CDHA u Phe Quan-phoi

7/23/2019 CDHA u Phe Quan-phoi

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CHN ON HNH NH

UNG TH PH QUN

-

PHIBS. NGUYN QU KHONG

BS. NGUYN QUANG TRNG

KHOA CHN ON HNH NH

BNH ViN AN BNH TP.HCM


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DN BI

i cng.

Phn loi:

Theo gii phu.

Theo m hc.

Phn loi TNM.

K phi th pht.


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DN BI

i cng.

Phn loi:

Theo gii phu.

Theo m hc.

Phn loi TNM.

K phi th pht.


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I CNG

U ph qun

-

phi rt nguy him, ch c 15% sng st

sau 5 nm.

M, 125.000 ngi/nm cht v U phi.

Nam b nhiu hn N, nhng nay th bnh nhn N

ang ngy cng tng ln.

Bnh thng gp la tui > 40.

Thuc l c xem l mt trong nhng tc nhn gy

Uph qun

-

phi.


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I CNG

Trong thuc l c Carcinogenic polycyclic

hydrocarbon

Epithelial mtaplasia

Ung th.

Tn sut U ph qun

-

phi rt cao nhng ngi ht

20 gi x nm (1 gi/ngy x s nm).

C 3 loi U ph qun

-

phi:

U lnh: 5% u nguyn pht.

U c: K ph qun

-

phi: 95% u nguyn pht.

U c th pht: K di cn.

99% K cc ph qun v cc ph nang.

1% K kh qun.


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PHN LOI1. Theo gii phu

: c hai loi.

a. Loi trung tm

: PQ ln c th b tc

Xp phi

biu hin triuchng lm sng sm.

b.

Loi ngoi bin

: PQ nh c thi gian yn lng lu

chn on tr.

*Tuy nhin khi khi u:

-

Loi trung tm c kch thc = 2cm.-

Loi ngoi bin c kch thc = 6mm.

Th i sng ca khi u tri qua.

2. Theo m hc

: c 5 loi chnh.

a. Ung th t bo vy (squamous cell carcinoma).

b.

Ung th t bo tuyn (adenocarcinoma).

c.

Ung th t bo nh (small cell carcinoma).

d.

Ung th t bo ln (large cell carcinoma).

e.

Ung th tiu ph qun

-

ph nang (bronchiolo

-

alveolar carcinoma).


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DN BI

i cng.

Phn loi:

Theo gii phu. Theo m hc.

Phn loi TNM.

K phi th pht.


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K PH QUN-PHI TH TRUNG TM (80%)

Tn thng nhu m: Xp phi (atelectasis): thng gp. Vim phi sau tc nghn (obstructive pneumonia). p xe phi. Kh ph thng: 2%.

Trn dch mng phi: 5%

Do tc nghn bch mch. Do xm ln vo mng phi (trn mu mng phi).

Lit thn kinh honh.


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Vim phi sau tc nghn (obstructive pneumonia):

Hnh nh thng gp trong Ung th ph qun-phi

(thy trong khong 35% bnh nhn b Ung thbiu msquamous cell carcinoma).

Nhu m phi xp v ng c, ph qun dn v lpy bi dch nhy to nn hnh nh Mucous

bronchogram, thy r trn CT sau chch thuc cnquang.

Richard Webb et al. Thoracic Imaging-Pulmonary & Cardiovascular Radiology, p66-111. 2005


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Khi u rn phi, thng km theo xp phi to duhiu ch S o ngc kinh in (SGoldens sign).

Weissleder et al.Diagnostic Imaging Expert.1998


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S Goldens sign: Small cell carcinoma



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Dalia Megiddo,M.D et al. Chest X-ray interpretation. Academia Medica,Jerusalem,ISRAEL.

S Goldens sign


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Joseph K.T.Lee. Lee computed body tomography with MRI correlation. 1998

S Goldens sign


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MUCOUS BRONCHOGRAM


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Jacques Rmy et al. Imagerie Thoracique. Socit Franaise de Radiologie - 2003

S GOLDENS SIGN

MUCOUS BRONCHOGRAM


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TNG QUAN GIA U V PH QUN


Daniel Jeanbourquin et al. Imagerie Thoracique de l'adulte. 2003

Rat-tail sign


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Chi trong lng kh qun, ph qun


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XC NH XM LN TRUNG THT


Hch trung tht c xem l ph ikhi ng knh theo trc ngn ca

hch 10mm.


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Khi u (T) xm ln khoang m trc carina, xm ln TM ch trn vihuyt khi trong lng (*) (tumor thrombus).


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Khi u (T) tip xc vi trung tht > 3cm, xm ln khoang m cnh MC,tip xc > chu vi MC (cc mi tn). Hch di carina (N).


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K PH QUN-PHI TH NGOI BIN (20%)

Tn thng hnh ng tin (coin lesion);

B thng khng u, c mi, hoc c ch lmvo, hoc c gai.

Tn thng c th vi ha hoc to hang.

Vi ha t gp (thng gp hn vi tn thnglnh tnh).

To hang 4% vi thnh dy > 16mm, vi nt vch, khng mc thy-kh.


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Nhng du hiu gi c tnh

Sebastian Lange, MD et al. Radiology of Chest Diseases. 2nd Edition, 1998


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Spiculated mass vi Pleural tail sign:adenocarcinoma


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Pleural tail sign:squamous cell carcinoma



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B hnh gai, hang thnh dy khng u, pleural tail sign,air bronchogram: Adenocarcinoma.


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Spiculated edge:adenocarcinoma



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Spiculated edge: Squamous cell carcinoma



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VI HA LNH TNH


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TUBERCULOMA


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HAMARTOMA


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HAMARTOMA


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HISTOPLASMOMA


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VI HA KHNG XC NH(LNH TNH HOC C TNH)


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EPIDERMOID CARCINOMA


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ADENOCARCINOMA


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LIN QUAN GIA KCH THC V C TNH


NG KNH C TNH

< 1cm

1-2cm2-3cm

>3cm

35%

50%80%

97%


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S BT THUC CA TN THNG

Tn thng bt thuc < 15HU: gi lnh tnh. Tn thng bt thuc > 20HU: gi c tnh.

( nhy: 98%, chuyn bit: 73%, chnh xc:85%)

Wolfgang Dahnert, MD. Radiology Review Manual. 5thEdition. 2003


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NH LUT NHN I TH TCH

Th tch ca mt khi u tng gp i khi ng knhkhi u tng 25% (cn khi ng knh tng gp i thth tch tng gp 8 ln).

Thi gian nhn i th tch < 1 thng: Nhim trng. Thi gian nhn i th tch 1 thng1 nm: U c.

Thi gian nhn i th tch > 1 nm: U lnh.

Lu : K tiu ph qun-ph nang c th khng ith tch trong 1-2 nm u.



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NH LUT NHN I TH TCH

1 thng: Ung th t bo nh xm ln (aggressive small cellcancer).

3 thng: Carcinoma t bo vy (squamous cell carcinoma). 4 thng: Carcinoma t bo ln (large cell carcinoma).

5 thng: Adenocarcinoma xm ln (aggressiveadenocarcinoma).

6 thng: Adenocarcinoma (aggressive adenocarcinoma).



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NH LUT NHN I TH TCH

nh lut ny ch c gi tr tin on dng 65% cc trnghp:

U c tnh pht trin chm: low-grade adenocarcinoma, di

cn t carcinoma thn (renal cell carcinoma). U c tnh pht trin rt nhanh: Osteosarcoma,

choriocarcinoma, testicular neoplasm.

Lu : Bronchogenic carcinoma c th tm thi gim kch

thc do: nhi mu, hoi t, x ha.



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XC NH XM LN THNH NGC



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To gc t vi thnh ngc (cc mi tn trng), xa lp m ngoi mngphi (mi tn en).


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Tip xc vi thnh ngc > 3cm, to gc t vi thnh ngc (cc mi tntrng), hy cung sn (mi tn en).


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Tip xc vi thnh ngc L=5cm,D=5cm. M ngoi mng phi c m thp, thy cc khong lin sn

(cc mi tn trng),

Hy cung sn v u thnh ngc.


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Tip xc vi thnh ngc L=5,6cm, D=8,7cm.


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DN BI

i cng.

Phn loi:


Phn loi TNM.

K phi th pht.

SQUAMOUS CELL CARCINOMA


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- 30% ung th ph qun-phi.

- Lin h nhiu vi thuc l.

- 65% xut pht t ph qun gc, thy, phn thy:

+Khi trong lng ph qun.

+Tc nghn ph qun.

+Thm nhim vch ph qun.+Xm ln ti ch.

+Khi rn phi.

+Thng gy xp v vim phi sau tc nghn.

- 30% hin din nh mt nt n c hoc mt khi.

+Thng hoi t to hang.

- Thi gian nhn i th tch: 3 thng. Di cn tr.

- Tin lng tt.


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U (M) gy xp phi to du hiu S Golden, hch cnh (P)kh qun (mi tn ln)


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U trong lng ph qun thy di (P) (Hnh A). lt ct thp hn (Hnh B): lngPQ tc nghn, xm ln xung quanh, to nn mt khi rn phi (M).

A B


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Farnoosh Sokhandon, MD et al. Bronchogenic Squamous Cell Carcinoma. Radiographics.

2003;23:1639-1643.

U rn phi (P), ph i hch trccarina (mi tn ln).

lt ct thp hn thy u bao bc quanhph qun thy trn (P) (mi tn), ph i

hch di carina.


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U to hang thnh dy, c nt vch, ngoi vi thy trn phi (P)


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ADENOCARCINOMA

-30-35% ung th ph qun-phi (loi TB thng gpnht).

-Khng lin h vi thuc l, thng thy nht ph n.-Thng lin kt vi x phi (lung fibrosis).

-75% hin din nh mt nt n c ngoi vi phi.

-B thng c gai (spiculated).

-Thi gian nhn i th tch 5-6 thng. Di cn sm.



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ADENOCARCINOMA


U c b dng mi, pleural tail sign (+): adenocarcinoma


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ADENOCARCINOMA

U ngoi vi phi vi b c gai

BRONCHIOLO-ALVEOLAR CARCINOMA


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- Subtype ca adenocarcinoma (3% ca K ph qun-phi).

- U khng xm ln.

- 60% hin din nh mt nt n c:+U khng tit nhy (non-mucinous cell type).

+Gii hn khng r.

+Air bronchogram (+).

+Bng kh thu quang (bubbly lucencies -pseudocavitation).

+Tin lng rt tt.

- 40% hin din nh mt vng ng c phi:

+ U tit nhy (mucinous cell type).

+ CT angiogram sign (+).

+ Tin lng xu.



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BRONCHIOLOALVEOLAR CARCINOMA


Nt m (mi tn) b khng r dokhng u, c gai. Trn CT thy airbronchogram v pseudocavitation


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Jeremy J. Erasmus, MD et al. Solitary Pulmonary Nodules: Part I. Morphologic Evaluation for

Differentiation of Benign and Malignant Lesions. Radiographics. 2000;20:43-58.

Pseudocavitation


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Nhiu nt m khng r b vi air bronchogram


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ng c c hai thy trn vi air bronchogram


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BRONCHIOLOALVEOLAR CARCINOMACT ANGIOGRAM SIGN

l hnh nh mch mu phi tng m , hin rtrn nn phi ng c, gim m .

Trc y du hiu ny c xem l c hiu trongchn on bronchiolo-alveolar carcinoma. Ngy nayngi ta chng minh rng i khi cng c th thytrong vim phi, ph phi

Roberto L. Maldonado, MD. The CT Angiogram Sign. Radiology. 1999;210:323-324.


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BRONCHIOLOALVEOLARCARCINOMA

Roberto L. Maldonado, MD. The CT Angiogram Sign. Radiology. 1999;210:323-324.


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J I Jung, MD et al. CT differentiation of pneumonic-type bronchioloalveolar cell carcinoma and

infectious pneumonia. British Journal of Radiology 74(2001),490-494.

AIR BRONCHOGRAM (+), CT ANGIOGRAM SIGN (+)


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Rosita M. Shah et al. CT angiogram sign: Incidence and Significance in Lobar Consolidations

Evaluated by Contrast-Enhanced CT. AJR 1998;170:719-722

AIR BRONCHOGRAM (+), CT ANGIOGRAM SIGN (+)

BAC VIM PHI THY


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SMALL CELL CARCINOMA

- 15-20% ung th ph qun-phi.


- Carcinoma thn kinh-ni tit (neuroendocrine),thng biu hin bng hi chng cn ung th(paraneoplastic syndrome).

- Phn ln xut pht t ph qun gc hoc ph qun thy.- Xm ln quanh ph qun.

- Khi ln rn phi hoc cnh rn phi, lm hp lng PQ.

- Ph i hch trung tht.

- Thi gian nhn i th tch: 1 thng. > 90% di cn ti thiim chn on.

-Tin lng rt xu.



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SMALL CELL CARCINOMA


U rn phi (P) , dy vch lin tiu thy thy gia do di cntheo ng bch huyt ln cn


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LARGE CELL CARCINOMA

- 10% ung th ph qun-phi.


- Chng lp nhiu loi t bo khc nhau.

- Thng biu hin bng mt khi ln ngoi vi, > 4cm.

- Thi gian nhn i th tch: 4 thng. Di cn sm.

- Tin lng xu.



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LARGE CELL CARCINOMA


Khi u ln phi (T), TDMP (T)


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SQUAMOUS ADENOCARCINOMA SMALL CELL LARGE CELL

Nt hoc khi ngoi vi

30% 75% 15% 65%

Xp phi 40% 10% 20% 15%

ng c phi 20% 15% 20% 25%

Rn phi to 40% 20% 80% 30%

Khi trungtht

< 5% < 5% 15% 10%

Trn dch

mng phi

5% 5% 5% 5%


K BIU M K TB TUYN K TB NH

V tr Trung tm (++)

Ngoi bin (+) Ngoi bin (++)

Trung tm (

) Trung tm (+) Ngoi bin (+)


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V tr Trung tm (++)Ngoi bin (+) Ngoi bin (++) Trung tm (-) Trung tm (+) Ngoi bin (+)

M hc TB biu m bit ha nhiu hayt

TB tuyn bit ha nhiu hayt

TB Kulchitsky (dng la mch)

i th Chi trong PQ. Hoi t (++). Khng hnh c hiu. U thm nhim quanh PQ.

X quang

Di cn -Ln cn

-Theo bch huyt

-Theo ng mu

-Ln cn

-Theo bch huyt

-Theo ng mu

Theo mu di cn vo xng,trung tht.

Gii, tui Nam > N. Tui > 50. N > Nam. Tui 40. Nam > N. Tui < 40.

Lin h nthuc l

+ - +/-

Tr liu -Phu thut (+).

-X tr (+/-).

-Phu thut (+).

-X tr (+/-).

-Ha tr (+)

-X tr (+/-).

-Ha tr (+)


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CC C TNH GI U C TNH

- U thy trn phi.- ng knh ln nht >2cm.

- B nhe, a cung, khng u, c gai.

- C air bronchogram, nhng bng kh nh (pseudocavitation).

- Hang vch dy > 16mm, c nt vch, khng c mc thy-kh.

- Vi ha dng lm tm hoc lch tm.

- Khng c nt v tinh.

- Bt thuc 20HU.- Thi gian nhn i th tch t 1 thng n 1 nm.



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DN BI

i cng.

Phn loi:


Phn loi TNM.

K phi th pht.

PHN LOI TNM


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T1 ng knh (ln nht) 3cm, xm ln mng phi tng, xp phi,vim phi sau tc nghn, cch carina > 2cm.

T3 U bt k kch thc, cch carina < 2cm, xm ln mng phi thnh,thnh ngc, vm honh, mng phi trung tht, mng tim, TDMP.

T4 Xm ln tim, mch mu ln, kh qun, thc qun, thn t sng,carina, TDMP c tnh.

N1 Hch quanh ph qun, rn phi cng bn.

N2 Hch trung tht cng bn.

N3 Hch rn phi, trung tht bn i din.M0 Khng di cn xa.

M1 Di cn xa.


PHN LOI TNM


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GIAI ON TNM IU TR


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GIAI ON TNM IU TR

IA T1, N0, M0 Ct b khi u.

IB T2, N0, M0 Ct b khi u.

IIA T1, N1, M0 Ct b khi u.

IIB T2, N1, M0T3, N0, M0

Ct b khi u.

IIIA

T1

, N2

, M0T2, N2, M0

T3, N1, M0T3, N2, M0

X tr hoc ha tr sau ct b khi u.

IIIB T1, N3, M0

T2, N3, M0T3, N3, M0

X tr v/hoc ha tr.

IV M1 Ha tr.



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PHN LOI TNM

U (mi tn) DI CN HCH TRUNG THTBN I DIN (u mi tn)


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PHN LOI TNM

U (M) di cn hch di carina (S), hch trc kh qun (P), hchtrung tht trc (A), hch trung tht bn i din (cc mi tn ln).

Di cn mng phi gy dy v TDMP (cc mi tn nh).



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PHN LOI TNM

UNG TH PH QUN-PHI TO HANG (cc mi tn)GIAI ON IV


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PHN LOI TNM

UNG TH PH QUN-PHI GIAI ON IV

S GIN N XC NH GIAI ON UNG TH PH QUN-PHI


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S GIN N XC NH GIAI ON UNG TH PH QUN PHI


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DN BI

i cng.

Phn loi:


Phn loi TNM.

K phi th pht.


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UNG TH PHI TH PHT

C ba loi:

K di cn ln phi theo ng mch mu. K di cn ln phi theo ng bch huyt.

K di cn theo ng ph qun.

UNG TH PHI TH PHT


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UNG TH PHI TH PHTDI CN THEO NG MU

Hnh nh bong bng bay (image en lcher de ballonscannon balls sign, golf balls sign).

Hnh nh dng k (miliary form).

Hnh nh dng nt th (coarse nodular form).

Nguyn nhn: t cc loi K thn, xng, gip, K t

bo nui, melanoma, tinh hon.

UNG TH PHI TH PHT


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UNG TH PHI TH PHT


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Di cn t Testicular teratocarcinoma


UNG TH PHI TH PHT


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Di cn t HCC

Sanjeev Katyal, MD et al. Extrahepatic Metastases of Hepatocellular Carcinoma.

Radiology. 2000;216:698-703.

6 thng sau

UNG TH PHI TH PHT


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Di cn to hang t Squamous cellcarcinoma ca ph qun gc (T).

Joon Beom Seo, MD et al. Atypical Pulmonary Metastases: Spectrum of Radiologic Findings.

Radiographics. 2001;21:403-417.

UNG TH PHI TH PHT


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UNG TH PHI TH PHTDI CN THEO NG BCH HUYT

Hnh mng v cc ng tua ta v 2 rn phi.

ng Kerley B, A, C, D. Hch rn phi ph i.

Nguyn nhn: t cc loi K v, d dy, gip.

UNG TH PHI TH PHT


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UNG TH PHI TH PHT


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Hnh nh bnh thng1 nm sau: di cn theo bch

mch, TDMP


UNG TH PHI TH PHT


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Dy vch lin tiu thy


UNG TH PHI TH PHT


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UNG TH PHI TH PHT


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Jacques Rmy et al. Cours de Tomodensitometrie Thoracique. CHRU de Lille. 2005

UNG TH PHI TH PHT


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UNG TH PHI TH PHTDI CN THEO NG PH QUN


Bronchioloalveolar carcinoma di cn theo ng phqun, biu hin bng nhng nt trung tm tiu thy

(cc mi tn).

UNG TH PHI TH PHT


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UNG DI CN THEO NG PH QUN


Squamous cell carcinoma vi hnhnh to hang

Vi nm sau: nt v khi to hang haibn


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Sng Seine nhn t thp Effel, 21/6/2005

CM N S CH CA QU BC S

TI LIU THAM KHO


99/99

TI LIU THAM KHO

Richard Webb et al. Thoracic Imaging-Pulmonary & Cardiovascular Radiology. 2005 Daniel Jeanbourquin et al. Imagerie Thoracique de l'adulte. 2003 Wolfgang Dahnert, MD. Radiology Review Manual. 5thEditon. 2003 Jacques Rmy et al. Imagerie Thoracique. Socit Franaise de Radiologie - 2003 Jacques Rmy et al. Cours de Tomodensitometrie Thoracique. CHRU de Lille. 2005 Sebastian Lange, MD et al. Radiology of Chest Diseases. 2nd Edition, 1998 Philippe Grenier et al. Imagerie Thoracique de l'adulte. 2e edition. 1996 Farnoosh Sokhandon, MD et al. Bronchogenic Squamous Cell Carcinoma.

Radiographics. 2003;23:1639-1643. Joon Beom Seo, MD et al. Atypical Pulmonary Metastases: Spectrum of Radiologic

Findings. Radiographics. 2001;21:403-417. J I Jung, MD et al. CT differentiation of pneumonic-type bronchioloalveolar cell

carcinoma and infectious pneumonia. British Journal of Radiology 74(2001),490-494.

Jeremy J. Erasmus, MD et al. Solitary Pulmonary Nodules: Part I. MorphologicEvaluation for Differentiation of Benign and Malignant Lesions. Radiographics.2000;20:43-58.

Sanjeev Katyal, MD et al. Extrahepatic Metastases of Hepatocellular Carcinoma.Radiology. 2000;216:698-703.

Documents

CDHA u Phe Quan-phoi