呼吸系统疾病英文医学培训课件.ppt

Interstitial pneumonia Interstitial infiltration of lymphocytes, macrophage and occasionally plasma cells 巨细胞病毒性肺炎 Centrilobular emphysema Panacinar emphysema Bullae Silicosis Clinical course palpable neck mass, headache, nasal obstruction, hearing loss, dysphagia Treatment Resection and/or radiotherapy Primary lung cancer Bronchogenic carcinomas Arising from the bronchial epithelium 95% USA 1/3 of cancer deaths in men the leading cause of cancer deaths in women Peak incidence 50~ 59 years Male : female = 1.5:1 A miscellaneous group 5% Etiology and pathogenesis Cigarette smoking Environmental insults ? A stepwise accumulation of a multitude of genetic abnormalities Transformation of benign progenitor into neoplastic tissue ? Hereditary(genetic) factors P-450 monooxygenase enzyme system P-450 genes ? Inactivation of the putative tumor suppressor genes located on 3p, TP53 mutations, KRAS activation, EGFR mutations, EML4-ALK tyrosine kinase fusion genes and c-MET tyrosine kinase gene amplications. Morphology Gross Small mucosal lesions Firm, gray-white Intraluminal masses Invading the bronchial mucosa Forming large bulky masses pushing into adjacent lung parenchyma Cavitation - central necrosis Focal hemorrhage Tumors arising from large bronchus In Central zone of lung or in the hilar region A globus shape, non-capsulated, an distinct irregular boundary Tumors arising from smaller bronchi or bronchiole In peripheral region of lung Small, solitary, without capsule, lobular in contour, hazy edge Cut surface: Greyish white Glistening when containing mucous element Diffuse type Four major histological types Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Small cell carcinoma A combination of histologic patterns Adenocarcinomas 36.8～46.5%, more common in women Arising from basal cell or gobl