医学课件生殖系统和乳腺疾病乳腺前列腺疾病.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二层,第三层,第四层,第五层,*,*,*,Content,*,Carcinoma of breast,;,Prostatic hyperplasia,12/3/2025,1,乳 腺 癌,C,arcinoma of breast,12/3/2025,2,小导管,乳房晕,小叶,12/3/2025,3,A,normal duct cells,B,basement membrane,C,lumen(center of duct),腺泡,腔,12/3/2025,4,12/3/2025,5,12/3/2025,6,导管双层上皮,内腺上皮，外肌上皮,Normal lobule of,mammary gland,乳腺,12/3/2025,7,全球每年120万妇女患乳腺癌，50万死于该病,北美、北欧高,我国3%/年，“,第一癌症杀手,”,40-60岁女性，男性罕见1%,乳腺,外上象限,中央区,内上象限,来自,乳腺终末导管小叶单元上皮,Introduction,12/3/2025,8,ER、PR(+)：,内分泌治疗好，预后好,C-erbB-2(+),ER(-):,预后差,乳腺是女性激素的靶器官,正常乳腺上皮细胞存在,雌激素受体（ER）,孕激素受体（PR）,ER、PR启动细胞分裂,促乳癌生长,12/3/2025,9,The cells of this breast carcinoma are highly,positive for estrogen receptor,with this immunoperoxidase stain.Estrogen receptor positivity correlates with a,better prognosis,（预后）,.,12/3/2025,10,This is progesterone receptor(PR)positivity in a breast carcinoma.The usefulness of this determination is not as well established as for estrogen receptors.Carcinomas that are PR positive,but not ER positive,may have a worse prognosis.,12/3/2025,11,分类：,乳腺癌,非浸润性癌,浸润性癌,导管内,原位癌,小叶,原位癌,粉刺癌,非粉刺导管内癌,乳头,Paget病,浸润性,导管,癌,浸润性,小叶,癌,特殊类型癌,小管癌,、,乳头Paget病,伴导管浸润癌,典型髓样癌,粘液癌,12/3/2025,12,属于,原位癌,没有突破,导管和腺泡的,基底膜,分类,:,导管内原位癌,小叶原位癌,一、非浸润性癌,12/3/2025,13,1导管内原位癌,（Intraductal carcinoma in situ）,起于,乳腺小叶的终末导管,限于导管内,基膜完整,检出率,，5%15%30%,组织学:,粉刺型,非粉刺型,20年，30%浸润癌,12/3/2025,14,A,normal duct cells,B,ductal cancer cells,C,basement membrane,D,lumen(center of duct),12/3/2025,15,Intraductal carcinoma.The neoplastic,（肿瘤的）,cells are confined to the duct by the basement membrane.The neoplastic cells are monotonous with round to oval nuclei and little pleomorphism.The cell borders are well demarcated,（区分）,.,12/3/2025,16,（1）粉刺癌,（Comedocarcinoma）,50%,位于乳腺中央部,质硬、肿块明显，易触诊,查出,导管扩张，内含坏死物质,挤压导管,坏死物质会像,粉刺,一样被挤出,12/3/2025,17,镜下,:,实性排列，中央坏死特征,癌细胞大，嗜酸，大小不一，核仁明显，,病理性,核分裂多,坏死区常见钙化,导管周间质纤维组织，慢性炎C浸润,12/3/2025,18,Comedocarcinoma,is characterized by the presence of,rapidly proliferating,high-grade malignant cells.,The cells in the center of the ducts are often,necrotic and calcify,.This central necrosis leads to the gross characteristic of,extrusion of cheesy material from the ducts with pressure,.,12/3/2025,19,12/3/2025,20,Comedocarcinoma,Note central necrosis(*)and pleomorphic nuclei.The cells do not extend,beyond the basement membrane(arrow).,12/3/2025,21,The center of the duct contains calcified material surrounded by necrotic,mostly acellular debris.The neoplastic cells exhibit nuclear pleomorphism and hyperchromasia.The basement membrane is intact,12/3/2025,22,(2)非粉刺型导管内癌,（Noncomedo intraductal carcinoma）,实性、,（微）,乳头状、筛状排列，,轻微坏死,癌细胞小，较规则,导管周间质纤维组织增生较轻,12/3/2025,23,12/3/2025,24,12/3/2025,25,12/3/2025,26,12/3/2025,27,2.小叶原位癌,（Lobular carcinoma in situ）,来自,小叶的终末导管及腺泡,癌细胞,局限于管泡内，未穿破其基底膜，,小叶结构存在,多中心性，常累及双侧，,无,明显肿块,（弥散）,癌细胞,实性排列，小而一致,，核圆，核分,裂罕见,癌细胞,无,坏死，,无,间质的炎症反应、纤维,组织增生,12/3/2025,28,A,normal lobular cells,B,lobular cancer cells,C,basement membrane,12/3/2025,29,12/3/2025,30,Lobular carcinoma in situ consists of a neoplastic proliferation,（增殖）,of cells in the terminal breast ducts and acini.The cells are small and round.There is a 30%risk for development of invasive carcinoma in the same or the opposite breast.,12/3/2025,31,12/3/2025,32,12/3/2025,33,导管内癌,乳头、乳晕,乳头、乳晕可见渗出、浅表溃疡,又称,“湿疹样癌”,表皮内：,瘤细胞孤立散在、成簇分布,大而异型，胞质透明,3.佩吉特病,（Paget disease),12/3/2025,34,12/3/2025,35,12/3/2025,36,12/3/2025,37,12/3/2025,38,癌细胞,穿破,乳腺导管或腺泡的,基底膜,而,侵入间质,占乳腺癌,85%,分类：,浸润性导管癌,和,浸润性小叶癌,两种类型可并存，占,10%,，浸润性小叶癌的预后较差,二、浸润性癌,12/3/2025,39,导管内癌细胞突破管壁基底膜向,间质浸润,最常见（70%）,1.浸润性导管癌,（Invasive ductal carcinoma）,12/3/2025,40,A,normal duct cells,B,ductal cancer cells,breaking through the,basement membrane,C,basement membrane,12/3/2025,41,大体,：,色灰白，质硬，无包膜,界不清，活动度差,浸润性生长,乳头下陷，,橘皮样外观,Pathological changes,12/3/2025,42,Here is a classic infiltrating,（浸润的）,ductal carcinoma,12/3/2025,43,This infiltrating ductal carcinoma of the breast is definitely infiltrating the surrounding breast.The central white area is very,hard,and,gritty,because the neoplasm is producing a desmoplastic reaction with lots of collagen.This is often called a,scirrhous,appearance.,12/3/2025,44,镜下,：,巢状、团索状、腺样，可见导管,内原位癌,癌细胞,异型明显,，核分裂多,伴坏死、纤维组织增生,单纯癌、硬癌、不典型髓样癌,12/3/2025,45,Cords and nests of cells irregularly invade the tissue.Reactive fiborsis(the desmoplastic reaction)surrounds tumor cells(arrows).,12/3/2025,46,In the center is a duct lined by carcinoma cells.However,this ductal carcinoma is not confined to just the duct,but infiltrates outward into the surrounding stroma as an infiltrating ductal carcinoma,12/3/2025,47,The pleomorphism of the carcinoma cells within the duct in the center(in a cribriform pattern),as well as the neoplastic cells infiltrating through the stroma and fat,can be seen with this infiltrating ductal carcinoma.,12/3/2025,48,The infiltrating ductal carcinoma of breast has pleomorphic cells infiltrating through the stroma.,12/3/2025,49,The blue arrows surround,a nest of neoplastic cells,in an infiltrating ductal carcinoma.The green arrowheads point to,intervening stroma.Mitotic figures,are seen.,12/3/2025,50,This higher magnification shows well differentiated,duct-like structures,infiltrating the stroma of the breast.,12/3/2025,51,Small,duct-like structures,are seen invading the breast stroma.Some tumor cells are single.Note the,abundant collagenous stroma,characteristic of breast carcinomas.,12/3/2025,52,Scirrhous,（硬的）,carcinoma of the breast,12/3/2025,53,5%,10%,，,老年妇女多见,癌细胞,突破,基底膜向间质浸润,约,20%,可累及双侧乳房,，,弥漫性多灶,性分布,，不易发现,2.浸润性小叶癌,（Invasive lobular carcinoma）,12/3/2025,54,A,normal cells,B,lobular cancer cells,breaking through the,basement membrane,C,basement membrane,12/3/2025,55,*,橡皮样,，灰白柔,韧,，边界不清,*,转移特殊性,：脑脊液、浆膜面、卵巢、,子宫、骨髓,肉眼,：,12/3/2025,56,串珠状,（列兵样排列）,、细条索或环形,排列正常导管周围,癌细胞,小、大小一致,、,核分裂象少见,镜下,：,12/3/2025,57,This is a closer view of linear arrays of lobular carcinoma cells infiltrating through dense fibrous stroma.,12/3/2025,58,Invasive lobular carcinoma,12/3/2025,59,The neoplastic,cells are notable for eccentric nuclei set into mucin rich cytoplasm.The nuclei are hyperchromatic and round to oval.No pleomorphism or mitoses are seen.The stroma is very dense with accellular collagen.,12/3/2025,60,Single strands of malignant cells infiltrating the stroma,(Indian filing).,12/3/2025,61,3.特殊型癌,具有特殊形态，如粘液癌、大汗腺样癌、,小管癌、,腺样囊性癌、鳞状细胞癌、炎性癌,12/3/2025,62,12/3/2025,63,12/3/2025,64,12/3/2025,65,直接浸润,：乳腺实质、乳头、皮肤、筋膜、,胸肌及胸壁,淋巴结转移,：,外上、外下象限和中心区,同侧腋窝淋巴结,内上、内下象限,乳内动脉旁淋巴结,血行转移,：,远处任何器官,转移途径,12/3/2025,66,前列腺增生症,Prostatic hyperplasia,12/3/2025,67,12/3/2025,68,12/3/2025,69,12/3/2025,70,Prostatic Hyperplasia,Prostate Cancer,Prostatitis,12/3/2025,71,Introduction,主要特点：,腺体、间质均增生,与激素平衡失调有关,临床表现：,尿道梗阻、尿流不畅,50岁，随着年龄增长增加,12/3/2025,72,核桃或鸡蛋大，表面光滑，结节状,以腺体增生为主,:,淡黄、质软、切面大小不等,蜂窝状腔隙，轻压有奶白色液溢出,以纤维平滑肌增生为主,:,苍白，,质韧，界不清,肉眼,：,Pathological changes,12/3/2025,73,12/3/2025,74,镜下,：,增生成分,:,腺体、纤维组织、平滑肌,腺体数目，腺腔囊性扩张，上皮细,胞,双层,排列，腺腔内可见,淀粉小体,可见鳞状上皮化生和小灶性梗死,12/3/2025,75,Note the nodule filled with,enlarged glands,.Though crowded,there is still,stroma,between the glands.,12/3/2025,76,Note that the columnar arrangement of cells near the gland lumina is preserved.Note several,pink amylacea in gland lumens.,12/3/2025,77,Lobular clusters of glands,with cribriform architecture.,12/3/2025,78,The glandular clusters have,punched out lumens.,12/3/2025,79,病例分析：,王某，女，,53岁,，发现乳腺肿物一周，肿物位于乳腺外上限，固定，,活动性差,，体查见乳头周围皮肤呈,桔皮样外观,。活检组织灰白，质硬，镜下见,癌细胞巢状、团索状、腺样等排列，细胞,异型明显，核分裂多,12/3/2025,80,病理诊断：？,乳腺浸润性导管癌,12/3/2025,81,