Epidemiology 242 Cancer Epidemiology流行病学242肿瘤流行病学.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * Classification of Tumor according to its differentiation (grade) Grade of Disease Grading is histo-pathologic evaluation of the lesion based on the degree of cellular differentiation and nuclear features: ? Well Differentiated (Grade I) – more resemble to normal tissue/cell Moderately differentiated (Grade II) - less resemblance of normal tissue/cell Undifferentiated (Grade III) - lost resemblance to normal tissue/cell Gleasons breakthrough was to develop a reproducible description of the glandular architecture, to which one assigns a score from 1 to 5. The pathologist looks for a major pattern and a minor pattern to give a Gleason sum between 2 and 10. On the left is a picture adapted from Gleasons 1977 article demonstrating the changes in gland pattern as one goes from grade 1 to grade 5 cancer. The glands in grade 1 cancer are small and round. Grade 5 cancer is hardly forming glands at all. Benign Prostate: Hyperplasia ????????????????????????????????????????????? Gleason Grade 1 Prostate Cancer ????????????????????????????????????????????? ????????????????????????????????????????????? ????????????????????????????????????????????? ????????????????????????????????????????????? Gleason Grade 1 Prostate Cancer ????????????????????????????????????????????? At right is Gleason 3 CaP. The glands are irregularly shaped. They are mixed in with some normal glands. This tumor is infiltrating the prostate. ????????????????????????????????????????????? At higher magnification, there are nests of glands with no intervening stroma. This is characteristic of higher grade CaP ????????????????????????????????????????????? ?The cells are not organized into glands, but are infiltrating the prostate as cords. ???????????????????????????????????????????? Here is Gleason 5, or poorly differentiated cancer. You can see that it is invading the seminal vesicle (stage T4) Precursors from intr