内分泌系统疾病2009课件.ppt

A 2.9cm minimally invasive follicular carcinoma of the thyroid 髓样癌:从滤泡旁细胞发生的癌,占甲状腺癌的5%,有家族发病倾向性,发病年龄多在30岁左右,恶性程度不一,平均存活6.6年.90%肿瘤分泌降钙素,有的还同时分泌生长抑素,前列腺素及其它多种激素样物质. 甲状腺腺瘤是甲状腺滤泡上皮发生的最常见的甲状腺良性肿瘤,多见于青中年妇女.腺瘤生长缓慢,大部分病人无明显症状,约1%的患者可出现甲亢。 Ⅱ、Pathological feature 肉眼:多为单发,呈圆形或椭圆形, 大小从直径数毫米到3-5cm,局限在一侧腺 体内,质地稍硬,表面光滑,无压痛,能随吞咽上下移动,有完整包膜,肿瘤中心有时可见囊性变,纤维化或钙化. Here is a surgical excision of a small mass from the thyroid gland that has been cut in half. The mass is well-circumscribed. Grossly it felt firm. By scintigraphic scan it was cold. This is a follicular adenoma. Here is another follicular neoplasm (a follicular adenoma histologically) that is surrounded by a thin white capsule. It is sometimes difficult to tell a well-differentiated follicular carcinoma from a follicular adenoma. 病理组织学分型: 滤泡型腺瘤 单纯型腺瘤 胶样型腺瘤 胎儿型腺瘤 胚胎型腺瘤 嗜酸性细胞腺瘤 ? The red arrow points to the predominantly small follicles contained in the adenoma. ? The blue arrows point to compressed normal thyroid. ? The yellow arros points to normal thyroid with much larger follicles than most of those within the adenoma. ? The red arrow is located within the adenoma. ? Although composed of follicular cells, little colloid is seen. ? The blue arrow points to the capsule of the adenoma, a few strands of connective tissue. ? The yellow arrow points to colloid within a large normal follicle Simple adenoma Colloid adenoma Fetal adenoma Embryonal adenoma ③前者周围甲状腺组织无压迫现象，临近甲状腺内与结节内有相似病变；后者周围有压迫现象，周围与远处甲状腺组织均正常。 鉴别： ①结节性甲状腺肿常为多个结节，无完整包膜；腺瘤多单发,有完整包膜； ②前者滤泡大小不一致，一般比正常大；后者则相反； Thyroid cancer Ⅰ、Conception 甲状腺癌是由甲状腺滤泡上皮或滤泡旁细胞发生的恶性肿瘤,女性明显多于男性.一般来说,甲状腺癌比其它器官的癌发展相对缓慢,病程相对较长.值得注意的是,有的原发灶很小,临床上常首先发现转移灶. Ⅱ、Pathological feature 乳头状癌:最多见,占甲状腺癌的40%--60%,青少年女性多见,恶性程度较低, 生长较缓慢,预后较好,五年存活率达75%.以具有乳头状结构为特征,临床上往往以颈部甲状腺旁淋巴结转移为首发症状. ? The thyroid is massively distorted by a multinodular growth. ? Shaggy external surface due to difficulty in dissecting organ from other structure