病理学：生殖系统和乳腺疾病（二）.ppt

病例分析 王氏，女，53岁，发现乳腺肿物一周，肿物位于乳腺外上限，固定，活动性差，体查见乳头周围皮肤呈桔皮样外观，活检组织灰白，质硬，镜下见癌细胞巢状、团索状、腺样等排列，细胞异型明显，核分裂多 病理诊断：？ 乳腺浸润性导管癌 * * * * [NORMAL BREAST HISTOLOGY]. A lobule of a TDLU is shown (arrowhead) without an obvious terminal duct entering/leaving this unit. Note that a TDLU is surrounded by a dense collagenous stroma (arrow) but the stroma inside the lobule is not as dense as outside. A breast is usually made up of about 10-20 lobes and each lobe in turn can contain up to several thousand lobules. Each lobule can contain 20-200 smaller ductules/acini. The number of breast lobes, lobules in each lobe, and ductules/acini in each lobule vary greatly. * [NORMAL BREAST HISTOLOGY]. This photomicrograph shows three acini with lumens (long arrow). Each acinus is lined by two layers: an outer complete layer of myoepithelial cells with clear cytoplasm (arrowheads) and an inner layer of cuboidal to columnar epithelial cells (curved arrow). Note that each acinus is enveloped in a basement membrane and the surrounding stroma contains fibroblasts, lymphocytes, and plasma cells. * * 小叶原位癌 来自小叶的末稍导管及腺泡 主要累及小叶 癌细胞局限于管泡内，未穿破其基底膜，小叶结构存在? 病 理 特 点 多中心，常累及双侧，无明显肿块 癌细胞实性排列,无坏死 癌细胞小，大小较一致，核圆，核分裂罕见 无间质的炎症反应、纤维组织增生 癌细胞穿破乳腺导管或小叶的基底膜而侵入间质 占乳腺癌 85% 分类：浸润性导管癌和浸润性小叶癌 约有10%浸润性导管癌与浸润性小叶癌并存，浸润性小叶癌的预后较差 浸润性癌 导管内癌细胞突破管壁基底膜向间质浸润 最常见的一种类型（70%） 浸润性导管癌　 （Invasive ductal carcinoma）　 大 体 切面灰白，质硬，界不清，活动度差，癌组织呈 树根状侵入邻近组织。 乳头下陷：癌肿侵犯乳头，伴纤维组织增生 橘皮样外观：阻塞淋巴管 卫星结节：晚期蔓延 溃疡：穿透皮肤 病理特点 This mastectomy specimen demonstrates the gross findings of inflammatory carcinoma of breast. This is not a specific histologic type of breast cancer, but rather it implies dermal lymphatic invasion by some type of underlying breast carcinoma. Such involvement of dermal lymphatics gives the grossly thickened, erythematous, and rough skin surface with the appearance of an orange peel 镜 下 巢状、团索状、腺样，可见导管内原位癌； 癌细胞异型明显，核分裂多； 伴坏死、纤维组织增生癌细胞在纤维间质中生长； 病理特点 At high magnification, the pleomorphism of the carcinoma cells w