《病理学》教学课件：4 肿瘤

1、Chapter 5 Tumor, Neoplasm,pathology,School of Basic Medical Sciences，Fudan University 刘秀萍（XiuPing Liu ） Office ：Rm. 203, East No.1 Building E-mail:,Cancer Incidence-common disease,1. There are about 1,800,000 （180万）new cancer cases in China. 2. There are about 1,300,000 （130万） new cancer cases in Am

2、erica. 3. There are about 9,000,000 （900万） new cancer cases in all over the world,Tumor-?disease,malignant tumors- severely damaged human health,1. The death of malignant tumors ： About 7,000,000 (700万) in the world About 1,000,000 (100万) in the China Cancer deaths accounting for all deaths: In west

3、ern countries: second cause. In china: first (in city) or third cause (in countryside).,The incidence or sarcoma,纤维瘤病,Parenchyma-tumor cells Main component: just one kind in most tumor (2) Determine tumors character, growth partner, shape, structure, and nomenclature (命名). (3) Differentiation refers

4、 to the extent to which tumor cells resemble their origin normal cells. Well (poor, lack) differentiation,2. Basic tumor tissue structure- two basic components,Stroma: connective tissue (fiber, matrix), blood vessel, nerve, immune cells (lymphocytes) (1) Connective tissue, blood vessel: support and

5、nutrition tumor parenchyma (2) Immune cells: anti tumor immune reaction (3) Myofibrils: limit tumor spread,2. Basic tumor tissue structure- two basic components,*Different tumors have their own specific parenchyma, but their stroma are almost the same.,1.Classification organtumor of stomach tissuefi

6、broma, lipoma behaviortumor, carcinoma (or sarcoma) For example: left breast invasive adenocarcinoma,二. Classification and Nomenclature,2.Nomenclature - according to Parenchyma (tumor cell) All tumors (benign and malignant) have two basic components.,2. Nomenclature Benign 中文：组织来源+瘤； 英文： tissue + “o

7、ma” adeno-(aden-) adenoma(腺瘤), lipo-, lipoma（脂肪瘤） More detail: cyst-, papillary- except: aneurysm (动脉瘤), atheroma (粥样瘤）, hematoma(血肿), granuloma (肉芽肿),Malignant tumor = cancer -carcinoma(癌):malignant tumors arise in epithelial tissues such as: squamous cell carcinoma, adenocarcinoma, basal cell carc

8、inoma, transitional cell carcinoma -sarcoma (肉瘤):malignant tumors arise in mesenchymal tissues lymphohematopoietic-no non-lymphohematopoietic such as: fibro- -fibrosarcoma (纤维肉瘤) lipo- leiomyo- chondro- osteo-,Difference between Carcinoma 上皮和神经 恶性 neuro-, medullo-, nephro-, hepato-, leiomyo-, osteo-

9、, chondro-, etc. customary leukemia, Hodgkins disease, Ewings tumor, melanoma, etc.,“malignant” - germ layer unkown: such as: menigioma（脑膜瘤）, malignant menigioma (恶性脑膜瘤） mesothelioma (间皮瘤) - multi germ layers: Tumors contain more than one germ-cell layer. such as: teratoma （畸胎瘤）, malignant teratoma

10、(恶性畸胎瘤） - single germ layer: Tumors contain more than one kind of elements, but all the elements arise in a single layer such as: polymorphism-mixed tumor（混合瘤） malignant mixed tumor（恶性混合瘤）,Special kinds,Polymorphic adenoma (mixed tumor),teratoma,多形性腺瘤,Grading: according to differentiation and mitosi

11、s Broders (1922): squamous cell carcinoma （75%）, , , Stout (1975-): well differentiation medium differentiation undifferentiation,三. Grading and Staging,Staging 肿瘤的范围和播散 Two methods of staging are currently in use: 1. TNM system (T, primary tumor; N, regional lymph node involvement; M, metastasis) b

12、y 国际抗癌联盟 2. AJC system ：肿瘤波及范围 by 美国癌肿分期联合委员会 (American Joint Committee),Staging according to extent and spread UICCTNM series T N M 1- 4 0-3 0-1 AJCS 0 in situ in organ out of organ invasion neighbour organ metastasis,胃活检是低分化癌，该病人的肿瘤分期是晚期癌 这话对吗？,Section II. Benign and Malignant tumors (How to disti

13、nguish benign and malignant tumors), according to harmfulness Benign borderline malignant related to treatment and prognosis,Differentiation（分化）: Parenchyma-tumor cells Benign: highly differentiated; Malignant: poorly differentiated. “Tumor is the disturbance of cell differentiation.”,2. Mode of gro

14、wth Benign: Expansive have envelope. marginated, capsulated, effective treatment Malignant:Infiltrative no envelop radical operation needed chemical and radiation treatment added,3. Speed of growth Benign: Slow, growth stopped, degeneration, might be malignant change Malignant: Fast, necrosis, bleed

15、ing,4. Mitosis（核分裂象） Benign: few, normal chrysanthemum, equatorial Malignant: more, abnormal multipolar, unsymmetrical, abortive,“菊花”状,“赤道板”状,Normal mitosis,Anormal mitosis,non- symmetry, tripolar, quadripolar, multipolar spindles and abortion types pathologic mitoses.,5. Spread of tumors Invasion (

16、侵袭), infiltration (浸润), metastasis (转移) Metastasis：是鉴别良、恶性肿瘤的重要依据 Detachment TransportationFormation Primary tumor, Secondary (Metastatic) tumor,6. Effects on host B.11).这用传统的细胞生成的方法是不能觉察的.此种易位可用于特异性诊断AML ,预后较差。,淋巴瘤细胞核型分析结果不同颜色代表着不同号数的染色体，图中有些染色体出现了不只一种颜色，箭号标示处为发生染色体易位之位置,Histochemistry DNA, RNA, fa

17、t, bilirubin, r-GT, DOPA reaction Immunohistochemistry, ISH AFP(甲胎蛋白) CK, Des, Vim, LN, FN, collagen Antigen of virusHBV, HCV, HPV, Oncogene, tumor suppressor gene and their protein products,毛玻璃肝细胞,Here is an example of c-erb-B2 positivity in a breast carcinoma.,名称： 赫赛汀 通用名： 注射用曲妥珠单抗 英文名： Trastuzuma

18、b,This is an example of bcl-2 positivity in a lymphoma.,2. Physiology Secretion APC gene: 5q21 Cell surface receptors SMAD2 gene, SMAD4 gene: DCC gene: 18q21 Other tumor suppressor genes NF- 2 gene,VHL gene: 3p; PTEN gene: 10q23, WT- 1 gene: 11p13,（转录因子）,RB,p53基因,Inhibit apoptosis: bc1- 2 gene (18q2

19、1), bc1-Xl Favor apoptosis: bax, bad, bc1-xS,Genes that regulate apoptosis,Telomere(染色体端粒)：真核细胞线性染色体末端序列的多个重复 人类：5TTAGGG3 作用：保护和稳定染色体末端，使细胞维持生长 Telomerase (端粒酶):核糖核蛋白酶 85-95%人类恶性肿瘤有端粒酶上调,telomerase activity increased in most human tumors.,Carcinogenesis is a multistep process at both the phenotypic

20、and the genetic levels,Section 10 (pp105) Common Tumors,Benign Papilloma Adenoma：Breast, Thyroid, Colon, Ovary Malignant Squamous cell carcinoma Basal cell carcinoma Transitional cell carcinoma Adenocarcinoma Undifferentiated carcinoma Carcinoid tumor,一. Epithelial tumors,A. Benign Tumors Derived in

21、 Epithelium: (Papilloma-P26; Adenoma-P28),(1) Papilloma Origin: coverage epithelium Shape: finger-like projections into the lumen or on the surface of skin Site: commonly in skin or bladder.,Papilloma,(2) Adenoma Origin: adenocytes Types: Typical adenoma Cystadenoma: having single or multiple cysts

22、containing watery secretion. Commonly in ovary,Adenoma of colon,Adenoma of colon,Cystadenoma of ovary, Fibroademoma: both adenocytes and fibrous are parenchymal compositions commonly in breast Plesmorphic adenoma: having gland, mucoid, and cartilage-like tissues. Commonly in salivary gland. Polypous

23、 adenoma: single or multiple commonly in gastrointestinal track.,Fibroadenoma of breast,Polypous adenoma,B. Malignant Tumors Derived in Epithelium: Carcinoma,Carcinima is the most common malignant tumor. The incidence of carcinoma is at least 9 times higher than that of sarcoma.,(1) Squamous cell ca

24、rcinoma Origin: squamous cell Morphology: grossly: cauliflower-like, polyp, mushroom-like, ulceration.,Histological: Well- differentiated type are similar to normal squamous epithelial cells, with intercellular bridges and nets of keratin pearls (carcinoma pearls). But poor-differentiated type are p

25、leomorphism, no intercellular bridges and keratin pearls.,Squamous cell carcinoma,Squamous cell carcinoma,(2) Basal cell carcinoma Origin: basal cells of skin Features: locally invasive growth, almost never metastasis commonly in face of ololster.,Basal cell carcinoma,色素性基底细胞癌 鳞状基底细胞癌,特点：形态上恶性程度高，但生

26、长慢，很少转移对放射线敏感，早期治疗预后好,Basal cell carcinoma Left, Gross appearance. Offered by Dr. Pan Jian-Kai. Right, Histological,鼻基底细胞癌 左：大体 右：镜下,Basal cell carcinoma,(3) Transitional cell carcinoma Origin: transitional cells Features: exoteric, finger-like, commonly in bladder, renal pelvis.,特点：多见于膀胱和肾盂 常呈乳头状生长

27、 早期发生浸润和转移,（Papillary） trasitional cell carcinoma,(4) Adenocarcinoma Origin: adenocytes large quantities of type: Typical adenocarcinoma Mucoid carcinoma or colloid Signet-ring cell and carcinoma mucin Solid carcinoma or carcinoma simplex Poor defferentiation adenoma carcinoma, and the tumor cells a

28、rrange in solid columns, or masses.,Adenocarcinoma：单纯，囊 乳头状囊 ，黏液 ，,Signet-ring cell carcinoma,Adenocarcinoma of breast,(carcinoma simplex),Types: a. Sclerous carcinoma: dense stroma b. Medullary carcinoma encephaloid carcinoma: Little stroma, and large masses of tumor cells. c. Carcinoma simplex: Po

29、or defferentiation adenocarcinoma with equal quantities of tumor cells and stroma.,Undifferentiated carcinoma：分化差，组织来源难鉴别的恶性肿瘤,特点：多见于肺，可见于胃，食道，鼻咽等 网状纤维染色用于鉴别诊断 恶性程度高，常发生血道转移 对放射线和化疗药较敏感,Carcinoid （类癌）argentaffin carcinoma 来源：神经嵴的嗜银细胞 好发部位：胃肠道与支气管，阑尾多 生长慢，cm很少转移 组织学特点：细胞小，大小和形态较一致核圆分裂少； 细胞质少，嗜银染色,you

30、nger person, B. M. tumors relativity, change of tissue (more forms, complicated elements) fibro - , lipo - , leiomyo - , rhabdomyo - , hemagio - , lymphangio - , osteo - , chondro ,二. Mesenchymal tissue (non lymphohematopoietic),2. Tumors of soft tissues,(1) tumors of fibro-tissue a. fibroma b. fibr

31、osarcoma,(2) tumors of fat tissue a. lipoma,(2) tumors of fat tissue b. liposarcoma,() Tumors of muscle Leiomyoma 部位：多见子宫和肠壁（子宫奇异型） 大体：界清，球形，硬 镜下：瘤细胞与正常平滑肌细胞相似 ，栅状排 列，核分裂象很少 Leiomyosarcoma 部位：多见子宫和肠壁 大体：鱼肉状 镜下：瘤细胞索状排列或不规则，核分裂象多 个/高倍,() Tumors of muscle leiomyoma leiomyosarcoma,Masson三色： 胶原纤维：绿色；肌纤维：

32、红色；红细胞：橘红色,Rhabdomyosarcoma 部位：多见四肢深部的横纹肌 大体：软，紫红色，伴出血坏死 镜下：瘤细胞极不一致（球拍形，蝌蚪形，带状 等），胞质红和可见纹，核分裂象多 恶性度高，早期血道转移 磷钨酸苏木素（）染色： 横纹肌：兰色；胶原纤维：黄红色,rhabdomyosarcoma,肉瘤有多的核分裂象,(4) Angioma a. Hemangioma（头颈皮下和肝脾；紫红色，界不清） b. Lymphangioma（颈，口腔等）,左：毛细血管瘤 右：海绵状血管瘤,三. Tumors of Bone,1. Osteochondroma (骨软骨瘤), osteoma (骨

33、瘤) 2. Chondroma (软骨瘤), 3. Osteosarcoma (骨肉瘤) 4. Giant cell tumor (巨细胞瘤)or Osteolastoma (破骨细胞瘤),osteoma (骨瘤) （儿童，青年） 部位：长骨（股骨下端，胫骨上端多见）,骨瘤 Benign osteoma.,2. Chondroma (软骨瘤) 小骨的软骨瘤：术后不易复发 长骨及扁骨的软骨瘤：术后易复发 软骨瘤软骨肉瘤,中心部,Osteochondroma. Left, The tumor seen on X-ray. Right, The histologic appearance of th

34、e tumor. The cartilagenous component forms a cap at the top of the bone,软骨瘤,3. Osteosarcoma (骨肉瘤) （青年，男多于女，有外伤史） 部位：长骨干端，股骨下端胫骨上端和肱骨上端 大体： 镜下：瘤细胞丰富， 恶性度高，早期血道转移病理性骨折 截肢外加化疗,A highly malignant tumor of bore Infiltrative growth manner both into the marrows and outwards into the surrounding soft tissue

35、. Formatting tumor osteoid by the tumor cells. Say characteristics: “sunburst” appearance codmans triangle,Osteosarcoma,codmans triangle,sunburst,Osteosarcoma,瘤细胞内多量碱性磷酸酶,Osteoclastoma (giant cell tumor of bone) 部位：长骨骨部，股骨下端胫骨上端和挠骨上端 大体：膨胀性生长，“蛋壳”，紫红色 镜下：单核基质及多核巨细胞 良性，预后好,Osteoclastoma (giant cell t

36、umor of bone),Tumors of Hematopoietic and Lymphoid System (Mesenchymal tissue): chapter 10,All the tumors of hematopoietic and lymphoid system are malignant tumors. Leukemia Lymphoma: Non-Hodgkin lymphoma and Hodgkin lymphoma Myeloma（骨随瘤）,Lymphoma,Hodgkin lymphoma,Hodgkin lymphoma,Hodgkin lymphoma,白血病肝,Tumors of nervous system,1. The central nervous tumors (1) Glioma Astrocytoma Oligodendroglioma Ependymoma (2) Medulloblastoma (3) Meningioma,成人脑瘤以胶质细胞瘤多，多位于大脑； 儿童脑瘤以胶质细胞瘤和髓母细胞瘤多