前列腺腺癌的Gleason评分进展课件

前列腺腺癌的Gleason评分进展和新的预后分组前列腺腺癌的Gleason评分进展前列腺腺癌的Gleason评分进展和新的预后分组纲要Gleason分级最新进展Gleason评分规则的应用新的预后分组信息(Newprognosticgradingsystem)WHOCIasefieatianatWHOclassificationofTumouroftheUrinarySystemandMaleGenitalOrgans(2016Gleason分级最新进展主要改变的内容有三点1.对具有特殊组织学形态的前列腺癌Gleason评分达成一致如:筛状形态、肾小球样腺体、粘液腺癌2新增导管内癌(IDGP)3.对前列腺癌亚型的分级如泡沫状癌,萎缩型癌,假增生型癌、导管腺癌、印戒细胞癌等纲要Gleason分级最新进展Gleason评分规则的应用新的预后分组信息(Newprognosticgradingsystem)WHOCIasefieatianatWHOclassificationofTumouroftheUrinarySystemandMaleGenitalOrgans(2016Gleason分级最新进展主要改变的内容有三点1.对具有特殊组织学形态的前列腺癌Gleason评分达成一致如:筛状形态、肾小球样腺体、粘液腺癌2新增导管内癌(IDGP)3.对前列腺癌亚型的分级如泡沫状癌,萎缩型癌,假增生型癌、导管腺癌、印戒细胞癌等Gleasongradingsystem(Gleason分级系统)ThemostwidelyusedgradingsystemforprostaticadenocarcinomaDevelopedin1966byDrDonaldGleasonBasedongeneralhistologicappearance(notmitoticcountorcelltypes)5patterns(patter1topattern5)(Gleasongrade1to5:5)Furtherrefinedin1974,1977,1992,2005,2014Gas0n分级量新进展2015修订版08的楼WenwenIYouaMedia02015IdaaUnlGleason分级最新进展1对特殊组织学形态的共ISUP2005ISUP2014筛状腺体小的边界Gleason3均为Gleason4(10%边界不规的Gleason肾小球样没有达成一致意见Gleason4(100%)腺体50%认为是Gleason4其余50%认为目前生物学行未粘液腺癌大约50%专家认为是Gleason4根据粘液腺癌本身的结构(91%):多数为其余50%认为根据粘液腺癌的结Gleason4,少量为3Gleason分级最新进展1國ARC原为Geao3和Gleason4现为gleason4多数为Gleason4,少数现均为Gleason4Gleason3,看腺体结构而定Geas0n分级最新进展2新增导管内癌(IDCP)Intraductalcarcinomaofprostate:IDC-P1985年首先由Ko提出目前最常用的诊断标准:2006年GuoandEpstein提出诊断标准Malignantepithelialcellsfillinglargeaciniandprostaticducts,withpreservationofbasalcellsandeitherasolidordensecribriformpatternoraloosecribriformormicropapillarypatternwitheithermarkednuclearatypia(nuclearsize6xnormal)orcomedonecrosisGeas0n分级最新进展2粉刺状|DCP实体型DCP筛状型[DCGeas0n分级最新进展2临床意义根治标本中DCP常与高级别浸润癌共存,与G