竺可青 胃癌的病理改变.ppt

The Gastrointestinal Tract Zhu keqing 竺可青 Pathology Department Zhejiang University School of Medicine 2015-5 5 Carcinoma of the esophagus 噫隔 Etiology and Pathogenesis Factors Associated with the Development of Squamous Cell Carcinoma of the Esophagus Dietary Deficiency of vitamins (A, C, riboflavin, thiamine, pyridoxine) Deficiency of trace elements (zinc, molybdenum) Fungal contamination of foodstuffs High content of nitrites/nitrosamines Lifestyle Burning-hot beverages or food Alcohol consumption Tobacco use Urban environment Esophageal Disorders Long-standing esophagitis Genetic Predisposition Long-standing celiac disease Ectodermal dysplasia Racial disposition??? Clinical Features Esophageal carcinoma is insidious in onset and produces dysphagia and obstruction gradually and late. 进行性吞咽困难 Patients subconsciously adjust to their increasing difficulty in swallowing by progressively altering their diet from solid to liquid foods. Hemorrhage and sepsis may accompany ulceration of the tumor. Occasionally, the first alarming symptom of this neoplasm is aspiration of food via a cancerous tracheoesophageal fistula. 5 Carcinoma of stomach Carcinoma is the most important and the most common (90% to 95%) of malignant tumors of the stomach. Next in order of frequency are lymphomas (4%), carcinoids (3%), and mesenchymal tumors (2%), which include gastrointestinal stromal tumors, leiomyosarcoma, and schwannoma. WHO Histologic Classification of Gastric Tumors Epithelial Tumors Intraepithelial neoplasia: adenoma Adenocarcinoma* Papillary adenocarcinoma Tubular adenocarcinoma Mucinous adenocarcinoma Signet-ring cell carcinoma Undifferentiated carcinoma Adenosquamous carcinoma Small-cell carcinoma