基础医学] 内分泌系统疾病.ppt

* * 1 1 内分泌系统疾病 Diseases of endocrine System 吴正蓉 南方医科大学病理学系 * * 2 2 内分泌系统的组成Constitutes of endocrine system ： 内分泌腺 glands、内分泌组织 tissue、内分泌细胞 cells * * 3 3 二、糖尿病（自学）Diabetes 一、甲状腺疾病 Thyroid disease * * 4 4 The butterfly-shaped thyroid * * 5 5 * * 6 6 This is the normal appearance of the thyroid gland on the anterior trachea of the neck. The thyroid gland has a right lobe and a left lobe connected by a narrow isthmus. The normal weight of the thyroid is 10 to 30 grams. It cannot easily be palpated on physical examination. * * 7 7 Normal thyroid seen microscopically consists of follicles lined by a an epithelium and filled with colloid. The follicles vary somewhat in size. The interstitium, which may contain “C“ cells, is not prominent. * * 8 8 * * 9 9 甲状腺上皮细胞可通过泡膜上的“碘泵”主 动摄取血浆中的I-。I-在甲状腺浓集，在过 氧化酶催化下，氧化成活性碘。 活性碘使甲状腺上皮细胞核糖体上的甲 状腺球蛋白中的酪氨酸残基碘化，生成一碘 酪氨酸（MIT）或二碘酪氨酸（DIT）残基。 在过氧化酶催化下，一分子DIT与一分子 MIT缩合成一分子T3，两分子DIT缩合成一分 子T4。 含T3、T4的甲状腺球蛋白在滤泡腔贮存。 碘的摄取和活化 MIT与DIT的形成 T3与T4的形成 贮 存 利 用 甲状腺激素的合成与碘的代谢 * * 1010 甲状腺肿 Goiter 甲状腺肿瘤 Thyroid neoplasm 甲状腺腺瘤 Thyroid adenoma 甲状腺癌 Thyroid carcinoma 弥漫性非毒性 Diffuse nontoxic 弥漫性毒性 Diffuse toxic 甲状腺疾病 Thyroid disease 甲状腺炎 Thyroiditis 亚急性 Subacute thyroiditis 慢性淋巴细胞性 Chronic lymphocytic thyroiditis * * 1111 l一般不伴甲亢，亦称单纯性甲状腺肿; l分散发性和地方性两种。地方性与缺碘有关，又称地 方性甲状腺肿。远离海岸的内陆山区和半山区多见， 发病率达10%以上，是散发性的10倍以上; l目前全世界约有10亿人生活在碘缺乏地区，我国病人 超过3亿。 弥漫性非毒性甲状腺肿 diffuse nontoxic goiter Concept： 甲状腺素分泌不足，促甲状腺素（TSH）分泌增 多，导致甲状腺滤泡上皮增生，胶质堆积而使甲状腺 肿大。 * * 1212 颈部甲状腺肿大，一般无临床症状 少数可引起压迫、窒息、吞咽和呼吸困难 可伴甲亢或甲低等症状 临床表现 Clinical manifestation： ： * * 1313 充满没有碘化的甲状腺 球蛋白 病因与发病机制 Etiology regressive change Pathological changes: Macroscope: * * 5252 Here is a surgical excision of a small mass from the thyroid gland that has been cut in half. A rim of slightly darker thyroid parenchyma is seen at the left. The mass is well-circumscribed. Grossly it felt firm. * * 5353 Thyroid adenoma * * 5454 单纯型腺瘤 胶样型腺瘤 胎儿型腺瘤 胚胎型腺瘤 嗜酸细胞性腺瘤 Histologic subtypes： 滤泡性腺瘤 * * 5555 A. 单纯性腺瘤 （Simple-） 包膜完整，大小较一致、拥 挤、内含胶质的滤泡 B. 胎儿型腺瘤 （Fetal-） 小而一致，仅含少量胶质或 无胶质的小滤泡，间质水肿 粘液样 microfollicular * * 5656 C. 胶样型腺瘤（Colloid-） 大滤泡或大小不一、内含胶 质的滤泡，间质少 macrofollicular D. 胚胎型腺瘤（Embryonal-） 瘤细胞小而一致，呈片状或 条索状，无胶质，间质水肿 * * 5757 * * 5858 E. 嗜酸性细胞腺瘤（Acidophilic cell-） 少见，瘤细胞大而多角，核小，胞浆内含 嗜酸性颗粒，排列成索网或巢状 * * 5959 Hurthle (oxyphile) cell tumor, lower power of photomicrograph, with well circumscribed margin established by an intact delicate fibrous capsule. This is a Hurthle cell tumor of low malignant potential (an adenoma). High power view of a High power view of a Hurthle cell tumor made Hurthle cell tumor made up of microfollicles lined up of microfollicles lined by by large acidophilic cell, , the cytoplasm of which is the cytoplasm of which is granular and filled with granular and filled with mitochondria. mitochondria. * * 6060 包膜：前者常为多发结节、无完整包膜； 后者一般单发，有完整包膜； 滤泡：前者大小不一致，一般比正常大； 后者则相反； 周围：前者周围甲状腺组织无压迫现象，邻近 甲状腺内与结节内有相似病变； 后者周围甲状腺有压迫现象，周围和远 处甲状腺组织均正常 结节性甲状腺肿和甲状腺瘤的诊断及鉴别要点： * * 6161 * * 6262 * * 6363 甲状腺癌 thyroid Carcinoma 较为常见，约占所有恶性肿瘤的1.3，占癌 症死亡病例的0.4 与其它器官癌相比，发展较缓慢 有的原发灶很小，临床上常首先发现转移灶 多数甲状腺癌患者甲状腺功能正常，仅少数引 起内分泌紊乱 主要特点： * * 6464 Histologic types： 乳头状癌 Papillary carcinoma 滤泡癌 Follicular carcinoma 髓样癌 Medullary carcinoma 未分化癌 Undifferentiated carcinoma * * 6565 最常见类型(60%) 青少年、女性多见 肿瘤生长慢，恶性程度较低，预后较好 局部淋巴结转移较早 1乳头状癌 papillary carcinoma * * 6666 圆形，直径约2-3cm，无包膜，质较硬 切面：灰白，常伴有囊性变，出血、 坏死、纤维化和钙化 Gross: * * 6767 * * 6868 The papillary carcinoma neoplasm can be multifocal because of the propensity to invade lymphatics within thyroid, and lymph node metastases are common. The larger mass is cystic and contains papillary excresences. * * 6969 l l 乳头乳头分枝多，中心有纤维血管间质，中心有纤维血管间质 l l 间质内常见间质内常见砂粒体（Psammona bodiesPsammona bodies） 呈同心圆状的钙化小体 l l 乳头上皮可单层或多层乳头上皮可单层或多层 l细胞核的改变：的改变：毛玻璃状核 核内假包涵体 核沟 甲状腺微小癌：癌直径甲状腺微小癌：癌直径40岁女性 比乳头状癌恶性程度高、预后差 早期血道转移 癌组织侵犯周围组织器官时，有相应的症状 2滤泡癌 follicular carcinoma * * 7979 结节状，包膜不完整，界较清 切面：灰白、质软 Gross:Gross: Unlike papillary Ca, which can have a circumscribed appearance, follicular carcinoma can have a more diffuse, infiltrating pattern as shown in the image above * * 8080 可见不同分化程度的滤泡 l l 分化好：类似于腺瘤，：类似于腺瘤，但有包膜和血管侵犯； l 分化差：呈实性巢片状呈实性巢片状 瘤细胞异型性明显瘤细胞异型性明显 滤泡少而不完整滤泡少而不完整 嗜酸性细胞癌 (Acidophilic cell carcinoma) 少见，由嗜酸性癌细胞构成 Microscope: * * 8181 Tumor cells infiltrate the amicula * * 8282 Poorly differentiated follicular carcinoma Poorly differentiated follicular carcinoma with oxyphilic features with oxyphilic features * * 8383 * * 8484 METATSTASIS TO BONE 7 YEARS LATER7 YEARS LATER * * 8585 由滤泡旁细胞（即C细胞）发生的恶性肿瘤，占，占5%-10% 高发期:40-60岁 部分为家族性常染色体显性遗传 90%的肿瘤分泌降钙素，产生严重腹泻和低血钙症 3髓样癌 medullary carcinoma * * 8686 瘤细胞圆形或多角，核仁不明显 实体片巢状、乳头状、滤泡状排列 间质内常有淀粉样物质沉着 IHC: 降钙素（calcitonin）+，甲状腺球蛋 白（thyroglobulin）- 单发或多发，假包膜 切面:灰白、黄褐色，质实而软 Gross: Microscope: * * 8787 At the center and to the right is a medullary carcinoma of thyroid. At the far right is pink hyaline material with the appearance of amyloid. These neoplasms are derived from the thyroid “C“ cells and, therefore, have neuroendocrine features such as secretion of calcitonin. * * 8888 Medullary (C-cell) carcinoma of the thyroid with amyloid stroma * * 8989 Here the amyloid stroma Here the amyloid stroma of the medullary thyroid of the medullary thyroid carcinoma has been carcinoma has been stained with Congo red.stained with Congo red. Immunohistochemical anti-calcitonin antibody stain of a medullary carcinoma showing strong positivity. * * 9090 * * 9191 少见，50岁女性多见 生长快，早期浸润和转移 恶性程度高，预后差 4未分化癌 undifferentiated carcinoma * * 9292 未分化癌：肿块较大，灰白，不规则，无包膜， 广泛浸润、破坏，常有出血、坏死 * * 9393 未分化癌：癌细胞大小、形态、染色深浅 不一，核分裂像多 * * 9494 * * 9595 糖尿病 diabetes mellitus 胰岛素相对或绝对不足 靶细胞对胰岛素敏感性 胰岛素结构上缺陷 碳水化合物、 脂肪、蛋白代 谢紊乱 高血糖、糖尿 诊断标准： 空腹血糖7.0mmol/L 餐后两小时血糖11.1mmol/L * * 9696 多饮、多食、多尿和体重 三多一少 并发症 酮症酸中毒、肢体坏疽、 多发性神经炎、失明及肾 功衰竭 * * 9797 * * 9898 Here is a normal pancreatic islet of Langerhans surrounded by normal exocrine pancreatic acinar tissue. The islets contain alpha cells secreting glucagon, beta cells secreting insulin, and delta cells secreting somatostatin. * * 9999 * * 100100 Normal islets of Langerhans, on the right with immunoperoxidase staining for insulin to identify beta cells and on the left with immunoperoxidase staining for glucagon to identify alpha ce