第12章 生殖系统和乳腺疾病2-乳腺、前列腺疾病.pptVIP

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 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 前列腺增生症 Prostatic hyperplasia Prostatic Hyperplasia Prostate Cancer Prostatitis 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 ? 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 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 Note the nodule filled with enlarged glands. Though crowded, there is still stroma between the glands. Note that the columnar arrangement of cells near the gland lumina is preserved. Note several pink amylacea in gland lumens. Lobular clusters of glands with cribriform architecture.? The glandular clusters have punched out lumens. 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 病理诊断：？ 乳腺浸润性导管癌 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. 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) 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 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）　 A normal duct cells B ductal cancer cells breaking through the basement membrane C basement membrane 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 Here is a classic infiltrating（浸润的） ductal carcinoma 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 a