培训课件-女性生殖系统疾病.pptVIP

（四）转移途径 直接蔓延：累及相应乳腺实质、乳头、皮肤、脂肪组织、筋膜、胸肌及胸壁其他结构。 淋巴结转移：约2/3浸润癌的病例在确诊时已发生局部淋巴结转移。外侧象限和乳腺中央区的肿瘤常转移至同侧腋窝淋巴结；内侧象限的肿瘤则沿着乳内动脉旁淋巴结转移；晚期转移至锁骨上淋巴结。 血道转移：常以肺、骨、肝、和脑等为多见。 乳腺癌转移途径 （五）乳腺癌与雌、孕激素受体 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）和孕激素受体（PR）。当细胞癌变时，ER和PR可以部分或全部保留，也可以部分或全部丢失。 目前可通过生化方法或免疫组化方法检测ER和PR。 检测ER、 PR的临床意义： ①估计乳腺癌的预后；大量资料表明： ER、 PR阳性的乳腺癌患者的预后较阴性者好，缓解率高，复发少。 ②合理进行内分泌治疗的依据。内分泌治疗只运用于激素依赖性乳腺癌病例。目前检测ER、 PR已成为乳腺癌患者治疗前必须进行的一项常规检查。 ER阳性 c-erbB-2 overexpression 谢 谢 * The normal cervical squamous epithelium at the left transforms to dysplastic changes on the right. There is also underlying chronic inflammation because abnormal epithelial surfaces do not provide the same protective barrier as normal epithelial surfaces do. * This is cervical squamous dysplasia at high magnification extending from the center to the right. The epithelium is normal at the left. Note how the dysplastic cell nuclei are larger and darker, and the dysplastic cells have a disorderly arrangement. * This is the gross appearance of a cervical squamous cell carcinoma that is still limited to the cervix (stage I). The tumor is a fungating red to tan to yellow mass. * Here is another cervical squamous cell carcinoma. Note the IUD string protruding from the cervix. This implies that someone could have done a Pap smear when it was inserted. There is a natural history of progression of dysplasia to carcinoma, so dont leave dysplasias alone. * This is a larger cervical squamous cell carcinoma which spread to the vagina. A total abdominal hysterectomy with bilateral salpingo-oopherectomy (TAH-BSO) was performed. * This is a pelvic exenteration done for stage IV cervical carcinoma. At the left, dark vulvar skin leads to vagina and to cervix in the center, where an irregular tan tumor mass is seen infiltrating upward to the bladder. A slit-like endometrial cavity is surrounded by myometrium at the mid-right. The rectum and sigmoid colon are at the bottom extending to the right. * This is another pelvic exenterati