生殖系统和乳腺疾病乳腺前列腺疾病.ppt

生殖系统和乳腺疾病（二）Diseasesofgenitalsystemandmammarygland,DepartmentofPathologySouthernMedicalUniversity,Content,*Carcinomaofbreast;Prostatichyperplasia,乳腺癌Carcinomaofbreast,小导管,乳房晕,小叶,AnormalductcellsBbasementmembraneClumen(centerofduct),腺泡,腔,导管双层上皮内腺上皮，外肌上皮,Normallobuleofmammarygland,乳腺,全球每年120万妇女患乳腺癌，50万死于该病北美、北欧高我国3%/年，“第一癌症杀手”40-60岁女性，男性罕见1%乳腺外上象限中央区内上象限来自乳腺终末导管小叶单元上皮,Introduction,ER、PR(+)：内分泌治疗好，预后好C-erbB-2(+),ER(-):预后差,乳腺是女性激素的靶器官正常乳腺上皮细胞存在雌激素受体（ER）孕激素受体（PR）ER、PR启动细胞分裂促乳癌生长,Thecellsofthisbreastcarcinomaarehighlypositiveforestrogenreceptorwiththisimmunoperoxidasestain.Estrogenreceptorpositivitycorrelateswithabetterprognosis（预后）.,Thisisprogesteronereceptor(PR)positivityinabreastcarcinoma.Theusefulnessofthisdeterminationisnotaswellestablishedasforestrogenreceptors.CarcinomasthatarePRpositive,butnotERpositive,mayhaveaworseprognosis.,分类：,乳腺癌,非浸润性癌,浸润性癌,导管内原位癌,小叶原位癌,粉刺癌,非粉刺导管内癌,乳头Paget病,浸润性导管癌,浸润性小叶癌,特殊类型癌,小管癌、乳头Paget病伴导管浸润癌,典型髓样癌,粘液癌,属于原位癌没有突破导管和腺泡的基底膜分类:导管内原位癌小叶原位癌,一、非浸润性癌,1导管内原位癌（Intraductalcarcinomainsitu）,起于乳腺小叶的终末导管限于导管内,基膜完整检出率，5%15%30%组织学:粉刺型,非粉刺型20年，30%浸润癌,AnormalductcellsBductalcancercellsCbasementmembraneDlumen(centerofduct),Intraductalcarcinoma.Theneoplastic（肿瘤的）cellsareconfinedtotheductbythebasementmembrane.Theneoplasticcellsaremonotonouswithroundtoovalnucleiandlittlepleomorphism.Thecellbordersarewelldemarcated（区分）.,（1）粉刺癌,（Comedocarcinoma）,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:实性排列，中央坏死特征癌细胞大，嗜酸，大小不一，核仁明显，病理性核分裂多坏死区常见钙化导管周间质纤维组织，慢性炎C浸润,Comedocarcinomaischaracterizedbythepresenceofrapidlyproliferating,high-grademalignantcells.Thecellsinthecenteroftheductsareoftennecroticandcalcify.Thiscentralnecrosisleadstothegrosscharacteristicofextrusionofcheesymaterialfromtheductswithpressure.,ComedocarcinomaNotecentralnecrosis(*)andpleomorphicnuclei.Thecellsdonotextendbeyondthebasementmembrane(arrow).,(2)非粉刺型导管内癌（Noncomedointraductalcarcinoma）,实性、（微）乳头状、筛状排列，轻微坏死癌细胞小，较规则导管周间质纤维组织增生较轻,2.小叶原位癌,（Lobularcarcinomainsitu）,来自小叶的终末导管及腺泡癌细胞局限于管泡内，未穿破其基底膜，小叶结构存在多中心性，常累及双侧，无明显肿块（弥散）癌细胞实性排列，小而一致，核圆，核分裂罕见癌细胞无坏死，无间质的炎症反应、纤维组织增生,AnormallobularcellsBlobularcancercellsCbasementmembrane,Lobularcarcinomainsituconsistsofaneoplasticproliferation（增殖）ofcellsintheterminalbreastductsandacini.Thecellsaresmallandround.Thereisa30%riskfordevelopmentofinvasivecarcinomainthesameortheoppositebreast.,导管内癌乳头、乳晕乳头、乳晕可见渗出、浅表溃疡又称“湿疹样癌”表皮内：瘤细胞孤立散在、成簇分布大而异型，胞质透明,3.佩吉特病（Pagetdisease),癌细胞穿破乳腺导管或腺泡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两种类型可并存，占10%，浸润性小叶癌的预后较差,二、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（70%）,1.浸润性导管癌（Invasiveductalcarcinoma）,AnormalductcellsBductalcancercellsbreakingthroughthebasementmembraneCbasementmembrane,大体：色灰白，质硬，无包膜界不清，活动度差浸润性生长乳头下陷，橘皮样外观,Pathologicalchanges,Hereisaclassicinfiltrating（浸润的）ductalcarcinoma,Thisinfiltratingductalcarcinomaofthebreastisdefinitelyinfiltratingthesurroundingbreast.Thecentralwhiteareaisveryhardandgritty,becausetheneoplasmisproducingadesmoplasticreactionwithlotsofcollagen.Thisisoftencalledascirrhousappearance.,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、纤维组织增生单纯癌、硬癌、不典型髓样癌,Cordsandnestsofcellsirregularlyinvadethetissue.Reactivefiborsis(thedesmoplasticreaction)surroundstumorcells(arrows).,Inthecenterisaductlinedbycarcinomacells.However,thisductalcarcinomaisnotconfinedtojusttheduct,butinfiltratesoutwardintothesurroundingstromaasaninfiltratingductalcarcinoma,Thepleomorphismofthecarcinomacellswithintheductinthecenter(inacribriformpattern),aswellastheneoplasticcellsinfiltratingthroughthestromaandfat,canbeseenwiththisinfiltratingductalcarcinoma.,Theinfiltratingductalcarcinomaofbreasthaspleomorphiccellsinfiltratingthroughthestroma.,Thishighermagnificationshowswelldifferentiatedduct-likestructuresinfiltratingthestromaofthebreast.,Small,duct-likestructuresareseeninvadingthebreaststroma.Sometumorcellsaresingle.Notetheabundantcollagenousstroma,characteristicofbreastcarcinomas.,Scirrhous（硬的）carcinomaofthebreast,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（Invasivelobularcarcinoma）,AnormalcellsBlobularcancercellsbreakingthroughthebasementmembraneCbasementmembrane,*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（列兵样排列）、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：,Thisisacloserviewoflineararraysoflobularcarcinomacellsinfiltratingthroughdensefibrousstroma.,Invasivelobularcarcinoma,Theneoplasticcellsarenotableforeccentricnucleisetintomucinrichcytoplasm.Thenucleiarehyperchromaticandroundtooval.Nopleomorphismormitosesareseen.Thestromaisverydensewithaccellularcollagen.,Singlestrandsofmalignantcellsinfiltratingthestroma(Indianfiling).,3.特殊型癌,具有特殊形态，如粘液癌、大汗腺样癌、小管癌、腺样囊性癌、鳞状细胞癌、炎性癌,直接浸润：乳腺实质、乳头、皮肤、筋膜、胸肌及胸壁淋巴结转移：外上、外下象限和中心区同侧腋窝淋巴结内上、内下象限乳内动脉旁淋巴结血行转移：远处任何器官,转移途径,前列腺增生症Prostatichyperplasia,ProstaticHyperplasia,ProstateCancer,Prostatitis,Introduction,主要特点：腺体、间质均增生与激素平衡失调有关临床表现：尿道梗阻、尿流不畅50岁，随着年龄增长增加,核桃或鸡蛋大，表面光滑，结节状以腺体增生为主:淡黄、质软、切面大小不等蜂窝状腔隙，轻压有奶白色液溢出以纤维平滑肌增生为主:苍白，质韧，界不清,肉眼：,Pathologicalchanges,镜下：,增生成分:腺体、纤维组织、平滑肌腺体数目，腺腔囊性扩张，上皮细胞双层排列，腺腔内可见淀粉小体可见鳞状上皮化生和小灶性梗死,Notethenodulefilledwithenlargedglands.Thoughcrowded,thereisstillstromabetweentheglands.,Notethatthecolumnararrangementofcellsneartheglan