病理学女性生殖系统和乳腺疾病.ppt

**患者1/4死亡**Thebreastiscomposedofasystemofbranchingductsdraininginto6-12lactiferousducts.Thesystemsareextensivelyintertwined,andIwouldurgeyoutoignoretalkaboutseparatelobes.Elasticfiberssurroundthelactiferousductsandtheirbranches.Thelactiferousductwidenstobecomethelactiferoussinusunderneaththenipple.乳腺被结缔组织分隔为15～25叶，每个叶又若干小叶，每个小叶是一个复管泡状腺。腺泡上皮为单层立方或柱状，在上皮细胞和基膜间有肌上皮细胞。导管包括小叶内导管、上间导管和总导管。小叶内导管多为单层柱状或立方上皮，小叶间导管为复层柱状上皮，总导管又称输乳管，开口于乳头，管壁为复层扁平上皮，下乳头表皮相续。**Thenormalmicroscopicappearanceoffemalebreasttissueisshownhere.Thereisalargerducttotherightandlobulestotheleft.Acollagenousstromaextendsbetweenthestructures.Avariableamountofadiposetissuecanbeadmixedwiththeseelements.**Thisisthemostcommonly-identifiedlesiononmammography.Theselesionsareusuallyunilateral,theyoftenaroundfordecades,andprobablyonlyaminorityeverinvade.Ofcourse,toconfirmthatthecancerisnon-invasive,thesavvypathologistcanstainthemyoepithelialcells.Smooth-musclemyosinheavychainismostpopulartoday(SMMHCJ.Clin.Path.57:625,2004).Low-gradeductalcarcinoma,ifleftalone,turnsinvasiveinmaybehalfofpatients,thoughoftendecadeslater.Ifaninvasivecancerdoesdevelop,usuallyitisatthesitethetheDCISwas**Justwhattodoafteranexcisionalbiopsyrevealsductalcarcinomainsituisstillunderstudy.Ontheonehand,itsmorelikelythannotthatthewomanwillhavenofurtherproblemsfollowingsimpleexcision.Ontheotherhand,ifcancerrecursandbecomesinvasive,itcankillher.*?Radiationaddedtosimpleexcisioncutstheratesofrecurrence(moreDCISandinvasivecancer),butevenwithoutradiation,fewerthan20%ofwomenrecurafterexcision(Lancet355:528,2000).Whileweretalkingaboutradiation...ifthemarginofexcisionis10mmormore,radiationclearlygavenobenefit,1-9mmwasaweakeffect,1mmorless,radia