肿瘤病理学(2013.10.25).pptVIP

病例分析 ＸＸＸ，女，21岁 主诉：近半年左下肢膝关节附近疼痛，活动后加重，一个月前发现左股骨下端局部隆起，逐渐长大，疼痛难忍，来诊。 查体：左股骨下端局部肿物，压痛（＋） 处置：1.左股骨下端X线正侧位像2. 胸部X线正侧位像3. 左股骨下端肿物穿刺活检 检查结果 1.左股骨下端X线正侧位像： 左股骨下端占位性病变，骨皮质 破坏并有骨膜反应。 2.胸部X线正侧位像： 未见明显异常 临床诊断：恶性骨肿瘤？ 活检病理诊断：骨肉瘤 治疗原则 1.手术切除 2.化疗 3.放疗 4.支持疗法 Definitions Differetiation extend of gland （2）cellular atypia 1) Pleomorphism of cell：shape， size 2)Pleomorphism of nuclear :shape, size Abnormal mitoses 3) the changes of the cytoplasm Mitotic figure Mitotic figure Characteristics of benign and malignant neoplasms Characteristics of benign and malignant neoplasms Tumor emboli in the lymphatic channel Grading and staging of cancerGrading of a cancer is based on the degree of differentiation of the tumor cells and the number of mitoses within the tumor as presumed correlates of the neoplasms aggressiveness. Thus, cancers are classified as grades I to IV with increasing anaplasia. 高 分 化 鳞 癌 （Ⅰ级） 低 分 化 鳞 癌（ Ⅲ级） Cancer Epidemiology Cancer Incidence Geographic and environmental factors Age Heredity Acquired preneoplastic disorders Clinical features of neoplasia Ultimately the importance of neoplasms lies in their effects on people. The following discussion considers: Effects of tumor on host Grading and staging of cancer Laboratory diagnosis of cancer Effects of tumor on host location and impingement on adjacent structures functional activity such as hormone synthesis bleeding and secondary infections when they ulcerate through adjacent natural surfaces initiation of acute symptoms caused by either rupture or infarction cachexia (wasting) paraneoplastic syndromes Clinical features of neoplasia Clinical features of neoplasia Cancer cachexia Patients with cancer commonly suffer progressive loss of body fat and lean body mass accompanied by profound weakness, anorexia, and anemia.