病理生理学精品课件（复旦大学）07 消化系统.pptVIP

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病理生理学精品课件（复旦大学）07 消化系统.ppt

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Morphology Gross appearance Characteristic features 1. Hepatomegaly肝大( up to 3000 – 7000g ) 2. Occlusive tumor thrombosis of PV 3. Frequency with Ci 4. Right lobe location Eggel ( 1901 ) Classification, three gross forms : 1. massive type( Unifocal, 巨块型) : A single large mass, 5cm in diameter,up to 10cm in diameter, replacing most of the liver. The tumor masses are usually yellow – white, punctuated sometimes by bile staining and areas of hemorrhage and necrosis. The tumor usually show a well circumscribed and surrounded by a grossly distinct capsule, and norelationship with Ci 2. Nodular type (Multifocal , 结节型) : A solitary or multiple nodular mass 3cm and 5 cm in diameter. The tumor usual show a background of the Ci 3. Diffusely infiltrative type (弥漫型): Permeating widely and sometimes involving the entire liver, blending imperceptibly into the cirrhotic liver background. 4. Small liver cancer ( Dr. Tang Zhao-You : subclinical hepatocellular carcinoma 1984 ) A single nodule, 3cm in diameter. The tumor show a well circumscribed and surrounded by a grossly distinct capsule. The tumor almost always have a background of the Ci. Microscopic appearanceGeneral features 1. Tumor cells have abundant, eosinophilic and fine granular cytoplasm of polygonal shape, that looks like arisen hepatocyte. 瘤细胞呈多边形 2. The pattern of growth of HCC is trabecula小梁 with a network of sinusoidal vessele surrounded the tumor cells. This is an important clue to diagnosis. 瘤细胞呈梁状排列,富有血窦 3. Occlusive tumor thrombosisof PV(门静脉瘤栓形成), almost always appear in the late stage, and in 30% small liver cancer, and sometimes in microfocus HCC ( 0.8 cm in diameter ) 门静脉瘤栓形成可有胆汁及胆栓形成 4. The well – differentiated HCC show the bile production by tumor cells. HCC Immunohistochemical stain AFP（+） Hep Par 1（+） CEA（+） Distinctive histopathological variant (不讲) 1. Clear cell type : rich glycogen 2.