病理学——女性生殖系统和乳腺疾病[精品].ppt

患者1/4死亡 The breast is composed of a system of branching ducts draining into 6-12 lactiferous ducts. The systems are extensively intertwined, and I would urge you to ignore talk about separate lobes. Elastic fibers surround the lactiferous ducts and their branches. The lactiferous duct widens to become the lactiferous sinus underneath the nipple. 乳腺被结缔组织分隔为15～25 叶，每个叶又 若干小叶，每个小叶是一个复管泡状腺。腺泡上皮为单层立方或柱状，在上皮细胞和基膜间有肌上皮细胞。导管包括小叶内导管、上间导管和总导管。小叶内导管多为单层柱状或立方上皮，小叶间导管为复层柱状上皮，总导管又称输乳管，开口于乳头，管壁为复层扁平上皮，下乳头表皮相续。 The normal microscopic appearance of female breast tissue is shown here. There is a larger duct to the right and lobules to the left. A collagenous stroma extends between the structures. A variable amount of adipose tissue can be admixed with these elements. This is the most commonly-identified lesion on mammography. These lesions are usually unilateral, they often around for decades, and probably only a minority ever invade. Of course, to confirm that the cancer is non-invasive, the savvy pathologist can stain the myoepithelial cells. Smooth-muscle myosin heavy chain is most popular today (SMMHC J. Clin. Path. 57: 625, 2004). Low-grade ductal carcinoma, if left alone, turns invasive in maybe half of patients, though often decades later. If an invasive cancer does develop, usually it is at the site the the DCIS was Just what to do after an excisional biopsy reveals ductal carcinoma in situ is still under study. On the one hand, its more likely than not that the woman will have no further problems following simple excision. On the other hand, if cancer recurs and becomes invasive, it can kill her. *?Radiation added to simple excision cuts the rates of recurrence (more DCIS and invasive cancer), but even without radiation, fewer than 20% of women recur after excision (Lancet 355: 528, 2000). While were talking about radiation... if the margin of excision is 10 mm or more, radiation clearly gave no benefit, 1-9 mm was a weak effect, 1 mm or less, radiation clearly helped