课件：生殖系统与乳腺疾病.ppt

Paget’s disease Paget’s disease 基本病变 非浸润性癌 浸润癌 特殊类型 导管内原位癌 小叶原位癌 Paget’s disease 浸润性导管癌 浸润性小叶癌 粉刺癌 非粉刺型 导管内癌 浸润性导管癌 浸润性导管癌 硬癌 浸润性导管癌－分化差 基本病变 非浸润性癌 浸润癌 特殊类型 导管内原位癌 小叶原位癌 Paget’s disease 浸润性导管癌 浸润性小叶癌 粉刺癌 非粉刺型 导管内癌 浸润性小叶癌 浸润性小叶癌 扩散 直接蔓延 转移 淋巴道转移：同侧腋窝淋巴结 血道转移：肺、肝、骨 预后 肿瘤级别、类型 肿瘤大小 淋巴结状态 雌激素受体状态 Estrogen receptror staining Progesterone receptor staining Cerb-B2 staining Fine Needle Aspiration 诊断方法 针吸细胞学 Tru-cut biopsy 冰冻切片 超声、造影 子宫脱垂，宫颈不规则增厚，表面呈湿疹样改变，渗出物在其表面形成白苔。 * 正常乳腺导管：可见导管双层上皮结构，内层为腺上皮细胞，外层为胞浆透明的肌上皮细胞。 * Here is a surgical excision of a small mass from the breast. The mass is well-circumscribed. Grossly it felt firm and rubbery. This is a fibroadenoma. The blue dye around the fibroadenoma was used to mark the lesion during needle localization in radiology so that the surgeon could find this small mass. Here is a side by side comparison of the gross characteristics of a classic infiltrating ductal carcinoma on the left and a benign fibroadenoma on the right. * This high power microscopic view demonstrates intraductal carcinoma. Neoplastic cells are still within the ductules and have not broken through into the stroma. Note that the two large lobules in the center contain microcalcifications. Such microcalcifications can appear on mammography. * Here is a comedocarcinoma pattern of intraductal carcinoma, which is characterized by the presence of rapidly proliferating, high-grade malignant cells. Note the prominent central necrosis in the ducts. * The cells in the center of the ducts with comedocarcinoma are often necrotic and calcify, as shown here. This central necrosis leads to the gross characteristic of extrusion of cheesy material from the ducts with pressure (comedone-like). * Lobular carcinoma in situ is seen here. Lobular CIS consists of a neoplastic proliferation of cells in the terminal breast ducts and acini. The cells are small and round. Though these lesions are low grade, there is a 30% risk for development of invasive carci