Atypical Hepatocellular Carcinoma

Atypical Hepatocellular Carcinoma

Trn Trng Ti Y5- TBMU

Chn on lm sng ca HCC l kh khn.Cc du hiu v triu chng lm sng thng trng lp vi cc bnh khc.

Alpha-fetoprotein thng ng mt vai tr trong vic chn on ban u v theo di bnh nhn c nguy c HCC nhng mt phn ba s bnh nhn b HCC khng c nhy cao pht hin HCC, ngay c trong bnh tin trin

Chn on sm ca HCC l rt quan trng c th can thip iu tr kp thi

M u:

Mc ch :Trong nhiu trng hp, HCC c th t tin chn on trn hnh nh khng xm ln.Tuy nhin, c rt nhiu s xut hin bin th bt thng ca HCC gy kh khn cho chn on !!

Slide ny vi mc ch bn n mt nhm nh i tng HCC trn mt nn gan lnh v khng c tin s cc bnh vim gan (hay cc nhm yu t nguyn nhn c hiu cho HCC) vi cc du hiu trn lm sng ngho nn v Khng in Hnh trn CTscanner

Ung th biu m gan bao gm:

Ung th t bo gan (HCC: hepatocellular carcinoma): (90%)

Ung th ng mt (trong gan) (CCA:cholangiocarcinoma)

Phn loi v mt t bo hc ca ung th biu m gan:HCCFibrolamella HCCCholangiocarcinomaHn hp (gia HCC v cholangiocarcinoma)Khng bit hoHepatoblastoma (rt him gp ngi ln)

Hepatocellular Carcinoma Mimicking Hemangioma( HCC bt trc U mu)

Case 1:Bnh nhn nam 70 tui nhp vin sau mt huyt khi tnh mch su t pht.Xt nghim mu cho thy tng bch cu v tng cao CRP, CT bng sng lc c thc hin.

Th ng Mch

Mt khi h phn thy IV, V gan Phi khng thy r du hiu ph quanh UTh ng mch bt thuc cn quang dng vin bt trc mt U mu (hemagioma) dng Hang

Th ng Mch

Th Tnh Mch

Th mun

Th mun : Khi U c thnh dy khng u trong c thoi ha dng nang, tng t trng cao hn nhu m gan thnh v phn c trong khi ** iu khng nh s ngm thuc dai dng ca khi U, khng ghi nhn huyt khi hay xm ln tnh mch ca v tnh mch trn ganChn on m bnh hc l(HCC.y l mt trng hp bt thng ca HCC bt chc mthemagioma dng hang

Case 2: N 77 tui

Mt ph n 77 tui c biu hin au bng pha trn gc phn t bn phi tng dn v mt trng lng 33 pound trong vng 3 thng.Khm lm sng gan ln 14 cm.Kt qu th nghim cho thy: aspartate aminotransferase, 126 IU / L;alanine aminotransferase, 50 IU / L;bilirubin, 2,8 mg / dL;phosphatase kim, 213 IU / L;-fetoprotein, 11 IU / mL,.Chp ct lp vi tnh (CT) chng minh bnh x gan c khi khng ng nht ln thy gan phi.Ngm thuc nt ngoi vi trong giai on ng mch hng tm v Chm thi thuc cc giai on TMC v th mun

66-year-old man with small hepatocellular carcinoma.Axial th ng Mch: y cng l mt v d in hnh v mt HCC bin th, ngm thuc km th ng mch nh TH in hnh. Tn thng khng r rngCase 3:

Vn case s 3:

Axial tng cng tng phn tnh mch ca: hnh nh giai on CT cho thy nt K=19-mm ra tri thuc(mi tn) ph hp vi ung th biu m t bo gan nh.

T trng m trong HCC:

Mt s khi U gan c t trng m bn trong gm: FNH Adenoma HCCAML

FatCase 4: Bnh nhn Nam 52 YoAxial cui giai on ng mch : hnh nh cho thy tng t trng ng nht (u mi tn). Trong tn thng cho thy lng ng cht bo, t trng m trung tm khi U (-60 HU) (FAT)

Case 4: vn bnh nhn !

Tnh cht thi thuc nhanh in hnh ca HCC, v t trng m trong khi vn khng thay i

M bnh hc cho thy c thoi ha m trong khi U

Mt case tng t c m trong HCC

Ngm thuc khng ng nht, khi c thoi ha m loang l bn trong ( t trng m )

Tn thng cha m tng t

Angiomyolipoma ca ganBt thuc mnh bt chc mt HCCPhn thy mi bt chc mt FNH

Liposarcoma gan

y l tn thng di cn t rut c t trng cht bo trong khi

Cystic DegenerationDng HCC thoi ha nang :

Mc d mt s TH ung th trong gan c th biu hin thoi ha nang, thoi ha dng nang trong HCC l cc k him, Nhiu hn na thng, khi u nang trong gan c th c gy ra bi cystadenocarcinoma ng mt, di cn,, ung th ng mt Thai ha nang ca HCC thng l kt qu ca hoi t ni b trong cc tn thng ln pht trin nhanh hn ngun cung cp mu ca n.Thoi ha nang ca HCC cng him sau khi iu tr

Case 5:Bn Nam -57 tui vi thoi ha nang ung th biu m t bo gan.Km c trngBN c xc nhn l HCC vi HU