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PHIẾU THU THẬP THÔNG TIN NGHIÊN CỨU

Code: Ngày ST: Loại ST: ST kim □ Mổ □ Tên bệnh nhân: Tuổi: Giới:

1. Ung thư biểu mô tế bào gan

1.1. ChỈ số AFP huyết thanh:

<20 mg/l □ 20-200mg/l □ >200-400 mg/l □ >400 mg/l □

1.2. Viêm gan B: có □ không □

1.3. Viêm gan C: có □ không □

1.4. Viêm gan đồng nhiễm: có □ không □

1.5. Số lượng u: 1 khối □ nhiều khối: □

1.6. Kích thước u: < 2cm □ 2-5cm □ > 5cm □

1.7. Típ mô bệnh học: Bè □ tuyến nang □ đặc □

1.8. Típ đặc biệt:

UTBMTBG thể xơ lát □

UTBMTBG xơ cứng, □
UTBM không biệt hóa, □	UTBM giống u lympho biểu mô □
UTBMTBG dạng sarcom □	Khác □

Tế bào sáng □
Biến đổi mỡ □	Chế tiết mật □
Thể hyaline □	Thể nhạt màu □
Thể vùi kính mờ □

Arginase 1: dương □ âm □
CD34: dương □ âm □	GP3: dương □ âm □
GS: dương □ âm □	HSP70: dương □ âm □
CK7: dương □ âm □	CK19: dương □ âm □