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BNH NGUYN BO NUIMc tiu hc tp 1- Trnh by c ngun gc pht sinh ca bnh nguyn bo nui 2- M t c cc giai on bit ha chnh ca t bo nui 3- Nu v m t c cha trng lnh tnh, cha trng c tnh v ung th t bo nui.

I. I CNGBnh nguyn bo nui l bnh xut pht t lp biu m nui, c nhim v nui dng v bo v cho thai nhi.V phng din ngun gc th lp biu m ny c hnh thnh rt sm, k t khi trng va mi th tinh v bt u lm t nim mc t cung ca ngi m. Bn thn nguyn bo nui l m u tin c bit ha trong bo thai cn non v tr thnh ngoi bo thai khi pht trin thnh nhau thai. N hnh thnh vch ngn cch bo thai vi m v mu ca ngi m. Cc bnh ca nguyn bo nui u lin quan n cha v do vy gy nhiu nh hng n ph n trong tui sinh . y l bnh duy nht thy c ngi m t bo pht sinh u li thuc v mt c th khc, tc l thai nhi. Bnh c c im din tin nhanh, c khi gy t vong cho ngi m trong khong 3-6 thng. Ngc li nu c iu tr kp thi th bnh p ng rt tt vi ha tr liu. Bnh cn c gi l bnh nguyn bo nui do cha v c lin quan n cha . C mang thai mi c cc bnh ny v l bnh rt ph bin, thng gp cc nc vng ng Nam . Ti cc nc nh Phi lip pin, Sing ga po, Innxia, Hng Kng t l mc bnh cha trng lnh tnh chim t 0,25% -0,85% ph n mang thai, trong khi th t l ny i vi cc nc Chu u chim khong 0,5%0 -1%0 . Hng nm, trn th gii c khong 126 triu ngi sinh th c ti 126.000 ngi mc bnh cha trng (chim 1%0 ), trong 10% cn c tin hnh ha tr liu cho bnh ung th nguyn bo nui v cha trng xm nhp. Theo c tnh, trong cha trng lnh tnh c 15% bin chng thnh cha trng xm nhp v 2-3% tr thnh ung th nguyn bo nui. V di truyn hc, bnh cha trng ton phn c nhim sc th l 46XX, nhng 2X ca cha do nhn i ca nhim sc th n bi ca tinh trng trong mt non rng (khng c NST gii tnh , khng c DNA ca m) v t 3-13% cha trng ton phn c nhim sc th l 46XY do th tinh ca hai tinh trng 1X, 1Y vo mt non rng. Nhim sc th ca cha trng bn phn thng l tam bi th vi 69 nhim sc th, trong 46 t cha v 23 t m.

II. QU TRNH TO THNH LP T BO NUI V S BIT HA1. Qu trnh to thnh lp t bo nui Trng sau khi th tinh 1/3 ngoi ca vi trng th bc vo qu trnh phn chia. Qua nghin cu cho thy khong 10 gi sau khi th tinh, trng th tinh bt u bc vo qu trnh phn chia . Qu trnh phn chia ln th nht to ra 2 nguyn bo, ln phn chia th hai cng c tin hnh theo mt phng thng ng to ra 4 nguyn bo, nhng n ln phn chia th ba trng li phn chia theo mt phng nm ngang v lch trc, kt qu to ra 8 nguyn bo c kch thc khng u nhau: bn nguyn bo cc trn c kch nh hn c gi l tiu nguyn bo. Cn bn nguyn bo cc di c th tch ln hn c gi l i nguyn bo.

106 Bc phn chia tip theo, do cc tiu nguyn bo cc trn c kch thc nh nn bc vo qu trnh phn chia nhanh hn so vi khi i nguyn bo cc di. Kt qu l to ra mt khi t bo bao ph ht khi i nguyn bo bn trong. Giai on ny c gi l phi du (trng phi ging qu du). Lp tiu nguyn bo bao ph bn ngoi trng v sau pht trin thnh l nui (gm cc t bo nui sau ny) v chng l phn quan trng ca nhau thai, c quan dinh dng chnh ca phi, cn phn i nguyn bo bn trong sau ny pht trin thnh thai nhi. Khi trng di chuyn xung nim mc t cung lm t th lp t bo nui cng va mi hnh thnh xong, chnh nh lp t bo nui ny nn trng mi c kh nng chui vo nim mc t cung lm t v pht trin. Lp t bo nui (trophoblast) gm hai hng t bo: hng trong l cc n bo nui (cytotrophoblast), hng ngoi cng l cc hp bo nui (plasmoditrophoblast). 2. S bit ha ca lp t bo nui T bo nui sau khi c hnh thnh s tip tc pht trin v bit ha. S bit ha ca lp t bo nui c th chia lm ba giai on chnh nh sau : + Giai on 1: giai on cha hnh thnh lng nhau, t ngy th 6-13 Giai on ny t bo nui hp thnh mt khi c gi l bn t bo nui, gm hai lp t bo r rt. Lp su l cc n bo nui, ranh gii r, nguyn sinh cht sng, l r, nhn ln. Lp nng l cc hp bo nui, chng c ranh gii khng r, bo tng bt mu v bn trong cha rt nhiu nhn. + Giai an 2: giai on b, t ngy th 13 -15 Lc ny trong khi c ca t bo nui li xut hin cc khe. Cc khe ngy cng gin rng v to nn h huyt. Cc hp bo nui bn ngoi xuyn qua h huyt ni lp trong v lp ngoi to nn hnh nh lng nhau nguyn thy. + Giai on 3: giai on mng m c lng nhau, t ngy th 15- 24 Lp trung m ca bo thai chui vo cc lng nhau nguyn thy v ti hnh thnh nhng huyt qun ni lin huyt qun ca bo thai. T y to nn lng nhau chnh thc m trc lin kt gia cha cc nguyn bo x non v cc huyt qun. H thng lng nhau ny c chc nng lc ly cht dinh dng t h huyt nui thai v lc ny bo thai sng t lp. Da vo s pht trin ca bo thai vi s bit ha ca lp t bo nui ngi ta chia 3 nhm bnh l chnh ca bnh nguyn bo nui l: cha trng lnh tnh, cha trng xm nhp, ung th t bo nui.

III. CHA TRNG LNH TNH (Hydatiform mole)1. nh ngha Cha trng lnh tnh l bnh lnh tnh ca biu m nui, c cc c im: -Lp t bo nui lt bn ngoi lng nhau qu sn nh -Thoi ha nc cc lng nhau -Trc lin kt cc lng nhau khng c cc huyt qun 2. Tn thng i th

107 Kch thc t cung ca bnh nhn to hn kch thc t cung bnh thng c cng tui thai, bnh nhn c th c ra huyt m o v triu chng nghn rm r hn. Quan st b mt lp thanh mc ngoi cng ca t cung thy trn lng, mu trng hng, c khi c xung huyt nh, vng y ca t cung to thnh mt khi phng to, n vo c cm gic lng nhng. X dc thn t cung thy bn trong lng t cung cha khi u c mng bao bc mu thm. Khi ny d mn nt v d tch ri khi nim mc t cung lc bc tch. X bc u, thy bn trong bc cha cc nang nc (bng nc) ging nh nhng chm trng ch c ng knh t 0,5-1cm. Cc nang to nh khng u v dnh li vi nhau bi cc cung nh trng nh nhng chm nho. Trung tm khi u c th gp cc hoi t, mn nt, mu vng nht hoc chy mu. 3. Tn thng vi th Hnh nh vi th ca cha trng lnh tnh c nhng im ging vi nhau thai bnh thng. Lp t bo nui lt bn ngoi cc lng nhau qu sn va phi, c ranh gii r rng gia n bo nui v hp bo nui, cc t bo u bnh thng. Trc lin kt bn trong ca cc lng nhau b thoi ha nc, trng phnh to v khng cn thy huyt qun.

Hnh1-2: Tn thng i th v vi th ca cha trng lnh tnh

IV. CHA TRNG XM NHP (Invasive mole)1. nh ngha Cha trng xm nhp l bnh c tnh ca biu m nui c c im: -Qu sn mnh ca nhiu t bo nui mang tnh cht c tnh -C s tn ti ca nhiu lng nhau -S xm nhp, ph hy v khu tr lp c t cung l ch yu 2. Tn thng i th Kch thc t cung thng khng to, bnh nhn cng c ra huyt m o, b mt lp thanh mc t cung trn lng, trng hng, i a s t cung khng thay i hnh dng nhng khi t chc u xm nhp v pht trin to ra th c th thy bn ngoi t cung ni g ln v pha

108 c u. C khi t cung b ph hy, nhiu nang trng cng m hoi t chui vo phc mc gy chy mu. Qua din ct thy t chc u xm nhp su vo lp c t cung, to nn cc hc nham nh km nhng m mn nt. 3. Tn thng vi th Cu to ca cha trng xm nhp rt phc tp. Nhng nang trng lnh tnh xen k vi nhng nang c tnh gm qu sn lp t bo nui rt mnh v hn lon, nhiu n bo nui rt to hp thnh khi ln quanh trc lin kt v c nhiu hnh thi chuyn tip thnh hp bo nui, xen k l cc hp bo nui nhiu nhn qui, ranh gii khng r. Lp c b thoi ha, hoi t v xm nhp nhiu n bo nui km t bo lympho.

Hnh 3-4 : Tn thng vi th ca cha trng xm nhp

V. UNG TH BIU M NUI (Choriocarcinoma)1. nh ngha Ung th biu m nui l bnh c tnh ca biu m nui, c c im : -Qu sn v lon sn hon ton cc t bo nui -Khng hnh thnh lng nhau -T chc u thng di cn n nhiu ph tng v di cn xa Hertig v Mansell nhn thy 50% ung th t bo nui c tin s cha trng lnh tnh, 25% c tin s sy thai, 22% pht trin t thai thng v 2,5% c tin s t thai ngoi t cung. 2. Tn thng i th Kch thc t cung ln, lp b mt thanh mc t cung trn lng, trng hng, t cung khng bin i hnh dng. Tuy nhin, mt s trng hp, trn thanh mc t cung c nhng khi trn ni g ln, mu tm sm hoc c khi t cung b v v pha y t cung cha y mu sm km m hoi t. Bung trng to hn bnh thng, c khi gp u nang bung trng ng knh c th n 10cm, cha y nc hoc mu. Qua din ct t cung gp cc nhn ung th nm b mt hoc n su vo lp c t cung. 3. Tn thng vi th

109 Lp c t cung b ph hy, t chc u xm ln gy chy mu d di, m b hoi t. Xen k gia cc b si c trn t cung b phn tn l cc m t bo nui mang tnh cht c tnh. Cc n bo nui lon sn to nh khng u, nhn qui d, ht nhn to, mt s chuyn dng thnh hp bo nui, cc hp bo nui cng qui g, phn b hn lon. Cc m t bo ny khi ng thnh m, khi th phn b xa nhau, c bit khng thy hnh nh lng nhau. M m c phn ng lympho bo yu nhng s hin din BCN rt nhiu (do bi nhim).

Hnh 5-6 : Tn thng vi th ca ung th t bo nui U thng cho di cn xa, 90% di cn n phi, 20-60% di cn n gan v no. Ngoi ra, u c th di cn n bt k ni no nh thn, bng, ng tiu ha, m h, m o... Trc khi c ha tr liu, tin lng ca bnh rt xu, ch c khong 30% bnh nhn sng thm 5 nm sau ct b t cung. Hin nay, vi ha tr liu, t l ny l 80%. Bnh nhn thng cht do xut huyt hoc ho ra mu.

VI. TIN TRIN CA BNH NGUYN BO NUI1. Cha trng lnh tnh + Cht do chy mu t cung + Thng t cung + Nghn mch do nguyn bo nui + Tin trin thnh cha trng xm nhp hocung th t bo nui 2. Cha trng xm nhp + Chy mu + Thng t cung (hay gp) + Di cn gn (m o), di cn xa (n phi v cc ph tng khc) + Bin thnh ung th t bo nui (him) + Thoi trin t nhin (him)

110 3. Ung th t bo nui + Chy mu (hay gp) + Thng t cung + Di cn n nhiu ph tng: hay gp nht l phi (hnh bng bay trn XQ)