng\u1ef1c. CT: kh\u1ed1i l\u1edbn c\u00f3 \u0111\u1eadm \u0111\u1ed9 m\u00f4 m\u1ec1m \u1edf th\u00e0nh ng\u1ef1c sau, ph\u00e1 h\u1ee7y x\u01b0\u01a1ng s\u01b0\u1eddn v\u00e0 th\u00e2n \u0111\u1ed1t s\u1ed1ng. C\u00f3 th\u1ec3 th\u1ea5y c\u00f3 x\u00e2m l\u1ea5n v\u00e0o \u1ed1ng s\u1ed1ng, trung th\u1ea5t sau v\u00e0 r\u1ed1n ph\u1ed5i. V\u00f4i h\u00f3a trong kh\u1ed1i \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y r\u00f5.<\/p>\n
$\"\"$ <\/p>\n
Ngu\u1ed3n tham kh\u1ea3o<\/h2>\n
Dr Mohamed Saber, Ewing sarcoma (chest wall)<\/a>, Radiopaedia. Truy c\u1eadp ng\u00e0y 28\/06\/2022<\/p>\n","protected":false},"excerpt":{"rendered":"
T\u1ea3i file PDF b\u00e0i vi\u1ebft Sarcoma Ewing (th\u00e0nh ng\u1ef1c)- Ewing sarcoma (chest wall)\u00a0t\u1ea1i \u0111\u00e2y B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c d\u1ecbch b\u1edfi Tr\u1ea7n Th\u1ecb Thu, Dr. L\u00ea V\u0169 Duy \u0110\u1ea1i c\u01b0\u01a1ng Kh\u1ed1i u sarcoma Ewing gia \u0111\u00ecnh (Ewing sarcoma family of tumors (ESFT)) hay c\u00f2n g\u1ecdi l\u00e0 sarcoma Ewing th\u00e0nh ng\u1ef1c, l\u00e0 kh\u1ed1i u \u00e1c t\u00ednh \u1edf tr\u1ebb […]\n","protected":false},"author":1,"featured_media":33073,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-33089","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33089","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=33089"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33089\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/33073"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=33089"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=33089"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=33089"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

MRI<\/h3>\nKh\u1ed1i kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u1edbi c\u00e1c v\u00f9ng ho\u1ea1i t\u1eed, tho\u00e1i h\u00f3a d\u1ea1ng nang, ch\u1ea3y m\u00e1u. Kh\u1ed1i u nh\u1ecf c\u00f3 th\u1ec3 \u0111\u1ed3ng nh\u1ea5t.<\/p>\n

\u0110i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng<\/h2>\n\n\u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt v\u00e0 h\u00f3a ch\u1ea5t +\/- x\u1ea1 tr\u1ecb.<\/li>\nTi\u00ean l\u01b0\u1ee3ng ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ed5n th\u01b0\u01a1ng t\u1ea1i ch\u1ed7 v\u00e0 di c\u0103n xa.<\/li>\n

Chu\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h2>\nCh\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t bao g\u1ed3m c\u00e1c kh\u1ed1i u kh\u00e1c \u1edf th\u00e0nh ng\u1ef1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng sarcomas kh\u00e1c.<\/p>\n

C\u00e1c v\u00ed d\u1ee5<\/h2>\n