2017乳腺和前列腺疾病.ppt

Small, duct-like structures are seen invading the breast stroma. Some tumor cells are single. Note the abundant collagenous stroma, characteristic of breast carcinomas. Scirrhous carcinoma of the breast 5%～10%，老年妇女多见 癌细胞突破基底膜向间质浸润 约20%可累及双侧乳房，弥漫性多灶 性分布，不易发现 2.浸润性小叶癌 A normal cells B lobular cancer cells breaking through the basement membrane C basement membrane ? * 橡皮样，灰白柔韧，边界不清 * 转移特殊性：脑脊液、浆膜面、卵巢、 子宫、骨髓 肉眼： ? 串珠状、细条索或环形 排列正常导管周围 癌细胞小、大小一致、 核分裂象少见 镜下： This is a closer view of linear arrays of lobular carcinoma cells infiltrating through dense fibrous stroma. Invasive lobular carcinoma The neoplastic cells are notable for eccentric nuclei set into mucin rich cytoplasm. The nuclei are hyperchromatic and round to oval. No pleomorphism or mitoses are seen. The stroma is very dense with accellular collagen. Single strands of malignant cells infiltrating the stroma (Indian filing). * * 转移及扩散的特殊性： 脑脊液 浆膜表面 卵巢 子宫 骨髓 3.特殊型癌 具有特殊形态： 粘液癌、大汗腺样癌、腺样囊性癌、鳞状细胞癌、炎性癌 1．导管内原位癌 起于乳腺小叶的终末导管 限于导管内,基膜完整 不见小叶结构 检出率↑，5%－15%－30% 组织学: 粉刺型,非粉刺型 20年，30%－浸润癌 A normal duct cells B ductal cancer cells C basement membrane D lumen (center of duct) Intraductal carcinoma—— 小而一致、基底膜完整 The neoplastic cells are confined to the duct by the basement membrane. The neoplastic cells are monotonous with round to oval nuclei and little pleomorphism. The cell borders are well demarcated. （1）粉刺癌 50%位于乳腺中央部 质硬、肿块明显，易触诊 查出 导管扩张，内含坏死物质 挤压导管, 坏死物质会像 粉刺一样被挤出 镜下: 癌细胞胞体大，嗜酸，大小不一；核仁明显，核分裂多见——异形型明显 实性排列，中央坏死（特征） 坏死区常见钙化 导管周间质纤维组织↑，慢性炎C浸润 Comedocarcinoma is characterized by the presence of rapidly proliferating, high-grade malignant cells. The cells in the center of the ducts are often necrotic and calcify. This central necrosis leads to the gross characteristic of extrusion of cheesy material from the ducts with pressure. The center of the duct contains calcified material surrounded by necrotic, mostly acellular debris. The neoplastic cells exhibit nucle