Alast Thực Tập Giải Phẫu Bệnh PDF

Chu nhiem bo mon :
Giang vien :
Gs.Ts.Bs. NGUYEN SAO TRUNG

Ts.Bs. AU NGUYET DIEU
Ths.Bs. BUI TH HONG KHANG
Ths.Bs. HUYNH NGOC LINH
Ths.Bs. NGUYEN NH TUAN
CN. LE TH THANH HUYEN
CN. TRIEU TH XUAN THU
LCH GIANG THC TAP GIAI PHAU BENH Y2008A

NAM HOC 2010 2011
*******
BAI
1
2
3
4
5
6
NGAY
05/04/11
07/04/11
14/04/11
15/04/11
19/04/11
21/04/11
26/04/11
28/04/11
05/05/11
06/05/11
10/05/11
12/05/11
C1
C1
C1
C1
C1
C1
C1
C1
C1
C1
C1
C1
BAI THC TAP

A
B
A
B
A
B
A
B
A
B
A
B
1. Not Tophi benh Gut

3. Chuyen san gai co t cung (CTC)
5. Viem ruot tha cap
7. Viem lao hach
8. Seo loi
10. Tang san tuyen tien liet
11. Nevi noi b
13. U m
15. Carcinom te bao gai cua da
17. Carcinom te bao ay cua da
19. U tuyen ong ruot gia (RG)
21. Carcinom tuyen RG di can hach
23. Carcinom tuyen RG di can phoi
2. Hach nhiem carbon

4. Nghch san carcinom tai cho CTC
6. Viem loet da man tnh
9. Tang san cuc tuyen giap
12. U nhu da
14. U lanh mach mau dang hang gan
16. Carcinom te bao gai di can hach
18. Carcinom TB gai khong sng hoa CTC
20. Carcinom tuyen RG
22. Carcinom tuyen RG di can gan
17/05/11 - C1 - A
19/05/11 - C1 - B
17/05/11 C2 - A
19/05/11 C2 - B
24. X gan
26. Carcinom tuyen da day mat nhan
25. Carcinom te bao gan

27. Carcinom tuyen mat nhan di can hach
24/05/11 - C1 - A
26/05/11 - C1 - B
28. Carcinom TB gai phoi

30. Carcinom tuyen giap dang nhu
29. Carcinom tieu phe quan phe nang

31. Carcinom te bao sang cua than
10
24/05/11
26/05/11
31/05/11
02/06/11
31/05/11
02/06/11
07/06/11
09/06/11
07/06/11
09/06/11
32.
34.
35.
37.
38.
40.
41.
43.
33. Sarcom c trn di can gan
11
12
13
14
- C2 - A
- C2 - B
C1 - A
C1 - B
C2 - A
C2 - B
- C1 - A
- C1 - B
- C2 - A
- C2 - B
Thi gian thc tap:
On lan 1
Sarcom si
Sarcom xng
U lanh si tuyen vu
Carcinom ong tuyen vu xam nhap
U c trn lanh tnh than t cung
Nhau nc toan phan
Hach tang san nang
Limphom nguyen bao mien dch
36. Bien oi si boc tuyen vu

39. U quai trng thanh buong trng
42. Hach tang san xoang
44. Limphom Hodgkin
Tong on
C1: 13g30-15g
C2: 15g-16g30
THI THC TAP GPB ngay 16/06/2011 luc 14g
LCH GIANG THC TAP GIAI PHAU BENH Y2008B

NAM HOC 2010 2011
*******
BAI
1
2
3
4
5
6
NGAY
09/05/11
10/05/11
11/05/11
12/05/11
16/05/11
17/05/11
18/05/11
19/05/11
23/05/11
24/05/11
25/05/11
26/05/11
S1
S1
S1
S1
S1
S1
S1
S1
S1
S1
S1
S1
BAI THC TAP

A
B
A
B
A
B
A
B
A
B
A
B

7. Viem lao hach
8. Seo loi
11. Nevi noi b
13. U m

4. Nghch san carcinom tai cho CTC
12. U nhu da
18. Carcinom TB gai khong sng hoa CTC
30/05/11 - S1 - A
31/05/11 - S1 - B
30/05/11 - S2 - A
31/05/11 - S2 - B
24. X gan

01/06/11 - S1 - A
02/06/11 - S1 - B


10
01/06/11
02/06/11
06/06/11
07/06/11
06/06/11
07/06/11
08/06/11
09/06/11
08/06/11
09/06/11
32.
34.
35.
37.
38.
40.
41.
43.
11
12
13
14
S2
S2
S1
S1
S2
S2
S1
S1
S2
S2
A
B
A
B
A
B
A
B
A
B
Thi gian thc tap:
On lan 1
Sarcom si
Sarcom xng
U lanh si tuyen vu
Carcinom ong tuyen vu xam nhap
U c trn lanh tnh than t cung
Nhau nc toan phan
Hach tang san nang
Limphom nguyen bao mien dch

39. U quai trntg thanh buong trng
44. Limphom Hodgkin
Tong on
S1: 07g30- 09g
S2: 09g-10g30
THI THC TAP GPB ngay 17/06/2011 luc 14g
LI NOI AU
Tap bai giang - Atlas thc tap
Giai phau benh c soan ra nham giup hoc
vien co the nam bat c cac muc tieu thc tap
trc khi vao lp, nh vay co the tan dung toi a
thi gian t oi cua moi buoi thc tap 2 tiet cho
viec tm kiem va quan sat cac muc tieu nay tren
tieu ban. Cuoi tap sach nay la danh sach tong
ket cac muc tieu thc tap, cung la ap an cho 4
dang cau hoi cua ky thi thc tap ket thuc khoa
hoc: Te bao g?, Cau truc g?, Hien tng g?,
Chat g?. Cac hnh anh ai the trong tap sach a
c chon loc e cho thay nhng tnh chat
tng oi ac trng cua ton thng, hoc vien
can ghi nh e tra li cho dang cau hoi th
nam, Hnh anh benh ly g?.
MUC LUC
******
4. Nghch san nang carcinom tai cho CTC
7. Viem lao hach
8. Seo loi
11. Nevi noi b
12. U nhu da
13. U m
18. Carcinom te bao gai khong sng hoa CTC
24. X gan
32. Sarcom si
34. Sarcom xng
35. U lanh si tuyen vu
37. Carcinom ong tuyen vu xam nhap
38. U c trn lanh tnh than t cung
40. Nhau nc toan phan
41. Hach tang san nang
43. Limphom nguyen bao mien dch
44. Limphom Hodgkin
Danh sach cac muc tieu thc tap Giai phau benh
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10
13
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20
23
25
29
31
34
36
38
41
44
47
49
51
54
57
60
63
67
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91
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102
106
109
112
116
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128
NOT TOPHI BENH GUT

La 1 ton thng ac trng cua benh gut, co dang not-cuc, thng xuat hien quanh cac
khp nho cua ban tay va ban chan. Not tophi c hnh thanh do s lang ong ngoai bao cua
cac tinh the urat trong mo mem quanh khp, kch thch manh phan ng viem man tnh va hoa
si. Not tophi nam nong co the loet ra da va r dch.
ai the: Not tophi co dang not-cuc, xuat hien quanh cac khp nho cua ngon tay va ban
tay (hnh 1)
Hnh 1: Not tophi quanh cac khp ngon tay

Vi the:
Muc tieu can tm:
1. Cac am tinh the urat lang ong ngoai bao
2. Cac te bao cua phan ng viem man tnh xung quanh am urat: ai thc bao,
limpho bao, ai bao an d vat
3. Phan ng hoa si: nguyen bao si, si collagen
Quan sat tieu ban vi vat knh (VK) 4, not tophi gom cac am tinh the urat to nho khong
eu, mau xam- tm nhat, c bao quanh bi mo si co tham nhap cac te bao viem man tnh
(hnh 2).
Vi VK 10 va VK 40, ta thay am urat c vien bi cac ai thc bao va ai bao an d
vat. ai thc bao co hnh a dien, nhieu bao tng, nhan bau duc nam lech qua 1 ben. ai bao
an d vat co kch thc rat ln, cha nhieu nhan hnh bau duc, rai eu trong bao tng. Gia cac
am urat la mo si tang sinh, gom cac nguyen bao si la nhng te bao hnh thoi co nhan hnh
bau duc hoac hnh thoi va t bao tng; phan bo gia cac si collagen mau hong (hnh 3).
Tm cac tieu tnh mach trong mo si e thay cac limpho bao tham nhap t trong long
mach vao mo xung quanh (hnh 4).
Hnh 2: 1- Cac am tinh the urat lang ong ngoai bao; 2- Mo si co tham nhap te
bao viem man tnh.
Hnh 3: 1- am tinh the urat; 2- ai thc bao; 3-. ai bao an d vat; 4- Nguyen bao si;
5- Si collagen; 6- Tieu tnh mach.
Hnh 4: 1- Urat; 2- ai bao an d vat; 3 -Nguyen bao si ; 4- Si collagen;

5- Tieu tnh mach; 6- Limpho bao.
HACH NHIEM CARBON

La hau qua cua tnh trang ht phai bui than, thung gap c dan cac thanh pho co tnh
trang o nhiem khong kh nang, ngi nghien thuoc la. Bui than lot en phe nang se c ai
thc bao phe nang an; cac ai thc bao ay bui than di chuyen ngc len tieu phe quan ho
hap, xuyen thanh va chui vao mach bach huyet e en cac hach quanh phe quan va hach ron
phoi.
ai the :
Mot hach nhiem carbon ron phoi co mau en nh hac n (hnh 1)
Hnh 1: Hach nhiem carbon ron phoi xe oi cho thay mat cat mau en nh hac n.
Vi the:
Muc tieu can tm:
1. ai thc bao ong carbon, tap trung trong cac xoang bach huyet cua hach
(xoang di vo, xoang quanh nang, xoang tuy).
2. Nang limpho th cap trong vung vo hach.
Lu y: Hoc vien can on lai cau tao mo hoc cua hach limpho.
Vi VK 4, quan sat cac thanh phan cau tao mo hoc bnh thng cua hach nh vo bao
si, vach ngan si vao vung vo, vung vo vi cac nang limpho th cap, vung can vo, vung tuy,
cac xoang bach huyet di vo, xoang quanh nang va xoang tuy (hnh 2).
Hnh 2: 1- Vo bao si; 2- Xoang di vo; 3- Xoang quanh nang ; 4- Nang limpho th cap.
Vi VK 10, quan sat trong xoang di vo va xoang quang nang thay co cha rat nhieu
ai thc bao ong carbon (hnh 3) .
Hnh 3: 1. Vo bao si; 2. Cac ai thc bao ong carbon.
6
Quan sat vi VK 40, ai thc bao ong carbon la nhng te bao ln, nhan hnh bau duc
hoac hnh kha lom nh qua than, nam lenh ben, bao tng nhieu mau hong nhat, co cha cac
hat bui than nho mau nau en (hnh 4).
Hnh 4: 1. ai thc bao ong cac hat bui than trong bao tng; 2. Limpho bao
CHUYEN SAN GAI CO T CUNG

Co t cung (CTC) gom co ngoai c bao phu bi bieu mo lat tang khong sng hoa, va
co trong bi bieu mo tru n tiet nhay. Ni noi tiep gia bieu mo co ngoai va co trong c goi
la ng tiep hp gaitru, nam ngay lo ngoai CTC tre gai cha day th. phu n trong o tuoi
hoat ong sinh duc, s phat trien cua CTC lam bieu mo tuyen co trong lon ra ngoai, tao ra vung
lo tuyen CTC, ay ng tiep hp gai - tru ra xa khoi lo ngoai CTC. e thch nghi vi moi trng
mi co tnh axt trong am ao, bieu mo tru n trong vung lo tuyen se chuyen san gai thanh bieu
mo lat tang nh hoat ong tang san cua cac te bao d tr; ket cuc tai tao 1 ng tiep hp gaitru mi ve ung v tr ban au; vung chuyen san gai con c goi la vung chuyen dang (hnh 1).
Hnh 1: A- CTC tre gai cha co vung lo tuyen; B- S hnh thanh vung lo tuyen lam ng tiep
hp gai-tru b ay xa khoi lo ngoai CTC; C- Hoat ong chuyen san gai ket cuc a tai tao ra 1
ng tiep hp gai-tru mi (ng cham cham mau xanh) tien gan en lo ngoai CTC.
8
ai the:
Vung lo tuyen co trong CTC co mau o ti, cha nhng vung chuyen san gai mau
hong lt tng t bieu mo co ngoai CTC (Hnh 1 C).
Vi the:
Muc tieu can tm:
1. Bieu mo tru n cua vung lo tuyen co trong CTC.
2. Bieu mo chuyen san gai.
Lu y: Hoc vien can on lai cau tao mo hoc cua co t cung.
Quan sat tieu ban vi VK 4 va VK 10, bieu mo tru n bnh thng cua co trong CTC
vung lo tuyen la 1 lp te bao hnh tru co nhan lech ve cc ay, bao tng cc nh cha ay
chat nhay; bieu mo nay gap nep sau xuong di mo em tao ra cac tuyen co trong CTC; gia
lp te bao tru va mang ay co cac te bao d tr phan bo rai rac (hnh 2).
Vi VK 40, quan sat doc theo lp bieu mo tru n be mat, ta thay hien tng chuyen san
gai bat au vi s tang san cac te bao d tr, tao thanh 1 lp te bao lien tuc (tng ng vi lp
ay cua bieu mo lat tang) nam ben di lp te bao tru n, hnh thanh 1 bieu mo chuyen san
gom 2 lp te bao (hnh 3).
Cac te bao cua lp ay lai tiep tuc tang san, tao thanh cac lp mi tng ng vi cac lp
trung gian cua bieu mo lat tang, hnh thanh 1 bieu mo chuyen san gom nhieu lp te bao gai (te
bao a dien, bao tng nhieu va ai toan); lp te bao tru n b ay len tren cung. Khi cac te bao
tru nay bong troc, se e lai mot bieu mo lat tang giong bieu mo co ngoai CTC; qua trnh chuyen
san gai t bieu mo tru n tiet nhay thanh bieu mo lat tang a hoan tat (hnh 4).
Hnh 2: 1- Lp te bao tru n tiet nhay; 2- Te bao d tr nam rai rac; 3- Mo em.
Hnh 3: 1- Te bao d tr tang san thanh 1 lp lien tuc; 2- Tuyen co trong CTC.
Hnh 4: 1- Te bao tru n b ay len be mat; 2- Te bao tru n a bong troc;

3- Cac lp te bao gai; 4- Mang ay; 5- Mo em.
10
NGHCH SAN NANG CARCINOM TAI CHO CO T CUNG (CIN 3)

Ton thng nghch san va carcinom CTC thng xuat phat t vung chuyen dang la do
hoat ong tang san va chuyen san tai ay khien no de b tac ong bi cac tac nhan sinh u (HPV
c xem la nhan to chnh). Nghch san la tnh trang roi loan tang sinh te bao, bieu th bi s roi
loan nh hng sap xep cua cac te bao, thay oi kch thc - hnh dang cua te bao va nhan,
bat thng ve v tr cua phan bao. oi vi bieu mo lat tang, tuy theo cac bien oi noi tren con
gii han 1/3 di,1/3 gia hoac a len ti 1/3 tren cua chieu day bieu mo, phan biet ra 3 mc
o nghch san: nhe, va va nang; khi toan bo chieu day bieu mo ke ca lp be mat cung b bien
oi th ton thng c goi la carcinom tai cho. Nghch san c xem la ton thng tien ung th
v nghch san nang co the chuyen thanh ung th. CTC, nghch san nang va carcinom tai cho
CTC c xep chung vao ton thng tan sinh trong bieu mo mc o 3 (CIN 3) va c x tr
giong nhau (cat bo bang vong ien, khoet chop).
ai the: Hnh anh ai the cua CTC co cha CIN 3 co the cung giong nh mot co t
cung b lo tuyen chuyen san gai thong thng; e phat hien sm, can tien hanh tam soat nh
ky bang phet mong Papanicolaou (hnh 1).
Hnh 1: Hnh anh co t cung cha CIN 3 khong khac viem lo tuyen chuyen san gai.
Vi the:
Muc tieu can tm:
1. Bieu mo lat tang cua co ngoai co t cung : lp ay, cac lp trung gian, lp be mat
2. Ton thng nghch san nang: hng sap xep cua cac lp te bao trung gian thang
goc vi mang ay, te bao co hnh dang va kch thc thay oi khac nhau, nhan
tang sac meo mo, phan bao tang va khong con gii han lp ay, nhng lp te
bao be mat van co nhan det giong bieu mo lat tang bnh thng.
3. Carcinom tai cho : hnh anh nghch san chiem toan bo chieu day cua bieu mo, lp
te bao be mat co nhan tang sac meo mo.
Lu y: hoc vien can on lai cau tao mo hoc bieu mo lat tang cua co ngoai CTC.
11
Quan sat tieu ban vi VK 4, bieu mo lat tang co ngoai CTC gom lp ay, cac lp trung
gian va lp te bao be mat. Vung bieu mo nghch san bat mau am hn do hoat ong tang sinh
te bao manh, mat o te bao cao. Gia 2 vung bieu mo la mo em si cua CTC, tham nhap cac
te bao viem man tnh (hnh 2).
Hnh 2: 1- Bieu mo lat tang bnh thng co ngoai CTC; 2- Ton thng nghch san
nang - carcinom tai cho; 3- mo em si CTC tham nhap te bao viem man tnh.
Vi VK 40, bieu mo lat tang bnh thng co ngoai co nh hng sap xep cua cac lp te
bao trung gian song song vi mang ay; lp te bao be mat co nhan det (hnh 3).
Hnh 3: Bieu mo tang bnh thng co ngoai CTC. 1- Lp te bao be mat; 2- Cac lp
trung gian; 3- Mo em
12
Vung bieu mo nghch san nang co nh hng sap xep cua cac lp trung gian thang goc
vi mang ay, kch thc va hnh dang te bao thay oi, nhan tang sac meo mo, phan bao tang
va xuat hien ca 1/3 tren cua bieu mo; tuy nhien lp te bao be mat van co nhan det giong bieu
mo lat tang bnh thng (hnh 4).
Hnh 4: Nghch san nang CTC, hnh anh nghch san len ti 1/3 tren cua bieu mo nhng
lp te bao be mat van co nhan det nh bieu mo lat tang bnh thng (mui ten).
vung carcinom tai cho, hnh anh nghch san chiem toan bo be day bieu mo; nhan cua
lp te bao be mat cung tang sac, meo mo (hnh 5).
Hnh 5: Carcinom tai cho, nhan lp te bao be mat cung meo mo, tang sac (mui ten).
Ta thay vung nghch san nang va carcinom tai cho nam noi tiep xen ke nhau, v vay
chung c xep chung vao ton thng CIN 3.
13
VIEM RUOT THA CAP TNH
La 1 cap cu ngoai khoa thng gap, can chan oan sm va ieu tr kp thi e tranh
bien chng thung gay viem mu phuc mac co the gay t vong. Viem ruot tha cap thng xay ra
o tuoi thanh nien, nam nhieu hn n.
ai the: ruot tha sng to, phu ne, cac mach mau sung huyet noi ro di thanh mac,
dch xuat t huyet ong thanh gia mac tren be mat thanh mac; xe oi ruot tha thay mu chay ra
t trong long ruot tha (Hnh 1).
Hnh 1: 1- Mach mau sung huyet noi ro di thanh mac; 2- Gia mac ong tren be mat.
Vi the:
3 ac iem mo hoc chnh cua viem cap la sung huyet ong, phu viem va tham nhap te
bao ma chu yeu la cac bach cau a nhan trung tnh.
Muc tieu can tm:
1. Hien tng sung huyet
2 . Hien tng phu viem:
- Dch xuat thanh huyet
- Dch xuat xuat huyet
- Dch xuat t huyet
- Dch xuat mu
3. Hien tng tham nhap bach cau a nhan
4. Hien tng hoai t niem mac
Lu y: Hoc vien can on lai cau tao mo hoc cua ruot tha
Quan sat bang mat tran, tieu ban gom 3 lat cat: 1 lat cat ngang nho, 1 lat cat ngang ln va 1
lat cat doc qua au mut ruot tha (hnh 2).
14
Hnh 2: Tieu ban viem ruot tha. 1- Lat cat ngang nho;
2- Lat cat ngang ln; 3- Lat cat doc.
Vi VK4, quan sat lat cat ngang nho, cau tao thanh ruot tha gom 4 lp: lp niem mac
vi cac tuyen Lieberkhn, lp di niem mac, lp c trn va lp thanh mac; trong mo em cua
lp niem mac va lp di niem mac, co cac nang limpho. Mat ngoai thanh mac co 1 lp dch
xuat t huyet (hnh 3).
Hnh 3: 1- Nang limpho trong lp di niem mac; 2- Dch xuat t huyet.

Chuyen sang VK 10 va VK 40 quan sat lat cat ngang ln va lat cat doc e thay:
1. Hien tng sung huyet ong: thay ro 1/2 ngoai cua thanh ruot tha, cac tieu tnh
mach gian rong, cha ay hong cau (hnh 4).
15
Hnh 4: 1- Tieu tnh mach sung huyet gian rong, cha ay hong cau; 2- Bach
cau a nhan tham nhap mo em ngoai mach; 3- Dch xuat xuat huyet;
4- Dch xuat thanh huyet.
2. Hien tng phu viem, bieu th bi s hien dien cua cac dch xuat (dch phu viem):
- Dch xuat thanh huyet: cac am bat mau hong, trong mo em ngoai mach (hnh 4).
- Dch xuat xuat huyet : cac am hong cau trong mo em ngoai mach (hnh 4, 5).
- Dch xuat mu trong long ruot tha, cau tao chu yeu bi cac bach cau a nhan thoai hoa
(co nhan mui v vun), hong cau va ai thc bao (hnh 6).
- Dch xuat t huyet, tao thanh gia mac bam ngoai mat thanh mac ruot tha, cau tao bi
li si t huyet bat mau o, gia cac mat li co hong cau va bach cau (hnh 3, 5).
Hnh 5: 1- Tieu tnh mach sung huyet gian rong; 2- Dch xuat xuat huyet;
3- Dch xuat t huyet .
16
Hnh 6: 1- Vung niem mac b hoai t; 2- Dch xuat mu; 3- Tuyen Lieberkhn.
3. Hien tng tham nhap bach cau a nhan: cac tieu tnh mach sung huyet, cac bach
cau bam vao be mat te bao noi mo (hien tng tu vach) va xuyen qua thanh mach e tham
nhap vao mo em ngoai mach (hnh 7 ).
4. Hien tng hoai t niem mac: lp niem mac ruot tha co nhng cho b hoai t, khong
con thay bieu mo be mat va cac tuyen Lieberkhn; thay vao o la cac am chat hoai t tao bi
xac te bao chet, bach cau va hong cau (hnh 6).
Hnh 7: 1- Bach cau a nhan tu vach tieu tnh mach; 2- Bach cau tham nhap
mo em ngoai mach.
17
VIEM LOET DA MAN TNH

Da b viem loet keo dai nhieu tuan nhieu thang, do tac nhan gay viem con ton tai hoac
do phan ng sa cha cua c the b roi loan ( ngi mac benh benh tieu ng, suy dinh
dng, thieu vitamin)
ai the: Vet loet co kch thc vai cm, b o loet hi go len do hoat ong tang sinh tai tao
cua lp bieu b; be mat o loet lon nhon dang hat mau o, de chay mau khi ung en, co the co
them dch xuat mu hoac dch xuat t huyet khi o loet b boi nhiem vi cac tac nhan gay viem cap
tnh (hnh 1).
Hnh 1: O viem loet da man tnh.

Vi the:
Viem man tnh co hai ac iem mo hoc chnh la tham nhap te bao n nhan va tang
sinh mo lien ket - mach mau.
Muc tieu can tm:
1. Hien tng tham nhap te bao n nhan :
- Limpho bao
- Tng bao
- ai thc bao
2. Hien tng tang sinh mo lien ket - mach mau
- Nguyen bao si
- Mach mau tan sinh
Lu y: Hoc vien can on lai cau tao mo hoc cua da
Quan sat tieu ban vi VK 4, tai o loet khong con thay bieu mo lat tang nhng b o loet,
bieu mo nay tang sinh day len (hnh 2).
Vi VK 10 va 40, quan sat vung ton thng ngay di bieu mo e phan biet cac dang te
bao n nhan khac nhau tham nhap trong mo em ngoai mach:
Limpho bao: ng knh 7-10 m (bang hong cau), nhan tron bat mau tm am, chiem
gan het the tch te bao (hnh 3).
18
Tng bao: ng knh 12-15 m, nhan tron nam lech 1 ben, chat nhiem sac ket thanh
am bam ngay di mang nhan (nhan hnh banh xe); bao tng bat mau tm hong, cha lai mot
khoang sang canh nhan; mang te bao ro net (hnh 3).
ai thc bao: ng knh 25-30 m, nhan sang, hnh bau duc hay hnh co kha lom nh
hat au, hach nhan nho, nam lech 1 ben; bao tng nhieu va bat mau lat, cha nhieu khong
bao (trong long co the cha cac vat the c thc bao; mang te bao sn x , khong ro net do
hoat ong thc bao (hnh 4).
Hnh 2: 1- B o loet hi go len do bieu b tang sinh tai tao; 2- O loet; 3- Dch xuat
t huyet; 4- Vung tang sinh mo lien ket - mach mau
Hnh 3: 1- ai thc bao; 2- Tng bao; 3- Limpho bao; 4- Nguyen bao si.
19
Hnh 4: 1- ai thc bao, bao tng co cha khong bao vi vat the c thc bao
nam ben trong; 2- Limpho bao; 3- Mach mau tan sinh co te bao noi mo
vi nhan phong to.
Hien tng tang sinh mo lien ket - mach mau c thay ro trong vung mo ac ben di
o loet. Cac nguyen bao si hnh thoi, nhan hnh bau duc, nam gia cac bo si collagen do chung
tong hp. Chen gia mo si co nhieu mach mau tan sinh; iem ac trng cua cac mach mau
nay la chung c lot bi cac te bao noi mo co nhan ln sang, hnh tron, tho vao trong long
mach (hnh 5).
Hnh 5: 1- Limpho bao; 2- ai thc bao; 3- Nguyen bao si; 4- Mach mau tan sinh
cat ngang; 5. Mach mau tan sinh cat doc
20
VIEM LAO HACH

La 1 dang viem hat cua hach do vi khuan lao gay ra. Hach viem lao thng thay vung
co, nach va tren on.
ai the: Hach viem lao co kch thc 1-4 cm; mat cat cho thay cac nang lao cha chat
hoai t ba au mau vang kem (hnh 1).
Hnh 1: Hach viem lao vi cac nang lao cha chat hoai t ba au mau vang kem
Vi the:
ac iem mo hoc cua viem lao la s hnh thanh cac u hat lao, con goi la nang lao. Nang
lao la mot tap hp te bao dang bieu mo, c bao quanh bi mot vien limpho bao va tng bao.
Cac te bao dang bieu mo co the hoa nhap vi nhau thanh ai bao Langhans. Khi cac cac te bao
dang bieu mo va ai bao Langhans trung tam nang lao b hoai t, se tao ra mot chat mau
vang kem, mem, giong nh ba au nen con c goi la chat hoai t ba au; nang lao tr thanh
nang ba au.
Muc tieu can tm:
1. Nang lao:
- Te bao dang bieu mo
- ai bao Langhans
- Chat hoai t ba au
- Vien limpho bao va tng bao
2. Mo limpho bnh thng con lai cua hach
Quan sat tieu ban vi VK4, nhu mo hach ben di vo bao si co cha cac nang lao vi
kch thc khac nhau, co hoac khong co chat hoai t ba au gia; gia cac nang lao la nhu
mo hach bnh thng con sot lai (hnh 2).
21
Hnh 2: 1- Vo bao hach; 2- Mo hach con sot lai; 3- Nang lao; 4- Chat hoai t ba au.
Vi VK 10 va 40, nang lao la 1 tap hp te bao dang bieu mo, bao quanh chat hoai t ba
au gia, ngoai ra la vien limpho bao va tng bao. Rai rac gia cac te bao dang bieu mo la
cac ai bao Langhans (hnh 3)
Hnh 3: 1- Chat hoai t ba au; 2- Vien limpho bao - tng bao; 3- Tng bao;
4- Cac te bao dang bieu mo; 5- ai bao Langhans.
22
Te bao dang bieu mo co nhan hnh bau duc, mang nhan ro, co 1 hach nhan nho, bao
tng nhieu mau hong, gii han te bao khong ro nen cac te bao nay trong co ve nh lien ket
chat che vi nhau giong te bao bieu mo ( v vay c goi la te bao dang bieu mo, mac du ban
chat cua chung la cac ai thc bao bien oi). ai bao Langhans la nhng te bao khong lo, co
hang chuc nhan, phan bo ngay di mang te bao ( ac iem nhan giong het nhan te bao dang
bieu mo). Chat hoai t ba au co dang hat, bat mau hong am (hnh 4).
Hnh 4: 1- Chat hoai t ba au; 2- ai bao Langhans; 3- Cac te bao dang bieu mo.
Vien limpho bao va tng bao tuy khong phan biet ro gii han vi mo limpho bnh
thng con sot lai cua hach, nhng van co the nhan ra nh s hien dien cua rat nhieu tng
bao (hnh 3).
23
SEO LOI
Do hoat ong tong hp qua ang si collagen cua cac nguyen bao si trong qua trnh
sa cha cac ton thng bang hnh thc hoa seo.
(hnh 1)
ai the: seo loi thng go cao va co mau sac am hn vung da bnh thng xung quanh
Hnh 1: Seo loi go cao va co mau sac am hn da xung quanh

Vi the:
Muc tieu can tm:
1. Nguyen bao si
2. Cac bo si collagen tang sinh
3. Cac bo si hyalin hoa
Quan sat tieu ban vi VK4, seo loi c phu tren be mat bi mot lp bieu b mong, ben
di la mo si tang sinh gom co nguyen bao si, cac bo si collagen tang sinh va bo si hyalin
hoa (hnh 2).
Hnh 2: 1- Bieu b teo mong; 2- Cac bo si collagen.
24
Vi vat knh 10 va 40, cac bo si collagen tang sinh bat mau hong lt, gom nhieu th si
xep song song; chen gia cac th si nay co nhieu nguyen bao si hnh thoi vi nhan hnh bau
duc, sang, cha 1-2 hach nhan (hnh 3). Cac bo si hyalin hoa bat mau hong am, ong nhat,
phan bo lon xon gia cac bo si tang sinh (hnh 4).
Hnh 3: Cac bo si collagen tang sinh. 1- Nguyen bao si; 2- Si collagen.
Hnh 4: 1- Bo si collagen tang sinh; 2- Bo si hyalin hoa.
25
TANG SAN CUC TUYEN GIAP ( PHNH GIAP LE TE)

nam.
La loai benh ly tuyen giap thng gap nhat, xay ra ngi tre, gii n nhieu hn gii
ai the: Tuyen giap phnh to, co nhieu cuc; mat cat mau nau, co nhng vung xuat huyet
hoac hoa boc (hnh 1).
Hnh 1: Tuyen giap phnh to, co nhieu cuc.

Vi the:
Muc tieu can tm:
1. Hien tng tang san te bao nang giap: nang giap nho, te bao nang hnh
tru thap, tang sinh tao nhu.
2. Hien tng thoai hoa boc: nang giap gian rong ay chat keo,te bao nang
det.
3. Hien tng xuat huyet, lang ong tinh the cholesterol, ai thc bao ong
hemosiderin.
4. Mo em tham nhap limpho bao, tang sinh mo si.
Quan
nnca
VK4,
vou bao
si mo
g bao
bocp.ben ngoai, ben trong la cac
Lusayt: tie
Houcba
vie
n onulaco
i ca
tao mo
hocntuye
n gia
Vi VK4, quan sat cac vung tang san te bao nang giap, vung thoai hoa boc, vung xuat
huyet, vung hoa si va tham nhap limpho bao (hnh 2).
Vi VK 10 va 40, vung tang san gom cac nang giap kch thc nho, te bao nang giap
hnh vuong hoac tru thap; trong 1 so nang giap, te bao nang tang sinh tao nhu tho vao long
nang (hnh 3).
vung thoai hoa boc, nang giap gian rong cha ay keo giap, te bao nang giap co cho
b ep det, long nang co the cha hong cau (do xuat huyet) va ai thc bao ong hemosiderin
mau nau trong bao tng (hnh 4, 6).
Mo em gia cac nang giap tang sinh mo si, tham nhap limpho bao (hnh 5).
Cholesterol giai phong t mang te bao chet lang ong thanh cac tinh the hnh kim trong
mo em gia cac nang giap (hnh 6 ).
26
Hnh 2: 1- Vung tang san te bao nang giap; 2- Vung thoai hoa boc; 3- Vung xuat
huyet; 4- Vung mo em tham nhap limpho bao.
Hnh 3: Vung tang san vi cac nang giap nho, te bao nang giap hnh vuong hoac
tru thap; trong 1 so nang giap, te bao nang tang sinh tao nhu tho vao long
nang (mui ten).
27
Hnh 4: Hien tng thoai hoa boc, nang giap gian rong, cha chat keo, te bao nang
giap b ep det (mui ten).
Hnh 5: Mo em gia cac nang giap tang sinh mo si. 1- Nguyen bao si; 2- Si
collagen; 3- Tham nhap limpho bao .
28
Hnh 6: Hien tng xuat huyet trong long nang giap. 1- Hong cau; 2- ai thc bao
ong hemosiderin; 3- Tinh the cholesterol hnh kim.
29
TANG SAN CUC TUYEN TIEN LIET

Thng gap ngi tren 50 tuoi vi xuat o tang dan theo tuoi tac; nguyen nhan cha
ro nhng chac co vai tro cua cac noi tiet to nam.
ai the: Tuyen tien liet tang kch thc va trong lng, khoang 60-100 gram; mat cat co
nhieu cuc tang san, tap trung vung trung tam, gay chen ep nieu ao (Hnh 1)
Hnh 1: Cac cuc tang san chen ep nieu ao chnh gia.

Vi the:
Muc tieu can tm:
1. Tang san ong tuyen
2. The amylacea
3. Tang san mo em si - c trn
Lu y: Hoc vien can on lai cau tao mo hoc cua tuyen tien liet
Quan sat tieu ban vi VK4, cuc tang san c tao bi cac tuyen ong tui (tubuloalveolar
gland) tang sinh, phan cach nhau bi mot mo em si va c trn tang san (hnh 2).
Vi VK 10 va 40, cac ong tuyen tang san co kch thc to nho khong eu, co ong tuyen
gian rong thanh boc. Ong tuyen c lot bi bieu mo gom 2 lp te bao: te bao ay det nam
di va te bao che tiet hnh tru ben tren; bieu mo tang sinh tao thanh nhieu nhu tho vao long
ong. Long ong tuyen thng cha cac the amylacea hnh tron mau hong lt (la chat che tiet b
co ac), mot so the amylacea b lang ong canxi . Gia cac ong tuyen, co hien tng tang san
mo em si- c trn vi s gia tang so lng cac nguyen bao si , si collagen va te bao c
trn. Te bao c trn co nhan hnh bau duc, bao tng ai toan (hnh 3).
30
Hnh 2: 1- Cac ong tuyen tang san; 2- Ong tuyen gian thanh boc; 3- Mo em si - c
trn tang san; 4- The amylacea.
Hnh 3: 1- Bieu mo ong tuyen gom 2 lp te bao; 2- Bieu mo tang sinh tao nhu;
3- Nguyen bao si; 4- Te bao c trn; 5- The amylacea.
31
NEVI NOI B
La 1 loai u sac to lanh tnh rat thng gap, xuat phat t cac hac to bao (melanocyte)
trong lp ay bieu b. U xuat hien ngay luc mi sinh hoac khi a vao o tuoi thieu nien.
ai the: U co dang not san hi go tren mat da, ng knh < 6mm, mau nau, gii han ro,
co hoac khong co long (hnh 1).
Hnh 1: A- Nevi noi b dang san hi go len tren da lng; B- Nevi noi b co long da ma
Vi the:
Muc tieu can tm:
1. Cac nevi bao xep thanh am nam trong lp b.
2. Cac am nevi bao ong sac to melanin lp b nong.
3. Cac am nevi bao biet hoa thanh cau truc giong the Meissner.
4. Phan phu da bnh thng: nang long, tuyen ba, tuyen mo hoi.
Quan sat tieu ban vi VK4, cac nevi bao hp thanh am trong lp b cua da, cac am
nam nong ngay di bieu b thng b ong nhieu sac to melanin trong bao tng, cac am
nam sau khong cha sac to va thng biet hoa theo hng than kinh (hnh 2).
Vi VK 10 va VK 40, quan sat cac lp cua bieu b, rai rac trong lp ay co cac hac to
bao bnh thng vi nhan tron, bao tng sang. Di chuyen xuong lp b nong, tc la phan nong
cua lp b ngay di bieu b; co cac nevi bao hnh tron hoac a dien xep thanh am, nhan tron
am mau nam chnh gia te bao, bao tng ay cac hat sac to melanin mau nau. Trong lp b
sau, tc la phan sau cua lp b, cung co cac am nevi bao vi hnh dang tng t nhng kch
thc te bao nho hn va bao tng khong cha melanin (hnh 3).
Cac nevi bao trong lp b sau co the biet hoa theo hng than kinh tao ra cau truc giong
the Meissner (hnh 4).
Ngoai ra, trong mo xung quanh u, con thay cac phan phu da bnh thng nh cau truc
nang long tuyen ba trong lp b; tuyen mo hoi trong lp ha b (hnh 5).
32
Hnh 2: 1- Bieu b; 2- am nevi bao ong melanin; 3- am nevi khong ong

melanin; 4- Cac am nevi bao biet hoa theo hng than kinh tao cau truc
giong the Meissner.
Hnh 3: 1- Hac to bao trong lp ay bieu b; 2- am nevi bao trong lp b nong

ong sac to melanin; 3- Cac nevi bao trong lp b sau co kch thc nho
hn, bao tng khong cha sac to melanin.
33
Hnh 4: 1- am nevi bao khong ong sac to melanin; 2- am nevi bao biet hoa
thanh cau truc giong the Meissner.
Hnh 5: A. 1- Nang long; 2- Tuyen ba.

B. 1- Ong bai xuat tuyen mo hoi; 2- Thanh phan che tiet cua tuyen mo hoi.
34
U NHU DA
La mot loai u lanh tnh cua da, gom cac cau truc nhu tao bi bieu b tang san bao quanh
truc lien ket mach mau. U nhu xay ra moi o tuoi, tren bat ky vung da nao cua c the.
ai the: U nhu da co ng knh 0,5 1 cm, noi go tren mat da, be mat nho len cac nhu
nho (hnh 1).
Hnh 1: U nhu da tao bi cac cau truc nhu, nho len tren be mat.
Vi the:
Muc tieu can tm:
1. Nhu bieu b
2. Bieu b tang san
- Hien tng tang gai
- Hien tng tang sng
3. Truc lien ket mach mau
Quan sat tieu ban vi VK4, u tao bi cac cau truc dang nhu, gom 1 bieu b tang san (day
gap 2-3 lan so vi bieu b cua vung da bnh thng xung quanh), bao quanh 1 truc lien ket co
cha cac mach mau (hnh 2).
Vi VK 10 va VK 40, so sanh gia bieu b tang san cua cau truc nhu va bieu b cua vung
da bnh thng xung quanh e thay ro: Hien tng tang gai vi so lng cac lp te bao gai tang
len gap 2-3 lan, cac te bao gai co hnh a dien, nhan bau duc nam chnh gia, cac te bao c
lien ket vi nhau bang cau lien bao (desmosomes). Hien tng tang sng vi lp sng day han
len, tao bi cac vay sng ai toan nam chong chat len nhau. Ngoai ra, so lng cac hat
keratohyalin trong lp hat cung tang ro ret. Truc lien ket mach mau nam gia cac cau truc nhu,
tao bi 1 mo lien ket tha gom 1 t nguyen bao si, si collagen va cac mach mau (hnh 3).
Trong lp b, co the thay cac phan phu da bnh thng nh nang long tuyen ba, tuyen
mo hoi (hnh 2).
35
Hnh 2: 1- Nhu bieu b; 2- Truc lien ket mach mau; 3- Bieu b bnh thng;
4- Nang long; 5- Ong bai xuat tuyen mo hoi.
Hnh 3: 1- Hien tng tang gai; 2- Hien tng tang sng; 3- Truc lien ket mach mau
4- Lp hat co so lng hat keratohyalin tang len.
36
U M
La loai u phan mem lanh tnh thng gap, xay ra ngi ln t 40-60 tuoi. U ln cham,
khong gay trieu chng, hnh khoi tron, mem, gii han ro, di ong, kch thc trung bnh khoang
3 cm, thng c tm thay trong mo di da cua vung co, lng va vai.
ai the: U m co vo bao si mong, mat cat vang ong nhat, mat o mem; mo chu u
c phan thanh cac tieu thuy bi cac dai mo si (Hnh 1)
Hnh 1: U m co vo bao, mat cat mau vang ong nhat; cac dai mo si mau trang
phan chia mo chu u thanh nhieu tieu thuy.
Vi the:
Muc tieu can tm:
1. Cac te bao u co hnh dang giong te bao m trng thanh.
2. Cac te bao si va cac dai si collagen
3. Vo bao si mong
Quan sat tieu ban vi VK4, u co vo bao si mong bao boc ben ngoai, ben trong la cac te
bao u co hnh dang giong te bao m trng thanh, kch thc ong eu, sap xep thanh cac tieu
thuy. Gia cac tieu thuy m co cac vach si gom te bao si, nguyen bao si va si collagen
(hnh 2).
Quan sat te bao u vi VK 40, bao tng cha 1 khong bao m ln, ep det nhan ra ngoai
vi (hnh 3).
37
Hnh 2: 1- Tieu thuy m; 2- Vach si
Hnh 3: 1- Nguyen bao si; 2- Si collagen; 3- Te bao m co nhan b ep det.
38
U LANH MACH MAU DANG HANG GAN

La loai u gan lanh tnh thng gap nhat, xay ra ngi ln, gii n nhieu hn gii nam.
U thng nho hn 2 cm, nam trong vung nhu mo di bao gan. U t co bieu hien trieu chng lam
sang, mot so trng hp co the gay au bung; ch can thiep phau thuat khi u ln, co nguy c v
qua bao gan.
ai the: U co gii han ro, mat o mem, mat cat cho thay cac khoang cha mau (hnh 1).
Hnh 1: U lanh mach mau dang hang co gii han ro, mau o, nam di bao gan.
Vi the:
Muc tieu can tm:
1. Cac mach mau dan rong, dang hang, cha ay mau, lot bi te bao noi
mo det.
2. Tieu thuy gan bnh thung; tham nhap te bao viem man tnh trong
khoang ca
Quan sat tieu ban vi VK4, u nam trong nhu mo gan, tao bi cac mach mau dan rong
dang hang, long mach cha ay hong cau (hnh 2).
Vi VK 10 va VK 40, cac mach mau dang hang thong noi ngoan ngoeo, ngan cach nhau
bang 1 vach si mong; thanh mach c lot bi mot lp te bao noi mo det. U khong co vo bao
si ngan cach vi mo gan xung quanh (hnh 3).
Mo gan quanh u gom cac tieu thuy gan bnh thng vi cac be te bao gan, tnh mach
trung tam tieu thuy va khoang ca; co mot t te bao viem man tnh tham nhap trong khoang ca
(hnh 4).
39
Hnh 2: 1- Cac mach mau dan rong dang hang; 2- Hong cau trong long mach;
3- Mo gan bnh thng.
Hnh 3: 1- Long mach cha hong cau; 2- Te bao noi mo det; 3- Vach si mong;
4- Mo gan bnh thng.
40
Hnh 4: 1. Tnh mach trung tam tieu thuy gan; 2- Khoang ca tham nhap limpho bao;
3- Cac be te bao gan.
41
CARCINOM TE BAO GAI CUA DA

La loai ung th thng gap ngi ln tuoi, gii nam nhieu hn gii n, tren vung da lo
ra anh sang mat tri. Ung th xuat phat t cac te bao bieu mo co kha nang tang sinh cua lp
ay; chuyen dang ac tnh, tang sinh va biet hoa theo hng te bao gai. Khi ung th con trong
giai oan tai cho, ton thng co dang mot dat o ong vay tren da. Khi ung th a xam nhap
qua mang ay, ton thng co dang choi sui, loet hoac tham nhiem cng.
ai the: Carcinom te bao gai xam nhap cua da thng co dang choi sui, loet hoac tham
nhiem, be mat ong nhieu vay sng mau trang; ng knh 1-2 cm (Hnh 1)
Hnh 1: A- Carcinom te bao gai dang choi sui. ong vay trang; B- Dang loet tham nhiem.
Vi the:
Carcinom te bao gai xam nhap cua da thng thuoc loai biet hoa tot, tao c cau sng;
te bao ung th co bao tng ai toan, lien ket nhau bang cau lien bao.
Muc tieu can tm:
1. am te bao gai ung th xam nhap mo em.
2. Carcinom te bao gai biet hoa tot: tao cau sng, cau lien bao.
Vi VK4, quan sat vung da bnh thng quanh u, gom bieu b vi lp ay, cac lp gai
trung gian, lp hat va lp sng; ben di mang ay la lp b tham nhap mot t te bao viem.
Chuyen sang vung u, cac am te bao gai ung th a xam nhap sau xuong lp b (hnh 2).
Vi VK 10 va VK 40, cac am te bao gai ung th co nhan d dang, tang sac, to nho
khong eu; hach nhan ln; t le phan bao tang va co mot so phan bao bat thng. a so
carcinom te bao gai cua da thuoc loai biet hoa tot nen gia cac am te bao gai ung th co cac
cau sng ai toan, la mot cau truc gom cac vay sng cuon lai vi nhau. Cac te bao ung th co
bao tng ai toan, lien ket vi nhau bang cac cau lien bao (hnh 3, 4).
42
Hnh 2: 1- Bieu b bnh thng; 2- Mang ay; 3- Cac am te bao gai ung th xam nhap.
Hnh 3: 1- Cau sng; 2- am te bao gai ung th.
43
Hnh 4: 1- Nhan d dang, hach nhan ln; 2- Phan bao bat thng; 3- Cau lien bao.
44
CARCINOM TE BAO GAI DI CAN HACH

Carcinom te bao gai cua da, hoc mieng, thanh quan, thc quan, co t cung, mot khi a
chuyen sang giai oan xam nhap eu co the chui vao mach bach huyet trong mo em e cho di
can en cac hach vung.
ai the: Hach di can tang kch thc; mat o cng chac hoac mem tuy theo mc o
tang sinh mo si va hoai t trong hach; vo bao hach co the con nguyen ven hoac a b pha v;
mat cat a dang do co cac o xuat huyet, hoai t va thoai hoa boc (hnh 1)
Hnh 1: 1- O ung th di can; 2- Thoai hoa boc; 3- Nhu mo hach bnh thng.
Vi the:
Muc tieu can tm:
1. am te bao gai ung th biet hoa va, xam nhap pha huy nhu mo hach.
2. Hien tng hoai t trung tam.
3. Nhu mo hach con sot lai.
Quan sat tieu ban vi VK4, di vo bao hach la cac am te bao gai ung th co kch
thc khac nhau, ang xam nhap pha huy nhu mo hach; nhng van con thay vai nang limpho
th cap cua vung vo hach con sot lai (hnh 2). cac am te bao ung th ln, co hien tng
hoai t trung tam do thieu dinh dng (hnh 3).
Vi VK 40, do ung th di can thuoc loai carcinom te bao gai biet hoa va, v vay cac te
bao ung th co nhan d dang, hach nhan ln, bao tng ai toan; lien ket vi nhau bang cau lien
bao nhng khong tao c cau sng. T le phan bao tang va co nhng hnh anh phan bao bat
thng; cac phan bao bat thng nay lam te bao chet, khong hoan tat c qua trnh phan bao
(hnh 4).
45
Hnh 2: 1- Vo bao hach; 2- Mo m quanh hach; 3- Nang limpho th cap;

4- Cac am te bao gai ung th xam nhap pha huy nhu mo hach.
Hnh 3: 1- Cac am te bao gai ung th xam nhap pha huy nhu mo hach; 2- Hoai t
trung tam; 3- Nhu mo hach con lai.
46
Hnh 4: 1- am te bao gai ung th; 2- Cau lien bao; 3- Phan bao bat thng (te bao
chet); 4- Nhu mo hach con lai.
47
CARCINOM TE BAO AY CUA DA

La 1 loai ung th da thng gap ngi tren 50 tuoi, tren vung da lo ra anh sang mat
tri. Ung th xuat phat t cac te bao bieu mo lp ay cua da, tang sinh biet hoa theo hng te
bao ay. U ln cham, co kha nang xam nhap pha huy tai cho rat manh nhng hiem khi cho di
can (t le di can thap hn 1/10.000). Trong qua trnh xam nhap, cac hac to bao bnh thng cung
b keo theo, san xuat melanin lam cho u co mau nau en, co the gay nham lan vi melanom.
ai the: Ung th co dang not cuc, mau nau en, thng co loet gia, ng knh 1- 2
cm. Ung th phat trien pha huy dan toan bo cau truc ben di do te bao u co kha nang xam
nhap rat manh (hnh 1).
Hnh 1: A- Carcinom te bao ay da goc ngoai mat, dang not cuc mau en, co loet
chnh gia; B- Ung th xam nhap pha huy cac cau truc ben di da mat.
Vi the:
Muc tieu can tm:
1. am te bao ay ung th.
2. Hien tng xep hang rao.
3. Thoai hoa boc.
4. Sac to melanin.
5. Cac phan phu bnh thng cua da : nang long, tuyen ba, tuyen mo hoi.
Quan sat tieu ban vi VK4, lp bieu b tng oi bnh thng nhng trong lp b co nhieu
am te bao ay ung th xam nhap kch thc khac nhau; cac am ln thng b thoai hoa boc
chnh gia; mot so am co cha sac to melanin mau nau am (hnh 2).
VK 10 va VK 40, cac am te bao ay ung th c tao bi cac te bao u tng oi
ong dang giong te bao lp ay bieu b vi nhan hnh tron hoac bau duc bat mau tm am, bao
tng t; nhan cua cac te bao ngoai ra xep song song, tao nen hnh anh xep hang rao. Hien
tng thoai hoa boc cac am ln la do te bao u b hoai t hoac tach ri nhau; trong long boc
co cha 1 chat giong chat can ban lien ket ( khong thay ro tren tieu ban). Cac hac to bao b keo
theo am te bao ung th san xuat ra melanin, sac to nay c thay trong bao tng cac te bao
ung th hoac trong cac ai thc bao cua mo em. Gia cac am te bao ung th la mo em gom
cac si collagen, nguyen bao si, ai thc bao (hnh 3).
Ngoai ra, trong mo quanh u con co cac phan phu da bnh thng nh nang long, tuyen
ba, tuyen mo hoi.
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Hnh 2: 1- Bieu b bnh thng; 2- Cac am te bao ay ung th xam nhap trong lp
b; 3- Thoai hoa boc; 4- Sac to melanin.
Hnh 3: 1- Hien tng xep hang rao; 2- Thoai hoa boc; 3- Sac to melanin trong am
te bao ay; 4- Sac to melanin trong ai thc bao cua mo em; 5- Mo em si.
49
CARCINOM TE BAO GAI KHONG SNG HOA CO T CUNG

Ung th co t cung van con la mot trong nhng loai ung th hang au thng thay phu
n Viet nam va khi c phat hien th a so a vao giai oan xam nhap, ieu nay chng to viec
tam soat ung th bang phet mong Papanicolaou van cha thc s hieu qua. Ve mo hoc, hn 3/4
trng hp ung th co t cung la carcinom te bao gai, trong o carcinom te bao gai khong sng
hoa la loai thng gap nhat, chiem t le khoang 68%.
ai the: Ung th co t cung thng co v tr vung chuyen dang; u dang choi sui, loet
hoac tham nhiem, kch thc t 0,5 en 4cm (hnh 1).
Hnh 1: Ung th xam nhiem dang choi sui vung chuyen dang cua co t cung.
Vi the:
Muc tieu can tm:
1. Cac am te bao gai d dang xam nhap mo em.
2. Cau lien bao.
3. Tuyen co trong bnh thng.
Quan sat tieu ban vi VK4, s hien dien cua cac tuyen co trong bnh thng trong mo
em chng to u nam trong vung chuyen dang cua co t cung. Ton thng tren be mat co cho
van con trong giai oan nghch san nang hoac carcinom tai cho (CIN 3); nhng ni khac, cac
am te bao ung th a pha v mang ay va xam nhap xuong mo em ben di (hnh 2).
Vi VK 10 va VK 40, cac am te bao ung th xam nhap la cac te bao gai d dang, nhan
tang sac, hach nhan ro, bao tng ai toan. T le phan bao cao. Cac te bao ung th lien ket nhau
bang cau lien bao nhng khong thay co cau sng; chng to ung th thuoc loai carcinom te bao
gai khong sng hoa, biet hoa va (hnh 3).
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Hnh 2: 1- Carcinom tai cho ; 2- Cac am te bao gai ung th xam nhap vao mo em;
3- Tuyen co trong bnh thng; 4- Mo em.
Hnh 3: 1-Cac am te bao gai ung th xam nhap vao mo em; 2- Phan bao;
3- Cau lien bao; 4- Mo em tham nhap limpho bao.
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U TUYEN ONG RUOT GIA

U tuyen thng co dang polyp nen con c goi la polyp tuyen (adenomatous polyp). U
tuyen xuat hien chu yeu ai trang vi xuat o tang dan theo tuoi tac, t le mac benh gii
nam/n ngang bang nhau. S hnh thanh u tuyen la ket qua hoat ong tang san kem nghch san
cua bieu mo ruot; nghch san co the xay ra moi mc o, t nhe en nang va co the tm thay
ca nhng o carcinom tai cho. V vay, co the xem u tuyen la 1 ton thng tien ung. Ve mat mo
hoc, phan biet 3 loai u tuyen: U tuyen ong, u tuyen nhanh va u tuyen ong-nhanh. Tieu ban c
quan sat ay la u tuyen ong, loai u tuyen thng gap nhat (90% cac u tuyen).
ai the: U tuyen ong thng co kch thc nho (t khi > 2,5cm) be mat tng oi lang va
co cuong. (Hnh 1A).
Hnh 1: A- u tuyen ong ai trang dang polyp co cuong (mui ten) . B- Lat cat u tuyen tren tieu
ban cho thay ro phan au va cuong polyp (mui ten).
Vi the:
Muc tieu can tm:
1. Bieu mo tuyen ruot tang san va nghch san phan au polyp.
2. Niem mac ruot bnh thng phan cuong polyp va thanh ruot bnh thng
quanh u.
3. Loi si cua cuong polyp.
Lu y: Hoc vien can on lai cau tao mo hoc cua ai trang.
Bang mat tran, co the thay ro hnh dang polyp co cuong cua u tuyen ong ai trang (hnh
1B). Quan sat tieu ban vi VK4, phan au cua polyp c tao bi cac tuyen ruot tang san va
nghch san, lam cho lp niem mac ruot tai ay day han len; phan cuong polyp co loi la mo si
cha cac mach mau, xuat phat t lp di niem mac cua thanh ruot va c bao quanh bi lp
niem mac ruot tng oi bnh thng (hnh 2). Thanh ruot quanh u co cau tao bnh thng, gom
4 lp la niem mac, di niem mac, c va thanh mac (hnh 3).
52
Hnh 2: 1- Niem mac ruot vi cac tuyen tang san va nghch san phan au polyp;
2- Niem mac ruot bnh thng phan cuong; 3- Loi si cua cuong polyp.
Hnh 3: Thanh ruot bnh thng quanh u, 1- Lp niem mac; 2- Lp di niem mac;
3- Lp c; 4- Lp thanh mac; 5- Lp c niem.
Vi VK 10 va VK 40, cac tuyen ruot tang san va nghch san phan au polyp co hnh
dang ngoan ngoeo, xep chen chuc nhau, lp mo em gia cac ong tuyen tham nhap nhieu
limpho bao. ac iem cua tnh trang nghch san bieu mo ruot c thay ro gom cac te bao co
nhan tang sac, hnh bau duc keo dai; xep chong len nhau thanh nhieu tang; t le phan bao tang;
53
so lng te bao ai tiet nhay giam han; trai ngc vi bieu mo ong tuyen Lieberkhn bnh
thng ch gom 1 lp te bao va co nhieu te bao ai. (hnh 4, 5).
Hnh 4: 1- Cac tuyen ruot tang san va nghch san; 2. Tuyen ruot tng oi bnh
thng cua phan cuong; 3- Te bao ai; 4- Mo em tham nhap limpho bao.
Hnh 5: 1- Nghch san bieu mo ruot, nhan tang sac, xep thanh nhieu tang;
2- Phan bao; 3- Mo em tham nhap limpho bao.
54
CARCINOM TUYEN RUOT GIA XAM NHAP

Carcinom tuyen chiem 98% cac ung th ai trc trang, tuy co the xuat hien bat ky ni
nao trong khung ai trang nhng v tr thng gap nhat la ai trang sigma va trc trang. Benh
dien tien am tham nen thng c phat hien tre, khi ung th a xam nhap vao lp c thanh
ruot (Dukes B) th t le song them 5 nam ch con 55-67% so vi t le tren 90% neu ung th con
gii han trong lp niem mac va di niem mac (Dukes A).
ai the: Ton thng co dang sui, loet hoac tham nhiem; 1 ben thanh ruot hoac lan
vong theo chu vi ruot, lan ngc len oan ruot pha tren hoac xuong pha di; lam day cng
thanh ruot, nhan nhum thanh mac va co the gay cht hep long ruot. (hnh 1)
Hnh 1: Carcinom tuyen ai trang sigma, ton thng dang sui loet.
Vi the:
Muc tieu can tm:
1. am tuyen ung th xam nhap
2. Tuyen Lieberkhn bnh thng
Quan sat tieu ban vi VK4, co s tng phan ro ret gia vung niem mac ruot cha cac
tuyen Lieberkhn bnh thng vi vung niem mac cha cac am tuyen ung th xam nhap bat
mau am hn (hnh 2).
Vi VK 10 va VK 40, cac am tuyen ung th co hnh dang meo mo nhng a so co long
ong vi mot t chat nhay ben trong; v vay ay la mot carcinom tuyen biet hoa tot. Cac te bao
ung th co nhan tang sac, d dang; xep chong chat len nhau thanh nhieu tang; t le phan bao
cao va co the thay phan bao bat thng. Mot so te bao ung th biet hoa tot san xuat c chat
nhay, co hnh dang giong te bao ai bnh thng. So sanh vi cac tuyen Lieberkhn cua vung
55
niem mac ruot bnh thng, bieu mo lot gom mot lp te bao hnh tru vi rat nhieu te bao ai
(hnh 3).
Tnh chat ac tnh con c bieu th bi hien tng xam nhap cua cac am tuyen ung th
vao mo em cua lp niem mac, lp di niem mac va lp c (hnh 4).
Hnh 2: 1- Cac tuyen Lieberkhn bnh thng; 2- Cac am tuyen ung th.
Hnh 3: 1. Cac te bao ung th xep thanh nhieu tang; 2- Te bao ung th san xuat
chat nhay giong te bao ai; 3- Phan bao bat thng; 4- Long ong cha
chat nhay.
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Hnh 4: 1- Cac am tuyen ung th; 2- Lp c trn thanh ruot.
57
CARCINOM TUYEN RUOT GIA DI CAN HACH

Carcinom tuyen ruot gia khi a xam nhap qua het thanh ruot th co kha nang di can theo
mach bach huyet vao cac hach trong mo m quanh ruot va cac hach mac treo (Dukes C), t le
song them 5 nam giam xuong con 20 - 40%.
ai the: Hach di can co ng knh t 0,5 cm en 2 hoac 3 cm; mat o cng chac hoac
mem b; mat cat trang sng (hnh 1).
Hnh 1: Carcinom tuyen trc trang xam nhiem (*), di can vao hach trong mo m
quanh trc trang (mui ten).
Vi the:
Muc tieu can tm:
1. am tuyen ung th xam nhap trong mo hach.
2. Hien tng hoai t u.
3. Mo hach bnh thng con sot lai.
Quan sat tieu ban vi VK4, hach co vo bao si mong va nam trong mo m, ben di vo
bao la vung vo hach vi cac nang limpho th cap. mot vung khac, co s hien dien cua cac
am tuyen ung th di can d dang, cac tuyen nay tang sinh xam nhap pha huy nhu mo hach va
ca vo bao si (hnh 2).
Vi VK 10 va VK 40, cac am tuyen ung th mot so co long ong ro ret, so khac tao
thanh am ac vi nhieu long nho (dang sang) vi t le gan bang nhau; v vay ay la mot
carcinom tuyen biet hoa va di can hach. Cac te bao ung th co nhan tang sac, d dang; xep
chong chat len nhau thanh nhieu tang; t le phan bao cao. Mot so te bao ung th biet hoa tot
san xuat c chat nhay, co hnh dang giong te bao ai bnh thng (hnh 3).
Xung quanh am tuyen, co phan ng tang tao si rat manh vi cac nguyen bao si va
nhieu si collagen (hnh 4). Hien tng hoai t u cung rat noi bat vi cac am chat hoai t dang
hat bat mau ai toan (hnh 5).
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Hnh 2: 1- Vo bao si; 2- Mo m; 3- Nang limpho th cap; 4- Cac am tuyen ung th;
5- Vung vo bao si b pha huy.
Hnh 3: 1. Tuyen co long ong ro, cha chat hoai t; 2- am tuyen ac dang sang;
3- Phan bao; 4- Te bao tiet nhay giong te bao ai; 5- Nguyen bao si.
59
Hnh 4: 1- Cac am tuyen ung th ac dang sang; 2- Phan bao; 3- Nguyen bao si;
4- Si collagen.
Hnh 5: 1- Cac am tuyen ung th; 2- Chat hoai t; 3- Mo si.
60
CARCINOM TUYEN RUOT GIA DI CAN GAN

Carcinom mot khi a tien trien qua giai oan xam nhap thng cho di can trc tien theo
ng bach huyet en cac hach vung; nhng cung co the cho di can theo ng mau nh vao
cac thong noi t nhien gia he thong mach bach huyet va he thong mach mau, hoac do ban
than te bao ung th xam nhap trc tiep vao cac tnh mach. Co khoang 75-77% cac trng hp
carcinom tuyen ai trang cho di can en gan, chu yeu theo ng tnh mach ca; t le song
them 5 nam cua nhng benh nhan nay (Dukes D) ch con di 10%.
ai the: Carcinom ai trang di can gan thng tao thanh nhieu o ung th th phat; cac o
co kch thc khong eu, mat cat khong ong nhat, mat o b; cac o ln co hoai t trung tam
(hnh 1).
Hnh 1: Carcinom ai trang di can gan, tao ra nhieu o th phat; 2 o ln co hoai t

trung tam (mui ten).
Vi the:
Muc tieu can tm:
1. am te bao tuyen ung th xam nhap mo gan.
2. Hoai t trung tam.
3. Tieu thuy gan bnh thng.
Lu y: Hoc vien can on lai cau tao mo hoc cua gan.
Quan sat tieu ban vi VK4, trong mo gan co cac o di can c tao bi cac am tuyen
ung th d dang; vung te bao gan ngoai ra o di can b chen ep va co s tham nhap nhieu limpho
bao (hnh 2).
Vi VK 10, cac am tuyen ung th phan ln co long ong ro ret, v vay ay la mot
carcinom tuyen biet hoa tot di can gan. cac am tuyen ln, co hien tng hoai t trung tam
(hnh 3).
Vi VK 40, cac tuyen ung th c lot bi cac te bao co nhan tang sac, d dang; xep
chong len nhau thanh nhieu tang; t le phan bao tang va co hnh anh phan bao bat thng. Long
ong tuyen cha chat nhay do te bao ung th san xuat. Gia cac ong tuyen co phan ng tang
sinh mo si (hnh 4).
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Mo gan xung quanh cac o di can co cau tao bnh thng, gom cac tieu thuy gan vi tnh
mach trung tam va khoang ca; trong khoang ca co nhanh cua ong mach gan, nhanh cua tnh
mach ca va tieu quan mat (hnh 5).
Hnh 2: 1- Cac am tuyen ung th; 2- Mo gan quanh o di can; 3- Limpho bao.
Hnh 3: 1- Cac am tuyen ung th; 2- Hoai t trung tam.
62
Hnh 4: 1- Cac am tuyen ung th; 2- Long ong cha chat nhay; 3- Phan bao bat
thng; 4- Mo si tang sinh.
Hnh 5: 1- Tnh mach trung tam tieu thuy gan; 2- Khoang ca.
63
CARCINOM TUYEN RUOT GIA DI CAN PHOI

Khoang 5 - 50% cac trng hp carcinom tuyen ai trang cho di can theo ng mau
en phoi; tao ra nhieu o ung th th phat tren ca 2 la phoi (hnh anh tha bong bong tren Xquang); t le song them 5 nam cua nhng benh nhan nay (Dukes D) ch con di 10%.
ai the: Cac o ung th th phat nam rai rac trong nhu mo phoi, gii han kha ro, mat cat
khong ong nhat do hien tng xuat huyet va hoai t, mat o mem b (hnh 1).
Hnh 1: 1- O ung th di can t carcinom tuyen ai trang co mat cat khong ong nhat
do xuat huyet hoai t ; 2- Mang phoi tang.
Vi the:
Muc tieu can tm:
1. am te bao tuyen ung th xam nhap trong nhu mo phoi.
2. Nhu mo phoi bnh thng: tieu phe quan ho hap, phe nang, ai thc bao
phe nang.
Lu y: Hoc vien can on lai cau tao mo hoc cua phoi.
Quan sat tieu ban VK4, o ung th di can c tao bi cac am tuyen d dang, xam
nhap vao gia cac am phe nang (hnh 2).
Vi VK 10, cac tuyen ung th co long ong ro ret, ben trong cha chat nhay mau tm nhat
hoac chat hoai t; v vay ay la mot carcinom tuyen biet hoa tot di can phoi (hnh 3).
Vi VK 40, te bao tuyen ung th co nhan d dang, tang sac, t le phan bao cao; mot so te
bao co hoat ong tiet nhay vi s hien dien cua 1 khong bao sang trong bao tng (hnh 4).
Ngoai ra cac am tuyen ung th, mo si tang sinh ngan cach vi nhu mo phoi xung quanh;
trong mo si co nhieu te bao viem tham nhap, chu yeu la limpho bao va 1 t tng bao (hnh 5).
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Hnh 2: 1- am tuyen ung th d dang; 2- Cac phe nang.
Hnh 3: 1- Cac am tuyen ung th; 2- Long ong cha chat nhay; 3- Long ong cha
chat hoai t; 4- Cac phe nang.
65
Hnh 4: 1- Te bao tuyen co nhan tang sac d dang ; 2- Te bao tuyen tiet nhay;
3- Phan bao bat thng; 4- Long ong cha chat hoai t.
Hnh 5: 1- Tuyen ung th d dang; 2- Mo si tang sinh, tham nhap te bao viem;
3- Phe nang.
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Nhu mo phoi quanh o di can co cau tao tng oi bnh thng, gom tieu phe quan ho
hap vi nhanh cua ong mach phoi i kem, cac phe nang lot bi phe bao I va II. Long phe nang
co cha cac ai thc bao phe nang vi bao tng cha ay khong bao nho va sang (nen con
goi la bot bao); mot so ai thc bao khac cha cac hat bui than mau nau en, c tm thay
trong long phe nang, mo ke cua vach phe nang va mo em quanh tieu phe quan (hnh 6).
Hnh 6: 1- Tieu phe quan ho hap; 2- Nhanh ong mach phoi; 3- Bot bao; 4- ai thc
bao ong carbon; 5- Mach bach huyet; 6- Vach phe nang.
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X GAN
X gan la giai oan cuoi cua cac benh ly gan man tnh do nhieu nguyen nhan khac
nhau, tai gan hoac ngoai gan, nh viem gan sieu vi, ngo oc, nghien ru, mat, cac benh
chuyen hoa, suy tim... Trong x gan, tnh trang hoa si lan toa bao quanh cac not te bao gan tai
tao lam cau truc bnh thng cua gan b pha huy, chc nang gan suy giam, tuan hoan mau va
dan lu dch mat trong gan b roi loan.
ai the: Khi au, gan x to hn bnh thng nhng cang ve sau th cang teo nho lai,
mat o chac, be mat gan lon nhon cac not tai tao. Tuy theo kch thc cua not tai tao, phan biet
2 dang ai the: x gan not nho (not < 3mm) va x gan not ln (t 3mm tr len) (Hnh 1).
Hnh 1: A- X gan not nho; B- X gan not ln

Vi the:
Muc tieu can tm:
1. Not te bao gan tai tao (Tieu thuy gia).
2. Te bao gan thoai hoa m, te bao gan thoai hoa nc.
3. Te bao gan tang san.
4. Ong mat gia va ong mat that.
5. Tang san mo si va tham nhap te bao viem.
Quan sat tieu ban vi VK4, cau truc bnh thng cua gan b pha huy, thay vao o la cac
not te bao gan tai tao to nho khong eu, ngan cach nhau bang mo si ngam te bao viem man
tnh. Cac not nay thoat nhn trong giong tieu thuy gan nhng thc ra ch la 1 tap hp te bao gan
tang sinh va thoai hoa, khong co tnh mach trung tam, v vay con co ten la tieu thuy gia (hnh 2).
Vi VK 10 va 40, mo si bao quanh not te bao gan tai tao gom nguyen bao si va cac
si collagen, tham nhap nhieu te bao viem man tnh nh limpho bao va tng bao. Trong mo
si, s tang sinh cac te bao bieu mo ong mat tao ra cac ong nho, khong thong noi vi he dan
mat trong gan nen con goi la ong mat gia. Nhng khoang ca con sot lai - cha b pha huy cho thay s hien dien cua bo ba gom ong mat that, nhanh cua ong mach gan va nhanh cua
tnh mach ca (hnh 3, 4).
Not tai tao gom cac te bao gan ang hoat ong tang sinh, te bao co 2 nhan, hach nhan
ro; cac te bao gan thoai hoa nc vi bao tng cha nhieu khong bao sang; cac te bao gan
thoai hoa m vi bao tng cha mot giot m ln, ay nhan lech qua 1 ben (hnh 5).
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Hnh 2: 1- Cac not te bao gan tai tao; 2- Mo si ngam te bao viem man tnh.
Hnh 3: 1- Not te bao gan tai tao; 2- Mo si ngam te bao viem man tnh; 3- Ong mat gia;
4- Ong mat that; 5- Nhanh cua ong mach gan; 6- Nhanh cua tnh mach ca.
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Hnh 4: Te bao gan tang sinh; 2- Te bao gan thoai hoa nc; 3- Te bao gan thoai
hoa m; 4- Mo si; 5- Limpho bao; 6- Ong mat gia.
Hnh 5: 1- Te bao gan tang sinh; 2- Te bao gan thoai hoa nc; 3- Te bao gan thoai
hoa m.
70
CARCINOM TE BAO GAN

Carcinom te bao gan la loai ung th gan nguyen phat thng gap nhat, gii nam nhieu
hn gii n. Carcinom te bao gan co xuat o kha cao cac nc ong Nam A, co le lien quan
vi tnh trang nhiem HBV, HCV va x gan kha pho bien tai ay.
ai the: Carcinom co dang mot o, a o hoac tham nhiem lan toa, lam gan to ra. O ung
th co mau lat hn nhu mo gan xung quanh, mat o mem b, mat cat khong ong nhat do xuat
huyet va hoai t (hnh 1).
Hnh 1: 1- O ung th gan nguyen phat chiem het thuy phai gan; 2- Mat cat khong
ong nhat, co cho nhuom mau sac to mat; 3- Not ung th ve tinh.
Vi the:
Muc tieu can tm:
1. Te bao gan ung th xep thanh be hoac cau truc tuyen
2. Mat
3. Cac be gan bnh thng
Quan sat vi VK4, trong mo gan co cac am te bao gan ung th xam nhap bat mau lt
hn so vi nhu gan bnh thng. Vung te bao gan bnh thng sat ngoai ra cac am ung th b
ep det (hnh 2).
Vi VK10 va 40, ay la mot trng hp carcinom te bao gan biet hoa tot nen cac te bao
ung th tng oi t d dang, con gi c nhieu ac iem cua te bao gan. Te bao ung th hnh
a dien, bao tng nhieu mau hong nhat, nhan tron nam gia te bao. Cac te bao ung th hp
thanh cau truc be gom nhieu lp te bao co mao mach cap 2 ben ( bat chc be Remak bnh
thng trong tieu thuy gan, ch gom 1 lp te bao nam gia 2 mao mach dang xoang) hoac tui
tuyen (xep vong tron co long ong gia), long tuyen co the cha sac to mat mau nau (hnh 3 va
4).
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Hnh 2: 1- Cac o te bao gan ung th; 2- Nhu mo gan bnh thng; 3- Vung te bao
gan b ep det.
Hnh 3: 1- Cac te bao gan ung th sap xep thanh cau truc dang tuyen vi sac to mat
trong long tuyen; 2- Phan bao; 3- Vung nhu mo gan bnh thng; 4- Vung te
bao b ep det.
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Hnh 4: 1- Cau truc be gom nhieu lp te bao u ; 2- Cac mao mach; 3- Hoai t u.
73
CARCINOM TUYEN DA DAY DANG MAT NHAN

Carcinom tuyen la loai ung th da day thng gap nhat, thng c phat hien tre khi
ung th a i vao giai oan xam nhap, do khi au ch co cac trieu chng m ho nh kho tieu
ay bung. Benh nhan thng tren 50 tuoi, gii nam nhieu hn gii n. V tr thng gap nhat cua
ung th la b cong nho vung hang - mon v. Da theo hnh thai mo hoc, phan biet 2 loai
carcinom da day: kieu ruot va kieu lan toa; carcinom tuyen da day dang mat nhan thuoc loai th
2, te bao ung th hnh nhan khong tao thanh tuyen, xam nhap vao tat ca cac lp cua thanh da
day.
ai the: Thanh da day b ung th xam nhap tr nen day cng, cac nep gap niem mac b
xoa; da day trong giong nh mot cai chai bang da (hnh 1).
Hnh 1: 1- Thanh da day day cng; 2- Cac nep gap niem mac b xoa.
Vi the:
Muc tieu can tm:
Cac te bao ung th dang mat nhan xam nhap cac lp thanh da day.
Lu y: Hoc vien can on lai cau tao mo hoc cua da day
Quan sat tieu ban vi VK4, niem mac vung hang - mon v gom cac tuyen mon v tiet
nhay; gia cac ong tuyen la mo em niem mac trong o cac te bao ung th dang mat nhan xam
nhap (hnh 2).
Vi VK 10 va VK 40, tuyen mon v c lot bi 1 lp bieu mo tru n tiet nhay. Mo em
niem mac nam gia cac ong tuyen la 1 mo lien ket tha giau mach mau va tham nhap nhieu
limpho bao va tng bao. Trong mo em nay, co cac te bao ung th dang mat nhan xam nhap,
nam rieng le hoac ket thanh nhng am nho. Te bao ung th hnh tron hay bau duc, bao tng
co 1 khong bao ln cha chat nhay bat mau xanh tm, ay ep nhan ra ngoai vi (hnh 3).
74
Di chuyen tieu ban qua lp di niem mac, lp c va thanh mac; cung co s hien dien
cua cac te bao ung th dang mat nhan; chng to ung th a xam nhap qua tat ca cac lp cua
thanh da day (hnh 4 va 5).
Hnh 2: 1- Cac tuyen mon v; 2- Mo em niem mac; 3- Te bao ung th dang mat nhan.
Hnh 3: 1- Tuyen mon v; 2- Te bao ung th dang mat nhan xam nhap; 3- Mo em
niem mac; 4- Mach mau.
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Hnh 4: 1- Lp niem mac; 2- Lp di niem mac; 3- Lp c niem; 4- Cac am te bao

ung th dang mat nhan xam nhap.
Hnh 5: 1- Lp c; 2- Lp thanh mac; 3- Cac am te bao ung th dang mat nhan

xam nhap.
76
CARCINOM TUYEN DANG MAT NHAN DI CAN HACH

Carcinom tuyen loai te bao dang mat nhan cua ong tieu hoa, thng gap nhat la t da
day, co the xam nhap vao mach bach huyet va di can en cac hach vung.
ai the: Hach di can co ng knh t 0,5 cm en 2 hoac 3 cm; mat o cng chac hoac
mem b; mat cat trang sng (hnh 1).
Hnh 1: 1- Da day; 2- Khoi hach di can cng sng nam doc theo b cong nho.
Vi the:
Muc tieu can tm:
1. Te bao ung th dang mat nhan xam nhap xoang di vo va xoang
quanh nang.
2. Nhu mo hach bnh thng con sot lai.
Quan sat tieu ban vi VK 4, cau truc hach con c bao ton kha nguyen ven: bao quanh
hach la vo bao si; nhu mo hach gom co vung vo vi cac nang limpho, vung can vo va cac
xoang bach huyet (xoang di vo, xoang quanh nang, xoang tuy). Trong cac xoang bach huyet,
co cac te bao tuyen ung th di can xam nhap, khac biet vi cac mo bao bnh thng cua xoang
(hnh 1).
Quan sat cac xoang di vo va xoang quanh nang vi VK 10 va VK 40, cac te bao ung
th tuyen xam nhap con nam trong cac xoang, cha pha v nhu mo hach. Te bao ung th co
khong bao ln cha chat nhay trong bao tng, ay lech nhan sang mot ben, tao hnh anh te
bao giong nh chiec nhan (hnh 3 va 4)
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Hnh 2: 1- Vo bao si; 2- Nang limpho th cap. 3- Cac te bao tuyen ung th di can
xam nhap xoang di vo va xoang quanh nang.
Hnh 3: 1- Vach si ngan vao trong nhu mo hach; 2- Nang limpho th cap; 3- Cac
te bao ung th tuyen dang mat nhan xam nhap trong xoang quanh nang.
78
Hnh 4: 1- Cac te bao tuyen ung th dang mat nhan co khong bao ln cha chat
nhay trong bao tng, ay lech nhan sang mot ben.
79
CARCINOM TE BAO GAI PHOI

La mot trong hai loai mo hoc thng gap nhat cua carcinom phe quan - loai ung th
ng hang au an ong Viet nam. Benh thng xay ra sau 40 tuoi, co lien quan mat thiet vi
tat nghien hut thuoc la.
ai the: U co v tr trung tam, thng xuat phat t cac phe quan ln gan ron phoi, tao
thanh mot khoi sui lap bt long phe quan va xam nhap vao nhu mo phoi xung quanh. U co mat
o cng chac hoac mem b; mat cat trang xam khong ong nhat, co nhng vung xuat huyet,
hoai t va thoai hoa boc (hnh 1).
Hnh 1: 1- U xuat phat t phe quan ln, xam nhap vao nhu mo phoi xung quanh
en tan mang phoi; 2- Hach ron phoi b di can.
Vi the:
Muc tieu can tm:
1. am te bao gai ung th biet hoa va xam nhap nhu mo phoi.
3. Nhu mo phoi quanh u b viem, xuat huyet, x hoa.
Lu y: Hoc vien can on lai cau tao mo hoc cua phoi.
Quan sat tieu ban vi VK4, lat cat mau mo co hai vung khac biet nhau: mo u gom nhng
am ac te bao ung th xam nhap trong mo em si; nhu phoi ke can b x hoa va tham nhap
te bao viem, con thay c cac khe trong la cac long phe nang (hnh 2).
Vi VK10 va 40, ay la mot trng hp carcinom te bao gai biet hoa va, v vay cac te
bao ung th co nhan d dang tang sac, hach nhan ln, bao tng ai toan; lien ket vi nhau bang
cau lien bao nhng khong tao c cau sng. T le phan bao tang va co nhng hnh anh phan
bao bat thng. Cac te bao ung th xep thanh am, xam nhap trong mo em; mot so am co
hien tng hoai t trung tam do te bao b chet v thieu dinh dng (hnh 3 va 4).
VK 10, vung mo phoi canh u b chen ep, viem, xuat huyet, vach phe nang x hoa day
len, tham nhap te bao viem, long phe nang b thu hep lai thanh cac khe mong.(hnh 5)
80
Hnh 2: 1- am te bao gai ung th xam nhap nhu mo phoi; 2- Hoai t trung tam;
3- Nhu mo phoi ke can b chen ep, x hoa, tham nhap te bao viem.
Hnh 3: 1- Te bao ung th co nhan d dang tang sac; 2- Hoai t trung tam;
3- Cau lien bao.
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Hnh 4: 1- Te bao ung th co nhan d dang tang sac; 2- Phan bao bat thng.
Hnh 5: 1 Vach phe nang x hoa day len; 2- Long phe nang thu hep; 3- Xuat huyet.
82
CARCINOM TIEU PHE QUAN PHE NANG

La loai carcinom phe quan thng gap phu n va ngi khong hut thuoc la. U xuat
phat t te bao Clara hoac phe bao II cua tieu phe quan tan hoac phe nang, do o v tr khi au
thng ngoai vi phoi; tien trien lan rong doc theo vach phe nang vao toan bo nhu mo phoi.
ai the: Ton thng co dang nhieu cuc mau xam trang rai rac khap trong nhu mo phoi,
cau truc cay phe quan tng oi con nguyen ven (hnh 1).
Hnh 1: 1- U co dang nhieu cuc mau xam trang nam rai rac khap nhu mo phoi;
2- Cay phe quan tng oi con nguyen ven
Vi the:
Muc tieu can tm:
1. Te bao ung th hnh vuong hoac tru, nhan tang sac, d dang; mot so
te bao co khong bao tiet nhay cc nh.
2. Te bao ung th: lot vach phe nang, tao nhu.
3. Mot so am te bao ung th rt vao long phe nang.
Quan sat tieu ban vi VK4, mau mo co hai vung khac biet; mo u la nhng phe nang co
vach lot bi te bao ung th, so sanh vi vung mo phoi bnh thng vi cac phe nang co vach
mong lot bi cac phe bao (hnh 2).
Vi VK10 va VK 40, tai ranh gii gia mo lanh va mo u, phe nang co te bao ung th lot
vach nam lien tuc vi phe nang bnh thng, hnh anh nay cho thay ay la loai ung th tien trien
lan tran doc theo vach phe nang vao toan bo nhu mo phoi. (Hnh 3)
Quan sat vung mo u VK10 va 40, phe nang lot bi cac te bao ung th hnh tru hoac
hnh vuong, nhan d dang tang sac va co hach nhan ln. Te bao ung th co ni tang sinh manh
tao thanh nhu tho vao long phe nang (nhu khong co truc lien ket mach mau). Te bao ung th co
the rt vao long phe nang, can phan biet vi cac ai thc bao phe nang ong bui than trong
bao tng (con goi la te bao bui). Mot so te bao ung th che tiet chat nhay, co khong bao cha
chat nhay cc nh, ay nhan lech sat ay, cho hnh anh giong te bao ai (hnh 4, 5).
83
Hnh 2: 1- Cac te bao ung th lot vach phe nang; 2- Vach phe nang bnh thng.
Hnh 3: 1- Cac te bao ung th lot vach phe nang; 2- Vach phe nang bnh thng;
3- ai thc bao phe nang.
84
Hnh 4: 1- Te bao ung th tang sinh tao nhu; 2- am te bao ung th rt vao long
phe nang; 3- Te bao ung th che tiet chat nhay; 4. ai thc bao phe nang.
Hnh 5: 1- am te bao ung th rt vao long phe nang; 2- ai thc bao phe nang
ong bui than (te bao bui).
85
CARCINOM TUYEN GIAP DANG NHU

La loai ung th thng gap nhat cua tuyen giap, tuoi mac benh trung bnh la 40 tuoi, gii
n mac benh nhieu hn gii nam gap 2-3 lan. U tien trien cham nhng co the cho di can hach
rat sm, hiem khi di can theo ng mau.
ai the: U co kch thc trung bnh 2-3cm, u ac khong vo bao, mat o chac, mat cat
trang xam khong ong nhat , co the co nhng vung hoa calci va thoai hoa boc (hnh 1).
Hnh 1: 1- U khong co vo bao, xam mhap vao mo giap xung quanh; 2- Mat cat trang
xam khong ong nhat, co cho thoai hoa boc
Vi the:
Muc tieu can tm:
1. Te bao ung th co nhan sang, bau duc, chong chat len nhau.
2. Tang san tao nhu phan nhanh, co truc lien ket mach mau.
3. The psammoma trong mo em.
Quan sat tieu ban vi VK4, u cau tao bi cac cau truc nhu phan nhanh, co truc lien ket
mach mau, c phu lp 1 te bao bieu mo vuong hoac tru thap. Ben canh cau truc nhu, te bao
u co the xep thanh nang tuyen co cha chat keo. Trong mo em u va tren cac truc lien ket
mach mau, ta co the tm thay cac the psammoma bat mau tm am (psammoma la mot cau truc
hnh tron gom nhieu lp ong tam do tnh trang lang ong canxi hoa nghch dng) (Hnh 2 va
3).
Vi VK 10 va VK40, ta thay cac te bao u co nhan sang, tron hoac bau duc, co ni tang
sinh chong chat len nhau tao hnh anh giong nh ro trng. (hnh 4)
86
Hnh 2: 1- Te bao ung th tang san tao nhu; 2- The psammoma.
Hnh 3: 1- Truc lien ket mach mau; 2- The psammoma.
87
Hnh 4: 1- Truc lien ket mach mau; 2- Nhan te bao u hnh bau duc, sang, chong
chat len nhau (giong ro trng).
88
CARCINOM TE BAO SANG CUA THAN

La loai ung th than thng gap nhat ngi ln vi xuat o tang dan theo tuoi, tuoi
trung bnh la 60 tuoi, gii nam nhieu hn gii n. U xuat phat t vung vo than, xam nhap vao
tuy than va ra ngoai vo bao than, cho di can hach vung va di can xa theo ng mau. Tien
lng benh phu thuoc chu yeu vao mc o lan tran cua ung th; tot nhat khi khoi u con gii han
trong vo bao than.
ai the: U dang khoi tron, ng knh 3-15 cm, mat cat khong ong nhat, mau vang
(do te bao u cha nhieu lipid), co nhng vung xuat huyet, hoai t, hoa boc (hnh 1).
Hnh 1: 1- Mat cat u mau vang; 2- Vung hoa boc; 3- Tuy than; 4- Vo than.
Vi the:
Muc tieu can tm:
1. Te bao ung th hnh tron hoac hnh a dien, nhan chnh gia, bao
tng nhieu va sang, xep thanh be hoac ong.
2. Nhu mo than bnh thng: cau than va ong than.
Lu y: Hoc vien can on lai cau tao mo hoc cua than.
Quan sat tieu ban vi VK4, ta thay mau mo gom co hai vung khac biet: vung u cau tao
bi cac te bao co bao tng sang va vung nhu mo than quanh u co cac cau than va ong than
(Hnh 2).
Vi VK10 va VK 40, vung u tao bi cac te bao hnh tron hoac a dien; bao tng nhieu
va sang; nhan tang sac, meo mo, nam gia te bao (bao tng sang la do cha nhieu lipid va
glycogen a b tan mat trong qua trnh x ly mau mo). Te bao u xep thanh cau truc dang be ac
hoac ong tuyen. U co phan bo mach mau phong phu (hnh 3).
89
Vung nhu mo than ke can u co cac cau than x hoa, ong than teo nho, mo em tham
nhap nhieu te bao viem man tnh (hnh 4).
Hnh 2: 1- Ranh gii gia u va nhu mo than xung quanh.
Hnh 3: 1- Te bao u co bao tng sang; 2- Mach mau.
90
Hnh 4: Nhu mo than quanh u: 1- Cau than; 2- Ong than; 3- Mo em tham nhap te
bao viem man tnh.
91
SARCOM SI
Xay ra chu yeu ngi ln t 30-60 tuoi, gii nam nhieu hn gii n. U ln cham, nam
sau, dang cuc, gii han ro, kch thc t 3-8 cm, mat o chac; v tr thng gap nhat la chi
di.
ai the: U co gii han ro nhng khong vo bao, mat o chac, mat cat co mau trang giong
mo si va co the co nhng o xuat huyet va hoai t (hnh 1).
Hnh 1: Sarcom si co gii han ro, mat cat mau trang va co nhng o xuat huyet.
Vi the:
Muc tieu can tm:
1. Cac te bao u hnh thoi, tao thanh cac bo an cheo nhau (hnh xng ca)
2. Cac hnh anh phan bao.
Quan sat tieu ban vi VK4, u co mat o te bao rat cao va c phan bo nhieu mach
mau. Cac te bao u tng oi ong dang, hnh thoi giong nguyen bao si; xep thanh cac bo an
cheo nhau giong hnh xng ca (hnh 2).
Vi VK 10 va VK 40, te bao u co nhan hnh bau duc vi 2 au nhon, tang sac, chat
nhiem sac tho; ranh gii gia cac te bao khong ro ret; t le phan bao cao (1-2 phan bao / vi
trng VK 40) (hnh 2).
Gia cac bo te bao u an cheo nhau, co mot t si collagen nhng tng oi kho nhan
dien (hnh 3).
92
Hnh 2: Te bao u xep thanh cac bo an cheo nhau hnh xng ca (mui ten).
Hnh 3: 1- Te bao u hnh thoi, nhan bau duc nhon 2 au; 2- Phan bao; 3- Mach mau;
4- Si collagen
93
SARCOM C TRN DI CAN GAN

Sarcom thng cho di can trc tien theo ng mau. Te bao ung th pha huy thanh
tnh mach, chui vao dong mau phat tan i khap ni trong c the, thng gap nhat la en gan va
phoi.
ai the: Sarcom c trn di can gan co the mot hoac nhieu o, mat cat u co nhieu thuy,
mau xam nhat, co vung hoai t, xuat huyet.
Hnh 1: A- Be mat u co nhieu thuy; B- Mat cat xam nhat, khong ong nhat,co vung
hoai t va xuat huyet.
Vi the:
Muc tieu can tm:
1. Cac am te bao c trn ac tnh, nhan d dang, co khuynh hng tao bo.
2. Mo gan bnh thng.
Quan sat tieu ban vi VK 4, ta thay trong mo gan co cac o di can tao bi nhng te bao
c trn hnh thoi, d dang (Hnh 2).
Vi VK 10 va VK 40, nhng te bao u co xu hng sap xep tao thanh cac bo ngan an
cheo nhau. Te bao u hnh thoi co t bao tng mau hong, nhan hnh bau duc thuon dai vi 2 au
tu, tang sac, d dang, rai rac co cac phan bao (hnh 3 va 4).
Mo gan bnh thng xung quanh o di can cau tao bi cac tieu thuy gan vi cac be te bao
gan, tnh mach trung tam, khoang ca (hnh 3 va 4).
94
Hnh 2: 1- Cac am te bao c trn ac tnh; 2- Mo gan bnh thng b xam nhap;
3- Tnh mach trung tam tieu thuy gan; 4- Khoang ca.
Hnh 3: 1- Cac am te bao u xep thanh bo ngan; 2- Nhan te bao u hnh bau duc
thuon dai vi 2 au tu; 3- Phan bao.
95
Hnh 4: 1- Cac te bao u tao bo; 2- Phan bao; 3- Mo gan b xam nhap.
96
SARCOM XNG
Sarcom xng la loai u xng ac tnh nguyen phat thng gap (chiem 35% cac u xng
ac tnh); benh nhan thng tre tuoi (10-25 tuoi), gii nam nhieu hn gii n. e chan oan ung
sarcom xng, can phoi hp gia lam sang, x-quang va giai phau benh, khong n thuan da
vao hnh thai vi the.
ai the: U co kch thc ln, ng knh t 5-10 cm; nam vung hanh xng, thng
pha v vo xng ac va xam nhap vao mo mem xung quanh. U mau xam nau, mat o co cho
mem b, cho cng chac. Mat cat a dang, co nhng vung xuat huyet, hoai t (hnh 1).
Hnh 1: Sarcom xng au tren xng chay; u a lan vao tuy xng, pha v vo
xng va xam nhap mo mem xung quanh .
Vi the:
Muc tieu can tm:
1. Te bao ung th a dang, d dang.
2. Chat dang xng.
3. Manh xng chet.
4. ai bao nhieu nhan (giong huy cot bao).
5. T le phan bao cao, phan bao bat thng.
Quan sat tieu ban vi VK4, u rat giau te bao va co phan bo mach mau phong phu, lam
noi bat cac be chat dang xng mau hong va nhng manh xng chet mau tm am (hnh 2).
Vi VK 10 va VK 40, te bao u co mot nhan ln tang sac, d dang, hach nhan ro; t le
phan bao cao va co hnh anh phan bao bat thng. Cac te bao u san xuat ra chat dang xng
roi vui vao trong o, tao hnh anh te bao u bam ngoai ra hoac lot vao gia cac be chat dang
xng. Ngoai ra, con co nhng ai bao nhieu nhan giong huy cot bao; ay la nhng te bao lanh
tnh, co ve nh a c huy ong en u di tac ong cua cac chat trung gian hoa hoc phong
thch t te bao viem (hnh 3).
Cac manh xng chet bat mau tm am, b nham nh; ben trong co cha vai hoc nho
trong do te bao xng a chet (hnh 4).
97
Hnh 2: 1- Chat dang xng; 2- Manh xng chet; 3- Mach mau.
Hnh 3: 1- Te bao u co nhan tang sac d dang; 2- Chat dang xng; 3- ai bao nhieu
nhan giong huy cot bao; 4- Phan bao bat thng.
98
Hnh 4: 1- Manh xng chet; 2- Mach mau.
99
U SI TUYEN VU
La u tuyen vu lanh tnh thng gap nhat, do tang san ca hai thanh phan, mo em trong
tieu thuy va bieu mo tuyen. Co the gap moi la tuoi, nhng thng nhat la phu n trc 30
tuoi.
ai the: U tron, gii han ro, co vo bao si, mat o chac, di ong tot. Kch thc u thay
oi t 1 - 10 cm, trung bnh la 2 - 4cm. Mat cat u phong, ong nhat, co mau trang xam. (hnh 1).
Hnh 1: U tron, gii han ro; mat cat phong, ong nhat.
Vi the:
Muc tieu can tm:
1. Tang sinh mo lien ket tha quanh cac ong tuyen vu.
2. Ong tuyen vu tang san, mot so b keo dan, ep det.
3. Bieu mo ong tuyen vu gom hai loai te bao: te bao bieu mo va
te bao c bieu mo.
4. Vo bao si quanh u.
Lu y: Hoc vien can on lai cau tao mo hoc tuyen vu.
Quan sat tieu ban vi VK4, u lanh si tuyen vu co vo bao si bao quanh. Vo bao u la
mot vach mo lien ket ac co cac te bao si va giau si collagen bat mau hong. Mo u cau tao bi
mo em tha trong tieu thuy tang san, bao quanh cac ong tuyen vu tang san (hnh 2).
Mo em tang san giau chat can ban, bat mau xanh tm, co nhieu nguyen bao si la cac
te bao co nhan hnh bau duc vi rat t bao tng. Ong tuyen vu tang san co the co hnh tron nho
hoac hi dan rong (hnh 2), hoac b keo dan va ep det lai di tac ong chen ep cua mo em
(hnh 3).
Vi VK10 va VK40, cac ong tuyen vu tang san luon c lot bi 2 loai te bao, te bao
bieu mo va te bao c bieu mo. Te bao bieu mo co hnh vuong hoac tru thap, tao thanh 1 lp lien
tuc pha trong tiep xuc vi long ong; co ni te bao bieu mo tang san thanh 2 - 3 lp. Te bao c
bieu mo co bao tng nhieu, sang; nhan tron nho am mau; tao thanh 1 lp khong lien tuc, nam
gia mang ay va lp te bao bieu mo (Hnh 4 va 5).
Ben ngoai vo bao si cua u la mo tuyen vu bnh thng vi cac tieu thuy vu (hnh 2).
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Hnh 2: 1- Vo bao si quanh u; 2- Cac ong tuyen vu tang san ; 3- Mo lien ket tha
tang san quanh ong tuyen vu ; 4- Tieu thuy vu bnh thng.
Hnh 3: 1- Cac ong tuyen vu b ep det; 2- Cac ong tuyen vu tang san (2 - 3 lp te bao
bieu mo); 3- Mo lien ket tha tang san quanh ong tuyen vu.
101
Hnh 4: 1- Cac te bao bieu mo; 2- Cac te bao c bieu mo; 3- Mo lien ket tha tang san
Hnh 5: 1- Cac te bao bieu mo tang san (2 - 3 lp te bao); 2- Te bao c bieu mo;
3- Mo lien ket tha tang san.
102
BIEN OI SI BOC TUYEN VU

La ton thng tuyen vu thng gap nhat. Bien oi si boc la nhng thay oi cua mo
tuyen vu theo tuoi tac, lien quan vi tnh trang mat can bang hormon (tang qua mc estrogen
hoac thieu hut progesteron). nh tuoi mac phai la 20-40 tuoi va ngay trc tuoi man kinh.
ai the:
Co the la mot boc ln kch thc vai cm hoac nhieu boc nho cha dch vang trong (hoac
dch nau xanh neu co xuat huyet cu trong boc), xen lan vi nhng vung mo tuyen vu hoa si
day len, dai, chac, co mau trang, gii han khong ro (hnh 1).
Hnh1: 1- Bien oi boc (boc cha dch mau xanh do xuat huyet cu; 2- Bien oi si;
3. M
Vi the:
Muc tieu can tm:
1. Ong tuyen dan rong thanh boc, bieu mo lot b ep det.
2. Mot so ong tuyen vu co bieu mo tang san nhieu lp, tao nhu; van con
thay ro te bao c bieu mo.
3. Tang sinh mo lien ket si ac quanh ong tuyen vu.
Quan sat tieu ban vi VK4, mot vai ong tuyen vu gian rong thanh boc, cha chat tiet bat
mau hong (hnh 2). Chuyen sang VK10 va VK 40, boc c lot bi lp bieu mo vuong hoac tru
thap, co khi lp bieu mo nay b ep det lai. Trong long boc co cha chat tiet va nhieu bot bao.
Bot bao la cac ai thc bao an chat tiet, co hnh a dien, nhan tron nho nam gia te bao, bao
tng cha nhieu khong bao nho (hnh 3).
Tr lai VK4, ben canh boc la cac tieu thuy tuyen vu cung b bien oi. Mot so ong tuyen
trong tieu thuy bat au gian rong. Mot so ong khac co tnh trang tang san bieu mo (hnh 2).
Vi VK10 va VK 40, tang san bieu mo co the ch mc o nhe (so lp te bao lot trong
long tang len hn 2 lp nhng khong qua 4 lp), hoac va (bieu mo tang san tao cau noi bac
ngang qua long ong), hoac nang (tang san lap ay long ong, cha lai nhng khoang trong
khong eu); co the thay ro cac te bao c bieu mo nam pha ngoai lp te bao bieu mo tang san
(hnh 4 va 5).
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Hnh 2: 1- Ong tuyen vu gian rong thanh boc; 2- Ong tuyen vu tang san; 3- Mo lien
ket si ac.
Hnh 3: 1- Ong tuyen vu gian rong thanh boc; 2- Te bao bieu mo b ep det; 3- Bot bao;
4- Mo lien ket si ac quanh ong tuyen vu.
104
Hnh 4: 1- Cac ong tuyen vu tang san; 2- Mo lien ket si ac quanh ong tuyen vu.
Hnh 5: 1- Cac ong tuyen vu tang san; 2- Te bao c bieu mo.
105
Mo lien ket si ac quanh cac boc va cac tieu thuy tang san len vao trong cac tieu thuy,
thay cho mo lien ket tha bnh thng cua tieu thuy. Hien tng tang sinh mo lien ket si ac
quanh ong tuyen vu nay co the thay ro khi so sanh vi cac tieu thuy vu con bnh thng nam
ngoai ton thng (hnh 6).
Hnh 6: 1- Tang sinh mo lien ket si ac quanh ong tuyen vu; 2- Tieu thuy vu bnh
thng; 3- Mo lien ket tha trong tieu thuy; 4- Ong tuyen vu trong tieu thuy.
106
CARCINOM ONG TUYEN VU XAM NHAP

Ung th vu la loai ung th ng hang au phu n Viet nam, ai a so la carcinom ong
tuyen vu, xuat phat t s chuyen dang ac tnh cua te bao bieu mo ong tuyen. Khi te bao ung th
pha v c mang ay e xam nhap vao mo em xung quanh, th carcinom ong tuyen vu a
chuyen t giai oan tai cho sang giai oan xam nhap.
ai the: Khoi u co mat cat sng lom, lam tam vang; gii han khong ro do xam nhap
vao mo xung quanh nh mo em si m, da ngc, can c (hnh 1).
Hnh 1: A- Ung th xam nhap da ngc, gay l loet; B- Khoi u co mat cat sng lom (1),
xam nhap vao mo m xung quanh (2), gay co keo da (3).
Vi the:
Muc tieu can tm:
1. Cac te bao bieu mo ac tnh, tao thanh ong va am ac xam nhap mo
em si m, khong con te bao c bieu mo.
2. Mo vu bnh thng con sot lai.
Quan sat tieu ban vi VK4, trong u khong con thay cau truc cac tieu thuy bnh thng
cua mo tuyen vu, thay vao o la cac am ac te bao bieu mo d dang, cac ong tuyen vu bat
thng, xam nhap lan toa trong mo em si va ca trong mo m (hnh 2).
Vi VK10 va VK 40, cac te bao bieu mo ac tnh co nhan to nho khong eu, tang sac
meo mo, chat nhiem sac tho, hach nhan ln; t le phan bao tang. Cac te bao ung th nay ket
thanh am ac, day hoac thanh ong tuyen nhng khong co te bao c bieu mo vien xung quanh
nh ong tuyen vu bnh thng. mot so ong con co hien tng hoai t trung tam do cac te bao
u nam gia b chet v thieu dinh dng. Quanh cac am te bao ung th, mo si tang sinh giau
si collagen do hoat ong tao si cua te bao u (hnh 3 va 4).
Trong mo vu ben ngoai khoi u, con thay mot so tieu thuy vu bnh thng hoac co bien
oi si boc (ong tuyen gian rong, cha chat tiet) (hnh 5).
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Hnh 2: Cac am ong tuyen vu ung th xam nhap mo em si m.
Hnh 3: 1- Cac am ong tuyen vu ung th xam nhap mo em si m; 2- Hoai t

trung tam; 3- Mo em si m.
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Hnh 4: 1- Cac am ac te bao ung th; 2- Phan bao; 3- Mo si tang sinh.
Hnh 5: 1- Cac am ac te bao ung th; 2- Tieu thuy vu bnh thng ngoai u.
109
U C TRN LANH TNH THAN T CUNG

La u lanh thng gap nhat t cung, lien quan vi noi tiet to estrogen. U co the khong
co trieu chng hoac gay au tran bung di, ra huyet am ao bat thng
ai the: Thng co nhieu u. U tron, chac, gii han ro, mat cat trang xam, co dang cuon,
kch thc t vai mm en 30 cm; v tr co the nam trong lp c, di noi mac t cung hoac di
thanh mac (hnh 1).
Hnh 1: 1- U c trn trong lp c, tron, gii han ro, mat cat trang, dang cuon;
2- U c trn di noi mac t cung; 3- U c trn di thanh mac.
Vi the:
Muc tieu can tm:
1. Te bao u hnh thoi, nhan bau duc xep thanh bo.
2. Te bao c trn bnh thng cua t cung b ep det.
3. Noi mac t cung tang san n gian.
Lu y: Hoc vien can on lai cau tao mo hoc cua than t cung.
Quan sat tieu ban VK4, mau mo lay t than t cung gom 1 lp noi mac t cung day
nam ta tren lp c trn. Trong lp noi mac, cac ong tuyen hi b gian rong, sap xep lon xon,
khong con nh hng song song vi nhau nh trong noi mac bnh thng ay la noi mac t
cung tang san n gian. Lp c trn ben di phan biet hai vung ro ret: mo u cau tao bi cac te
bao c trn tang san manh nen co mat o te bao cao, te bao chen chuc nhau; phan biet vi
vung mo c trn bnh thng cua lp c trn than t cung nam gia u va noi mac t cung, b ep
det tao thanh vo bao gia cua u, bat mau hong am hn (hnh 2 va 5).
Quan sat vung mo u VK10 va 40, ta thay te bao u la nhng te bao c trn tang san
manh, co hnh dang va kch thc giong nhau; te bao hnh thoi, bao tng mau hong, nhan bau
duc thuon dai vi 2 au tu, xep thanh cac bo an cheo nhau. Khong co hnh anh phan bao (hnh
3 va 4).
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Hnh 2: 1- Noi mac t cung tang san n gian; 2- Vo bao gia; 3- U c trn
Hnh 3: U tao bi cac te bao c trn tang san xep thanh bo an cheo nhau.
111
Hnh 4: Cac te bao c trn tang san hnh thoi, bao tng mau hong, nhan bau duc
thuon dai vi 2 au tu (mui ten), xep thanh cac bo an cheo nhau.
Hnh 5: 1- Cac tuyen noi mac tang san gian rong; 2- Mo em noi mac t cung.
112
U QUAI TRNG THANH BUONG TRNG

La loai u te bao mam thng gap nhat buong trng; co the xuat hien moi o tuoi. U
cau tao bi nhieu thanh phan xuat phat t ca 3 la phoi sap xep lon xon; do te bao mam biet hoa
theo hng mo trong phoi.
ai the: U co kch thc trung bnh 15 cm, dang boc, be mat lang, cha toc va chat ba.
Ben trong boc co cac not ac, cha rang va xng (hnh 1).
Hnh 1: 1- U quai trng thanh dang boc, cha toc; 2- Not ac cha rang, xng.
Vi the:
Muc tieu can tm:
Cac thanh phan mo xuat phat t 3 la phoi:
1. Ngoai b: bieu b, nang long, tuyen ba.
- Ngoai b than kinh: Mo than kinh em (te bao than kinh em, chat nen
than kinh), hach than kinh.
2. Trung b: Xng, sun, mo m
3. Noi b: bieu mo tru gia tang co long chuyen, bieu mo tuyen tiet nhay.
Lu y: Hoc vien can on lai cau tao mo hoc cua mo xng, sun, mo than kinh
em, hach than kinh.
Quan sat vi VK 4, tieu ban gom 2 lat cat, mot lat cha bieu b, nang long tuyen ba, cac
bieu mo, mo m, mo than kinh em va hach than kinh, lat kia cha xng, sun va mo than kinh
em.
Quan sat lat cat th nhat vi VK 10 va VK 40, bieu b la 1 bieu mo lat tang sng hoa, tao
ra nhieu vay sng bong rt vao trong long boc, ben di bieu mo nay co cac phc hp nang
long tuyen ba (hnh 2). mot vung khac cua lat cat, co the thay bieu mo tru gia tang co long
chuyen giong bieu mo ho hap (ben di bieu mo nay co cac am tuyen tiet nhay giong tuyen
nhay trong niem mac phe quan) va bieu mo tru n tiet nhay giong bieu mo lot ng tieu hoa
(hnh 3). Xen lan gia cac loai bieu mo, co cac am te bao m, mo than kinh em va 1 hach
than kinh. Mo than kinh em tao bi cac te bao than kinh em co nhan tron am mau giong
limpho bao; gia cac te bao nay la chat nen than kinh (neuropil), co dang li si rat manh bat
113
mau hong nhat (hnh 4). Hach than kinh la 1 cau truc hnh bau duc, tao bi cac te bao hach than
kinh vi cac te bao ve tinh bao quanh. Te bao hach than kinh co bao tng mau hong, nhan tron
sang nam chnh gia vi 1 hach nhan ln (hnh 5).
Hnh 2: 1- Bieu mo lat tang sng hoa; 2- Nang long; 3- Tuyen ba.
Hnh 3: 1- Bieu mo tru gia tang co long chuyen; 2- Tuyen tiet nhay; 3- Bieu mo tru n
tiet nhay.
114
Hnh 4: 1- Te bao than kinh em; 2- Chat nen than kinh.
Hnh 5: 1- Te bao hach than kinh; 2- am te bao m.
115
Quan sat lat cat th hai vi VK 10 va VK 40, co the thay cac be xng co b nham nh
sac canh, bat mau o; trong be xng co cac hoc nho cha te bao xng. Phan biet vi cac o
sun co b eu, bat mau xanh tm; trong o sun cung co rat nhieu hoc nho cha te bao sun (hnh
6).
Hnh 6: 1- Cac be xng, b sac canh nham nh; 2- O sun, b eu.
116
NHAU NC TOAN PHAN

La benh te bao nuoi thng gap nhat, thng c phat hien trong thang th 3 cua thai
ky do trieu chng ra huyet am ao hoac rt cac manh mo nhau nc ra ngoai.
ai the: Cac long nhau ph ai, phu ne, giong nh chum nho, kch thc t vai mm en
1,5cm; lap ay long t cung lam t cung to ra (hnh 1).
Hnh 1: A- Mo nhau nc toan phan lap ay long t cung, lam t cung to ra;
B- Cac long nhau ph ai phu ne giong chum nho.
Vi the:
Muc tieu can tm:
1. Long nhau thoai hoa nc
2. Te bao nuoi: n bao nuoi va hp bao nuoi
Quan sat tieu ban VK4, cac long nhau b thoai hoa nc, phong to, mo em phu ne,
khong co mach mau. Xung quanh long nhau la cac te bao nuoi tang san gom n bao nuoi va
hp bao nuoi (hnh 2).
Hnh 2: Cac long nhau b thoai hoa nc, phong to, khong co mach mau.
117
Quan sat cac long nhau thoai hoa nc vi VK10 va VK 40, mo em la mot xoang cha
dch, phu ne; n bao nuoi vien xung quanh cac long nhau thoai hoa nc, la nhng te bao a
dien co mot nhan tron, bao tng bat mau hong, co hat; hp bao nuoi nam canh cac long nhau
la nhng te bao ln, co nhieu nhan, bao tng bat mau hong va co nhieu khong bao nho (hnh 3
va 4).
Hnh 3:
1- Long nhau thoai hoa nc; 2- n bao nuoi.
Hnh 4:
1- Long nhau thoai hoa nc; 2- n bao nuoi; 3- Hp bao nuoi .
118
HACH TANG SAN NANG

Hach tang san phan ng la mot ton thng lanh tnh va co tnh kha hoi, do kch thch
khang nguyen lam cho mot hay nhieu thanh phan te bao cua hach tang san. Hach tang san
nang thng gap trong cac nhiem trung man tnh do tac nhan kch thch gay ap ng mien dch
dch the; hay gap vung co, nach va ben. Hach to ra nhng thng di 1,5cm, gii han ro, di
ong; rat t khi phai sinh thiet ngoai tr nhng trng hp hach ln hn 1,5 cm, e loai tr cac
ton thng ac tnh cua hach hoac viem lao hach (hnh 1).
ai the: Mot hay nhieu hach to ra, ng knh 1- 1,5cm; co vo bao, mat o mem hoac
hi chac.
Hnh 1: Hach tang san nang vung sau tai sau mot nhiem trung mui hong.
Vi the:
Muc tieu can tm:
1. Cau truc hach con nguyen ven: vung vo hach, vung tuy hach va cac
xoang bach huyet.
2. Vung vo co cac nang limpho tang san, kch thc khong eu, trung tam
mam gian rong vi s a dang te bao.
Quan sat tieu ban vi VK4, bao quanh hach la vo bao si tao bi mo lien ket ac giau
si collagen bat mau hong; nhu mo hach la phan mo limpho va cac xoang bach huyet nam pha
trong vo bao. Phan nhu mo hach nam ngay di vo bao la vung vo, cha cac nang limpho;
trung tam mau mo la vung tuy va cac mach mau cua ron hach. Trong tang san nang, cau truc
hach van con nguyen ven nhng do vung vo tang kch thc chen ep cac vung con lai; v vay
ch co vung vo la noi bat, khong thay ro vung can vo, vung tuy, va cac xoang bach huyet. Vung
vo co rat nhieu nang limpho tang san, kch thc to nho khong eu va xep thanh nhieu lp nang
(hnh 2).
Vi VK 10 va VK 40, nang limpho tang san co trung tam mam gian rong vi mot vien
limpho bao nho bao quanh. Trung tam mam co hnh anh a dang te bao do c tao bi cac
limpho bao co hnh dang va kch thc khac nhau nh nguyen tam bao ( te bao ln, nhan khong
kha, co vai hach nhan nam sat di mang nhan), tam bao ( te bao nho nhan kha, hach nhan
khong ro) va ai thc bao ( te bao ln trong nh nhng hoc sang nho v co nhieu bao tng,
trong cha cac manh v cua te bao chet c thc bao) (hnh 3).
119
Hnh 2: 1- Vo bao hach; 2- Cac nang limpho tang san kch thc khong eu, trung
tam mam gian rong; xep thanh nhieu lp nang.
Hnh 3: Nang limpho tang san: 1- Cac nguyen tam bao va tam bao; 2- ai thc bao;
3- Vien limpho bao nho.
120
HACH TANG SAN XOANG

Hach tang san phan ng la mot ton thng lanh tnh va co tnh kha hoi, do kch thch
khang nguyen lam cho mot hay nhieu thanh phan te bao cua hach tang san. Hach tang san
xoang c ac trng bi tnh trang tang so lng va kch thc cac xoang bach huyet ay mo
bao tang san, thng gap cac hach dan lu t cac khoi ung th, th du cac hach nach trong
trng hp ung th vu.
ai the: hach tang san xoang co ng knh 1- 1,5cm, con vo bao, mat o mem hoac
hi chac.
Vi the:
Muc tieu can tm:
Cac xoang bach huyet gian rong, cha nay cac mo bao tang san
Quan sat tieu ban vi VK4, bao quanh hach la vo bao si tao bi mo lien ket ac giau
si collagen bat mau hong; nhu mo hach la phan mo limpho va cac xoang bach huyet nam pha
trong vo bao. Trong tang san xoang, cau truc hach van c bao ton. Tuy nhien tang san xoang
lam cac xoang tang kch thc chen ep thu hep cac vung con lai cua nhu mo hach, v vay ay
ch thay vai nang limpho cua vung vo, chu yeu la cac xoang bach huyet gian rong vi cac dai
limpho bao nam chen gia (hnh 1).
Vi VK 10 va 40, ta thay cac xoang gian rong cha ay mo bao tang san. Mo bao la
nhng te bao co nhan tron hoac bau duc sang, hach nhan nho, bao tng nhieu, mau hong, gii
han te bao khong ro, nam chen chuc nhau trong cac xoang bach huyet (hnh 2 va 3).
Hnh 1: 1-Vo bao hach; 2- Cac xoang bach huyet gian rong; 3- Nang limpho.
121
Hnh 2: 1- Vo bao hach; 2- Vach si ngan vao trong nhu mo hach; 3- Cac xoang
bach huyet gian rong
Hnh 3: 1- Xoang bach huyet gian rong, cha ay mo bao tang san (mui ten).
122
LIMPHOM NGUYEN BAO MIEN DCH

Limphom nguyen bao mien dch la limphom khong Hodgkin xuat phat t mot nguyen
bao mien dch chuyen dang ac tnh, a so co nguon goc t te bao dong B. Thng gap tuoi
trung nien va ngi ln tuoi. Benh tien trien nhanh, tac ong vao cac hach ngoai vi hoac cac
hach nam sau trong trung that va o bung; lam hach sng to thanh khoi ln, khong au.
ai the: Hach to ra, ng knh 3 -4 cm, mat o chac, mat cat ac trn lang nh tht ca
(hnh 1).
Hnh 1: Hach to, mat cat ac trn lang nh tht ca.

Vi the:
Muc tieu can tm:
1. Cau truc hach b xoa.
2. Tham nhap lan toa cac nguyen bao mien dch (te bao ln gap 5 lan
limpho bao, nhan ln hnh bau duc, co 1-2 hach nhan to).
Quan sat tieu ban vi VK4, cau truc bnh thng cua hach bao gom cac nang limpho va
xoang bach huyet a b xoa hoan toan, thay the bang hnh anh n dang mot loai te bao tan
sinh ac tnh. Cac limpho bao ac tnh nay xam nhap vo bao va mo m quanh hach (hnh 2 va 3).
Vi VK40, limpho bao ac tnh la cac nguyen bao mien dch co nhan ln gap 5 lan limpho
bao nho bnh thng, co 1-2 hat nhan to ro nam gia nhan; co nhieu phan bao va cac phan bao
bat thng, phan anh hoat ong tang sinh manh cua te bao u (hnh 4).
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Hnh 2: Cau truc hach b xoa hoan toan, co hnh anh n dang te bao.
Hnh 3: Cac te bao limpho ac tnh xam nhap vo bao va mo m quanh hach (*)
124
Hnh 4: 1- Cac nguyen bao mien dch; 2- Phan bao.
125
LIMPHOM HODGKIN
Limphom Hodgkin la benh ly tan sinh ac tnh cua hach, ac trng bi s hien dien cua te
bao Reed-Sternberg nam tren nen te bao viem phan ng, vi tnh trang x hoa nhng mc o
khac nhau. Benh thng xay ra hai nh tuoi, 15-20 tuoi va sau 50 tuoi, gii nam nhieu hn
gii n. Benh thng tac ong vao hach co, lam hach to, chac hoac cng, di ong, khong au.
ai the: Hach to, ng knh 3- 4 cm, mat o chac hoac cng tuy mc o x hoa, mat
cat ac, co dang not (hnh 1).
Hnh 1: Hach to, mat cat ac, dang not.

Vi the:
Muc tieu can tm:
2. a dang te bao:
Te bao Reed-Sternberg:
+ Dang hai nhan (te bao R-S kinh ien ien hnh)
+ Dang mot nhan (te bao Hodgkin)
+ Dang nhieu nhan
Limpho bao.
Tng bao.
Bach cau a nhan ai toan.
3. Hien tng x hoa.
Quan sat vi VK4, ta thay cau truc bnh thng cua hach a b xoa hoan toan, khong
con nhn thay c vung vo, vung can vo, vung tuy va cac xoang bach huyet. (hnh 2)
Vi VK10 va 40, nhu mo hach b thay the bi cac te bao tan sinh ac tnh nam tren nen
nhieu te bao viem phan ng tao nen hnh anh a dang te bao. Hien tng x hoa tao nen cac
dai si collagen nam chen gia cac am te bao trong nhu mo hach (hnh 3).
Thanh phan tan sinh ac tnh la cac te bao Reed-Sternberg (R-S), chiem khong qua 10%
the tch u, gom: Te bao R-S kinh ien ien hnh la nhng te bao co kch thc ln (20-50m),
bao tng nhieu mau hong nhat, co 2 nhan hoac 2 thuy nhan nam oi xng nhau; gia moi
nhan co mot hach nhan tron ln, ai toan; tao nen hnh anh mat cu; te bao R-S kinh ien dang
nhieu nhan co nhan gom 3-4 thuy, moi thuy cung co mot hach nhan tron ln va ai toan; te bao
R-S bien the dang mot nhan (con goi la te bao Hodgkin) cung co cac ac iem tng t, nhng
nhan ch co mot thuy vi mot hach nhan ln ai toan (hnh 4 va 5).
126
Thanh phan te bao viem phan ng gom cac limpho bao, tng bao, bach cau a nhan ai
toan nam xen nhng te bao tan sinh ac tnh (hnh 3, 4 va 5).
Hnh 2: Cau truc hach b xoa hoan toan.
Hnh 3: Hnh anh a dang te bao: 1- Te bao R-S kinh ien ien hnh; 2- Limpho bao;
3- Bach cau ai toan; 4- Tng bao; 5- Phan bao; 6- Si collagen.
127
Hnh 4: 1- Te bao R-S kinh ien ien hnh; 2- Limpho bao.
Hnh 5: 1- Te bao R-S kinh ien nhieu nhan; 2- Te bao R-S dang 1 nhan; 3- Bach
cau ai toan; 4- Si collagen.
128
DANH SACH CAC MUC TIEU THC TAP GIAI PHAU BENH
***********

1. Cac am tinh the urat lang ong ngoai bao
2. Cac te bao cua phan ng viem man tnh xung quanh am urat: ai thc bao, limpho bao,
ai bao an d vat
3. Phan ng hoa si: nguyen bao si, si collagen
1. ai thc bao ong carbon, tap trung trong cac xoang bach huyet cua hach (xoang di vo,
xoang quanh nang, xoang tuy).
2. Nang limpho th cap trong vung vo hach.
1. Bieu mo tru n cua vung lo tuyen co trong CTC.
2. Bieu mo chuyen san gai.
4. Nghch san nang carcinom tai cho CTC
1. Bieu mo lat tang cua co ngoai co t cung : lp ay, cac lp trung gian, lp be mat.
2. Ton thng nghch san nang: hng sap xep cua cac lp te bao trung gian thang goc vi mang
ay, te bao co hnh dang va kch thc thay oi khac nhau, nhan tang sac meo mo, phan bao
tang va khong con gii han lp ay, nhng lp te bao be mat van co nhan det giong bieu mo
lat tang bnh thng.
3. Carcinom tai cho : hnh anh nghch san chiem toan bo chieu day cua bieu mo, lp te bao be
mat co nhan tang sac meo mo.
1. Hien tng sung huyet
2 . Hien tng phu viem:
- Dch xuat thanh huyet
- Dch xuat xuat huyet
- Dch xuat t huyet
- Dch xuat mu
3. Hien tng tham nhap bach cau a nhan
4. Hien tng hoai t niem mac
1. Hien tng tham nhap te bao n nhan :
- Limpho bao
- Tng bao
- ai thc bao
2. Hien tng tang sinh mo lien ket - mach mau
- Nguyen bao si
- Mach mau tan sinh
7. Viem lao hach
1. Nang lao:
- Te bao dang bieu mo
- ai bao Langhans
- Chat hoai t ba au
- Vien limpho bao va tng bao
2. Mo limpho bnh thng con lai cua hach
129
8. Seo loi
1. Nguyen bao si
2. Cac bo si collagen tang sinh
3. Cac bo si hyalin hoa
1. Hien tng tang san te bao nang giap: nang giap nho, te bao nang hnh tru thap, tang sinh tao
nhu.
2. Hien tng thoai hoa boc: nang giap gian rong ay chat keo,te bao nang det.
3. Hien tng xuat huyet, lang ong tinh the cholesterol, ai thc bao ong hemosiderin.
4. Mo em tham nhap limpho bao, tang sinh mo si.
1. Tang san ong tuyen
2. The amylacea
3. Tang san mo em si - c trn
11. Nevi noi b
1. Cac nevi bao xep thanh am nam trong lp b.
2. Cac am nevi bao ong sac to melanin lp b nong.
3. Cac am nevi bao biet hoa thanh cau truc giong the Meissner.
4. Phan phu da bnh thng: nang long, tuyen ba, tuyen mo hoi.
12. U nhu da
1. Nhu bieu b
2. Bieu b tang san
- Hien tng tang gai
- Hien tng tang sng
3. Truc lien ket mach mau
13. U m
1. Cac te bao u co hnh dang giong te bao m trng thanh.
2. Cac te bao si va cac dai si collagen
3. Vo bao si mong
1. Cac mach mau gian rong, dang hang, cha ay mau, lot bi te bao noi mo det.
2. Tieu thuy gan bnh thung; tham nhap te bao viem man tnh trong khoang ca.
1. am te bao gai ung th xam nhap mo em.
2. Carcinom te bao gai biet hoa tot: tao cau sng, cau lien bao.
1. am te bao gai ung th biet hoa va, xam nhap pha huy nhu mo hach.
3. Nhu mo hach con sot lai.
1. am te bao ay ung th
2. Hien tng xep hang rao
3. Thoai hoa boc
4. Sac to melanin
5. Cac phan phu bnh thng cua da : nang long, tuyen ba, tuyen mo hoi
18. Carcinom Te bao gai khong sng hoa CTC
1. Cac am te bao gai d dang xam nhap mo em.
2. Cau lien bao.
3. Tuyen co trong bnh thng.
130
1. Bieu mo tuyen ruot tang san va nghch san phan au polyp.
2. Niem mac ruot bnh thng phan cuong polyp va thanh ruot bnh thng quanh u.
3. Loi si cua cuong polyp.
1. am tuyen ung th xam nhap
2. Tuyen Lieberkhn bnh thng
1. am tuyen ung th xam nhap trong mo hach.
2. Hien tng hoai t u.
3. Mo hach bnh thng con sot lai.
1. am te bao tuyen ung th xam nhap mo gan.
2. Hoai t trung tam.
3. Tieu thuy gan bnh thng.
1. am te bao tuyen ung th xam nhap trong nhu mo phoi.
2. Nhu mo phoi bnh thng: tieu phe quan ho hap, phe nang, ai thc bao phe nang.
24. X gan
1. Not te bao gan tai tao (Tieu thuy gia).
2. Te bao gan thoai hoa m, te bao gan thoai hoa nc.
3. Te bao gan tang san.
4. Ong mat gia va ong mat that.
5. Tang san mo si va tham nhap te bao viem.
1. Te bao gan ung th xep thanh be hoac cau truc tuyen
2. Mat
3. Cac be gan bnh thng
26. Carcinom tuyen da day dang mat nhan
Cac te bao ung th dang mat nhan xam nhap cac lp thanh da day.
27. Carcinom tuyen dang mat nhan di can hach
1. Te bao ung th dang mat nhan xam nhap xoang di vo va xoang quanh nang.
2. Nhu mo hach bnh thng con sot lai.
1. am te bao gai ung th biet hoa va xam nhap nhu mo phoi.
3. Nhu mo phoi quanh u b viem, xuat huyet, x hoa.
1. Te bao ung th hnh vuong hoac tru, nhan tang sac, d dang; mot so te bao co khong bao tiet
nhay cc nh.
2. Te bao ung th: lot vach phe nang, tao nhu.
3. Mot so am te bao ung th rt vao long phe nang.
1. Te bao ung th co nhan sang, bau duc, chong chat len nhau.
2. Tang san tao nhu phan nhanh, co truc lien ket mach mau.
3. The psammoma trong mo em.
131
1. Te bao ung th hnh tron hoac hnh a dien, nhan chnh gia, bao tng nhieu va sang, xep
thanh be hoac ong.
2. Nhu mo than bnh thng: cau than va ong than.
32. Sarcom si
1. Cac te bao u hnh thoi, tao thanh cac bo an cheo nhau (hnh xng ca)
2. Cac hnh anh phan bao.
1. Cac am te bao c trn ac tnh, nhan d dang, co khuynh hng tao bo
2. Mo gan bnh thng
34. Sarcom xng
1. Te bao ung th a dang, d dang.
2. Chat dang xng.
3. Manh xng chet.
4. ai bao nhieu nhan (giong huy cot bao).
35. U si tuyen vu
1. Tang sinh mo lien ket tha quanh cac ong tuyen vu.
2. Ong tuyen vu tang san, mot so b keo dan, ep det.
3. Bieu mo ong tuyen vu gom hai loai te bao: te bao bieu mo va te bao c bieu mo.
4. Vo bao si quanh u.
1. Ong tuyen dan rong thanh boc, bieu mo lot b ep det.
2. Mot so ong tuyen vu co bieu mo tang san nhieu lp, tao nhu; van con thay ro te bao c bieu
mo.
3. Tang sinh mo lien ket si ac quanh ong tuyen vu.
37. Carcinom ong tuyen vu xam nhap
1. Cac te bao bieu mo ac tnh, tao thanh ong va am ac xam nhap mo em si m, khong con te
bao c bieu mo.
2. Mo vu bnh thng con sot lai.
38. U c trn lanh tnh than t cung
1. Te bao u hnh thoi, nhan bau duc xep thanh bo.
2. Te bao c trn bnh thng cua t cung b ep det.
3. Noi mac t cung tang san n gian.
Cac thanh phan mo xuat phat t 3 la phoi:
1. Ngoai b: bieu b, nang long, tuyen ba.
- Ngoai b than kinh: Mo than kinh em (te bao than kinh em, chat nen than kinh),
hach than kinh.
2. Trung b: Xng, sun, mo m
3. Noi b: bieu mo tru gia tang co long chuyen, bieu mo tuyen tiet nhay.
40. Nhau nc toan phan
1. Long nhau thoai hoa nc
2. Te bao nuoi: n bao nuoi va hp bao nuoi
41. Hach tang san nang
1. Cau truc hach con nguyen ven: vung vo hach, vung tuy hach va cac xoang bach huyet.
2. Vung vo co cac nang limpho tang san, kch thc khong eu, trung tam mam gian rong vi s
a dang te bao.
132
Cac xoang bach huyet gian rong, cha nay cac mo bao tang san
43. Limphom nguyen bao mien dch
2. Tham nhap lan toa cac nguyen bao mien dch (te bao ln gap 5 lan limpho bao, nhan ln hnh
bau duc, co 1-2 hach nhan to).
44. Limphom Hodgkin
2. a dang te bao:
Te bao Reed-Sternberg:
+ Dang hai nhan (te bao R-S kinh ien ien hnh)
+ Dang mot nhan (te bao Hodgkin)
+ Dang nhieu nhan
Limpho bao.
Tng bao.
Bach cau a nhan ai toan.
3. Hien tng x hoa.

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Chu nhiem bo mon :

Gs.Ts.Bs. NGUYEN SAO TRUNG

LCH GIANG THC TAP GIAI PHAU BENH Y2008A

BAI THC TAP

1. Not Tophi benh Gut

2. Hach nhiem carbon

25. Carcinom te bao gan

28. Carcinom TB gai phoi

29. Carcinom tieu phe quan phe nang

33. Sarcom c trn di can gan

Thi gian thc tap:

36. Bien oi si boc tuyen vu

THI THC TAP GPB ngay 16/06/2011 luc 14g

LCH GIANG THC TAP GIAI PHAU BENH Y2008B

BAI THC TAP

1. Not Tophi benh Gut

2. Hach nhiem carbon

25. Carcinom te bao gan

28. Carcinom TB gai phoi

29. Carcinom tieu phe quan phe nang

33. Sarcom c trn di can gan

Thi gian thc tap:

36. Bien oi si boc tuyen vu

S1: 07g30- 09g

THI THC TAP GPB ngay 17/06/2011 luc 14g

NOT TOPHI BENH GUT

Hnh 1: Not tophi quanh cac khp ngon tay

Hnh 4: 1- Urat; 2- ai bao an d vat; 3 -Nguyen bao si ; 4- Si collagen;

HACH NHIEM CARBON

Hnh 3: 1. Vo bao si; 2. Cac ai thc bao ong carbon.

CHUYEN SAN GAI CO T CUNG

Hnh 4: 1- Te bao tru n b ay len be mat; 2- Te bao tru n a bong troc;

NGHCH SAN NANG CARCINOM TAI CHO CO T CUNG (CIN 3)

VIEM RUOT THA CAP TNH

Hnh 3: 1- Nang limpho trong lp di niem mac; 2- Dch xuat t huyet.

VIEM LOET DA MAN TNH

Hnh 1: O viem loet da man tnh.

VIEM LAO HACH

Hnh 1: Seo loi go cao va co mau sac am hn da xung quanh

Hnh 2: 1- Bieu b teo mong; 2- Cac bo si collagen.

Hnh 3: Cac bo si collagen tang sinh. 1- Nguyen bao si; 2- Si collagen.

Hnh 4: 1- Bo si collagen tang sinh; 2- Bo si hyalin hoa.

TANG SAN CUC TUYEN GIAP ( PHNH GIAP LE TE)

Hnh 1: Tuyen giap phnh to, co nhieu cuc.

TANG SAN CUC TUYEN TIEN LIET

Hnh 1: Cac cuc tang san chen ep nieu ao chnh gia.

Hnh 2: 1- Bieu b; 2- am nevi bao ong melanin; 3- am nevi khong ong

Hnh 3: 1- Hac to bao trong lp ay bieu b; 2- am nevi bao trong lp b nong

Hnh 5: A. 1- Nang long; 2- Tuyen ba.

Hnh 2: 1- Tieu thuy m; 2- Vach si

Hnh 3: 1- Nguyen bao si; 2- Si collagen; 3- Te bao m co nhan b ep det.

U LANH MACH MAU DANG HANG GAN

CARCINOM TE BAO GAI CUA DA

Hnh 3: 1- Cau sng; 2- am te bao gai ung th.

CARCINOM TE BAO GAI DI CAN HACH

Hnh 2: 1- Vo bao hach; 2- Mo m quanh hach; 3- Nang limpho th cap;

CARCINOM TE BAO AY CUA DA

CARCINOM TE BAO GAI KHONG SNG HOA CO T CUNG

U TUYEN ONG RUOT GIA

CARCINOM TUYEN RUOT GIA XAM NHAP

Hnh 4: 1- Cac am tuyen ung th; 2- Lp c trn thanh ruot.

CARCINOM TUYEN RUOT GIA DI CAN HACH

Hnh 5: 1- Cac am tuyen ung th; 2- Chat hoai t; 3- Mo si.