肿瘤病理学课精要.ppt

肿瘤病理学 Pathology of Neoplasia 基础医学研究所病理生物学研究室 陆应麟 Introduction: Inflammatory, Degenerative Neoplastic Growth – Increase in size due to synthesis of tissue components. Proliferatation- Cell division. Differentiation: functional and structural maturity of cells. Tumor – Swelling / new growth / mass Controls of Growth: Cytokines: Cyclins, Cyclin dependent kinases (CDK). Growth factors – PDGF, FGF Growth Inhibitors. Cancer suppressor genes – p53 Oncogenes – c-onc, p-onc, v-onc etc. Non-Neoplastic Proliferation: *Controlled Reversible Hypertrophy 肥大 – Size Hyperplasia 增生– Number Metaplasia 化生– Change Dysplasia 异常增生– Disordered Neoplasia: Progressive, Purposeless, Pathologic, Proliferation of cells characterized by loss of control over cell division. DNA damage at growth control genes is central to development of neoplasm. Carcinogens – Chemical, physical genetic ? DNA damage ? Neoplasm. Pathogenesis of Neoplasia: Normal ? Hyperplasia ? Metaplasia化生 ?(DNA damage) ? Dysplasia 异常增生 ? (DNA damage) ? (DNA damage) Anaplasia 间变? (DNA damage) Infiltration 浸润? (DNA damage) ? Metastasis转移…. Progressive DNA Damage – features of neoplasia. Pathogenesis of Neoplasia: Non lethal DNA Damage leading to uncontrolled cell division. 病理 恶性肿瘤的发生发展过程 一般致癌因素作用30~40年，经10年左右的癌前阶段恶变为原位癌。 原位癌历时3~5年，在促癌因素作用下发展成浸润癌。 浸润癌的病程一般1年左右。 2.肿瘤细胞的分化分为高分化、中分化、低（未）分化。组织化学的变化：(1)核酸增多(2)酶的改变(3)糖原减少 3. 生长方式： 4. 生长速度： 良性肿瘤：外生性生长 良性肿瘤生长慢 恶性肿瘤：浸润性生长 恶性肿瘤生长快 Normal Adaptation Benign Malignant Structure of Neoplasm: Neoplastic cells parenchyma. Non-neoplastic - stroma (Connective tissue BV) Fast growth ? less stroma Less stroma ? more necrosis, Biology of Neoplasm: Cell of origin Rate of growth Differentiation Local Invasion Metastasis Lung cancer Grade - low, high Well, Mod, P, Un. Staging Staging Benign Malignant: Slow growing, capsulated, Non-invasive do not metastasize, well differentiated, suffix “oma” eg. Fibroma. F