内分泌系统疾病课件

内分泌系统疾病,基础医学院病理学教研室,goiter,thyroid tumor,APUDoma,Diffuse nontoxic goiter,、Conception,由于甲状腺素分泌不足、促甲状腺激素分泌增多，甲状腺滤泡上皮增生，胶质堆积而引起的甲状腺肿大。也称单纯性甲状腺肿，,1、概念,2、分类,散发性甲状腺肿,地方性甲状腺肿,弥漫性非毒性甲状腺肿,3、正常解剖组织学复习,甲状软骨,甲状腺,The thyroid gland has a right lobe and a left lobe connected by a narrow isthmus.,单层立方上皮,胶质,Normal thyroid seen microscopically consists of follicles lined by a an epithelium and filled with colloid.,This immunoperoxidase stain with antibody to calcitonin identifies the “C“ cells,immunofluorescence test positive for anti-microsomal antibody,immunofluorescence positivity for anti-thyroglobulin antibody,、Etiology,1、缺碘,2、致甲状腺肿因子,3、遗传与免疫,、Pathogenesis,、Pathological feature,1、Stage of hyperplasia,Diffuse hyperplastic goiter,小滤泡大量增生，胶质少,2、 Stage of stored colloid,Diffuse colloid goiter,滤泡扩张，大量胶质贮积,弥漫性胶样甲状腺肿,3、Stage of nodule,Nodular goiter, The red arrow points to an area of scarring. The blue arrow points to a large and the yellow to a small follicle,The follicular cells have round to oval nuclei with small visible nucleoli. The follicle cell cytoplasm is scant,可见结节形成，部分滤泡显著 扩张，部分滤泡增生、萎缩。, Enlarged thyroid with more enlargement on left. Left lobe also shows multiple nodules, Cut surface of one lobe of thyroid gland showing ill defined nodules. Focus of cystic degeneration seen (blue arrow). Some hemorrhage (red arrow) and some scarring.,This diffusely enlarged thyroid gland is somewhat nodular. This patient was euthyroid,甲状腺显著肿大， 有结节形成。,、Clinio- pathological relationship,1、甲状腺肿大,2、压迫症状,3、一般不伴有甲状腺功能亢进,Diffuse toxic goiter,、Conception,1、 定义： 指血中甲状腺素过多，作用于全身各组织所引起的临床综合症，临床上统称为甲状腺功能亢进症，简称“甲亢”，又称突眼性甲状腺肿。多见于女性, 男/女=1/4-6，以20-40岁最多见。,2、甲状腺激素的功能, 促进机体的新陈代谢；, 提高神经的兴奋性；, 促进机体的生长发育。,、Etiology and Pathogenesis,自身免疫性疾病,、Pathological feature, Diffusely enlarged red tan thyroid gland. Slight lobulation but no large cyst formed.,光镜：,滤泡上皮增生呈高柱状,常有乳头形成；,滤泡腔内胶质稀薄, 在紧靠上皮的胶质 内出现很多吸收空泡;,间质血管增生,明显充血,大量淋巴细胞 浸润,并形成淋巴滤泡。,A diffusely enlarged thyroid gland associated with hyperthyroidism is known as Graves disease. At low power here, note the prominent infoldings of the hyperplastic epithelium.,At high power, the tall columnar thyroid epithelium with Graves disease lines the hyperplastic infoldings into the colloid.,、Clinico-pathological relationship, 眼征:良性突眼征,恶性突眼征., T3.T4分泌过多综合症:怕热多汗,多食善饥消 瘦,疲乏无力,神经过敏,脉搏加快, 脉压差增大., 甲状腺肿:双侧对称性弥漫性肿大,随吞咽上下移动,左右叶上下极有震颤伴血管杂音.,Thyroid adenoma,、Conception,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。,、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,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：,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；,前者滤泡大小不一致，一般比正常大；后者则相反；,Thyroid cancer,、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.,、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 structures, a feature which suggests malignancy., The dark reddish brown tissue is characteristic of normal thyroid. The large tan nodules represent carcinoma. No large areas of hemorrhage and necrosis are seen.,Sectioning through a lobe of excised thyroid gland reveals papillary carcinoma.,This is the microscopic appearance of a papillary carcinoma of the thyroid. The fronds of tissue have thin fibrovascular cores. The fronds have an overal papillary pattern., The blue arrow points to a papillary structure. The center is fibrovascular; the cells covering it are epithelial. The red arrow shows a similar papillary structure in cross section., This closeup shows that the cells range from low columnar to columnar. The red arrow shows a cell with an Orphan Annie eye nucleus.,滤泡性癌:占甲状腺癌的10%-15%,多见于50岁以上的女性,以具有滤泡结构为特征. 分化良好者与滤泡性腺瘤不易区别,可根据包膜或血管是否浸润来确定.分化差者早期出现血道转移,五年存活率为30%-40%.,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.,This immunoperoxidase stain with antibody to calcitonin identifies the “C“ cells,肉眼:多为单个肿块,无包膜,但境界清楚,较软,呈黄褐色.,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.,光镜:肿瘤细胞为圆形,多角形或梭形的小细胞, 排列成簇状,索状或小滤泡状.间质较丰富,常有淀粉样物质和钙盐沉着.,Medullary Carcinoma of Thyroid,Thyrocalcitonin markers in Medullary Carcinoma of the thyroid. Immunoperoxidase stain,刚果红显示红染的淀粉样物质,未分化癌:占15%,恶性度高,生长快,早期即可向周围组织浸润和转移.根据组织学形态可分为小细胞癌,巨细胞癌,梭形细胞癌.其中巨细胞癌预后最差.,甲状腺炎,1.亚急性甲状腺炎 滤泡破坏,胶质外溢,引起类似结核结节的肉芽肿,有多种炎症细胞形成微小脓肿,无干酪样坏死. 2.慢性淋巴细胞性甲状腺炎(桥本氏甲状腺炎) 自身免疫性疾病,萎缩,大量淋巴细胞浸润,淋巴滤泡形成,纤维增生,可有多核巨细胞. 3.慢性纤维性甲状腺炎(慢性木样甲状腺炎) 萎缩,大量纤维增生,玻变,有淋巴细胞浸润,无淋巴滤泡.,APUDoma,(amine-precursor-uptake and decarboxylation),源于神经嵴的弥散分布在全身各器官的神经内分泌细胞，具有摄取胺的前体经脱羧而形成多肽激素的功能,因而称为APUD细胞.由APUD细胞发生的肿瘤称为APUD瘤,1、定义,2. APUD细胞,分布: 内分泌腺-垂体前叶,肾上腺髓 质,甲状腺,松果体,胰岛等 其它器官 胃,小肠,支气管,颈动脉体等,组织来源:神经嵴,形态特点: 光镜-胞浆内有嗜银颗粒 电镜-胞浆内含有大小不等 的神经分泌颗粒,3、APUDoma,APUD瘤有的是良性,有的是恶性,有的是交界性肿瘤.良性的亦可发生癌变.肠道的类癌,肺的类癌,小细胞肺癌,甲状腺的髓样癌均属于APUD瘤.此类肿瘤常同时分泌多种激素或激素样物质,如甲状腺的髓样癌除分泌降钙素外,还可分泌生长抑素,前列腺素,5-羟色胺等,从而引起多种复杂的症状,甚至引起内分泌障碍.,Diabetes mellitus,、Conception,1、定义,是一种体内胰岛素相对或绝对不足及靶细胞对胰岛素敏感性降低，或胰岛素本身存在结构上的缺陷而引起的碳水化合物、脂肪和蛋白质代谢紊乱的一种慢性疾病，其主要特点是高血糖、糖尿。 “三多一少”,2、分类及病因,原发性糖尿病,继发性糖尿病,IDDM（型）,NIDDM（型）,糖尿病,、Pathological changes,1、胰岛病变,2、动脉病变：细动脉硬化、动脉粥样硬化,3、肾脏病变：体积增大、肾小球、肾 小管、肾间质、血管,4、视网膜病变,5、神经系统病变,6、其它,思 考 题