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秃鲍
5 years ago
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1 Breast disease 马丽琴

2 乳腺解剖结构和各部位主要病变

4 Lobular structure

5 Lactating mammary gland

6 Main contents Non-neoplastic lesions Fibrocystic changes --Nonproliferative changes --Proliferative changes Sclerosing adenosis Tumors of breast Benign --Fibroadenoma --Intraductal papilloma Malignant Carcinoma Noninvasive carcinoma Invasive carcinoma

7 Proliferative Change

8 Common disease for female 20~40-year-old Cyst formation, proliferative fibrocystic changes (fibrocystic breast disease) --- precancerous lesions. involved in endocrine disorders by ovarian progesterone, estrogen

9 Pathological changes Lobular hyperplasia, ductal hyperplasia and fibrosis, Cyst formation Nonproliferative changes and Proliferative changes: -- Nonproliferative: Mainly as cysts and interstitial fibrosis; blue top cyst( 蓝顶囊肿 ) -- Proliferative: cyst formation, interstitial fibrosis, hyperplasia of peripheral catheters and alveolar epithelium.

10 Fibrocystic changes of breast

11 Non-proliferative changes

12 Fibrocystic change

13 Type of Proliferative changes 1Mild hyperplasia cancer risk 2Florid hyperplasia( 旺炽性增生 ): times 3Atypical hyperplasia 5 times 4Carcinoma in situ 10-fold

14 旺炽性增生 : 上皮增生, 肌上皮存在 ; 残存大小不规则空隙

15 不典型增生 : 上皮单一, 缺肌上皮 ; 形成筛孔状

16 导管上皮不典型增生 : 微乳头形成 ;

17 轻度增生旺炽性增生增生性纤维囊性变非典型性增生原位癌

18 Sclerosing adenosis Contain marked intralobular fibrosis and proliferation of small ductules and acini G: Hard, rubbery consistency M: Proliferation of lining epithelium and myoepithelial cells in small ducts and ductules Marked stromal fibrosis may compress and distort the epithelium, or completely compress the lumina of acini and ducts, so that they appear as solid cords of cells

19 腺体和小叶间质结节状增生

20 Sclerosing adenosis

21 Fibroadenoma of the breast Overview: a common benign tumor for young women with high levels of estrogen secretion Pathological changes: --G: border--clear round or oval nodules,grey-white --M: proliferation of fibrous stroma and glands

22 Fibroadenoma of the breast

23 Fibroadenoma of the breast

24 纤维腺瘤 ; 管内型, 腺体裂隙状

25 纤维腺瘤 ; 管内型, 腺体裂隙状

26 管周型 : 纤维间质围绕腺管

27 导管内乳头状瘤

28 Carcinoma of the breast

29 Overview 32% of all malignant tumors in women 20% of all cancer death in women Most cases >35 years old

30 Etiology Hormonal influence: estrogen level excess --Nulliparity ( 未经产 ) -- late age at first child -- functioning ovarian tumor Fibrocystic disease Radiation exposure Genetic predisposition Viral factors

31 Site Carcinoma of the breast inner upper 10% outer upper 50% Central zone 20% inner lower 10% outer lower 10%

32 乳腺癌非浸润性癌 (15-30%) 浸润性癌 (70-85%) 导管内原位癌小叶原位癌浸润性导管癌浸润性小叶癌粉刺癌非粉刺导管内癌乳头 Paget 病伴导管原位癌特殊类型癌 : 乳头 Paget 病伴导管浸润癌, 典型髓样癌粘液癌小管癌等

33 Pathological change G:outer upper 50% Size,consistence, boundary, grey-white Hemorrhage, necrosis, ulceration, skin "orange peel" appearance.

34 Pathological changes Classification: 1. Noninfiltrating carcinoma Intraductal carcinoma (intraductal carcinoma in situ) Comedocarcinoma Noncomed intraductal carcinoma lobular carcinoma in situ 2. Infiltrating carcinoma Invasive ductal carcinoma: Account for 70% Invasive lobular carcinoma Special types

35 Noninfiltrating carcinoma ( 一 ) 1. Intra ductal carcinoma ( 导管内癌 ) Occurred in the terminal duct lobular, but have no lobular structures Cancer cells limited to the intra-duct, basement membrane integrity After 20 years, 30% changing to infiltrating carcinoma

36 Noninfiltrating carcinoma Carcinoma of the breast Intra ductal carcinoma a. comedocarcinoma ( 粉刺癌 ) Solid sheets of high grade malignant cells, central necrosis, microcalcifications b. Noncomed intraductal arcinoma ( 非粉刺癌 ) Monomorphic Solid Papillary Cribriform

37 Intra ductal carcinoma c. Paget s disease of the nippl with intraductal carcinoma ( 乳头 Paget 病伴导管内癌 ) : exudation, ulcers, extends from nipple ducts into skin involvement of the epidermis by malignant cells

38 粉刺癌非粉刺导管内癌乳头 Paget 病

39 Noninfiltrating carcinoma( 二 ) Carcinoma of the breast 2.Lobular carcinoma in situ (LCIS) One or more terminal ducts or acini filled with monomorphic cell Bilateral involvement in 30% cases LCIS is virtually always an incidental finding, unlike DCIS, it dose not form masses The involved lobules remain recognizable, basement membrane integrity

40 乳腺小叶原位癌

41 Infiltrating carcinom Infitrating ductal carcinoma: most common,70% Pathological change: G: infiltrating the surrounding breast tissues-- no capsule, hard, retracted and dimpling of skin -- Orange peel, involvement of the lymphatic pathways -- lymphedema, the skin becomes thickened around hair follicles M: carcinoma simplex ( 单纯癌 ), fibrocarcinoma( 硬癌 ), carcinoma medullare ( 髓样癌 )

42 乳腺癌穿破皮肤形成溃疡

43 乳腺癌

44 乳腺癌左 : 乳腺表面皮肤呈橘皮样外观, 乳头凹陷右 : 切面见肿物位于乳头下, 乳头凹陷 ( 箭头处 )

45 浸润性导管癌

46 单纯癌

47 硬癌

48 髓样癌

49 浸润性导管癌硬癌髓样癌单纯癌

50 Invasive lobular carcinoma G: rubbery and poorly circumscribed M: --Lobular carcinoma in situ penetrates the basement membrane to stroma, about 5% -10% --Cancer cells: Single-line beaded, cord-like, --About 20% involving the bilateral breast, --multifocal distribution is not easy to be checked. IHC: Infiltrating carcinoma E-cadherin: - or -/+, P120( 连环素蛋白 ): + (plasma)

51 浸润性小叶癌

52 浸润性小叶癌 : 正常腺体周靶环状排列瘤细胞

53 Carcinoma of the breast Infiltrating carcinoma Special types A. Medullary carcinoma solid sheets of large cells with pleomorphic nuclei, frequent mitosis, lymphocytic infiltration surround and within tumor, pushing, well-circumscribed borders B. Tubular carcinoma C. Mucinous carcinoma (colloid carcinoma)

54 粘液癌 : 近期预后好

55 小管癌 : 不常见, 浸润癌的一种

56 小管癌

57 乳腺黏液癌

58 乳腺黏液癌

59 Metastasis Direct spread: Lymphoatic: axillary node, subclavian node Bloodstream: lung, bone, liver, and brain

60 腋窝淋巴结乳腺癌

61 乳腺癌与雌孕激素受体乳腺是女性激素 ( 雌激素孕激素 ) 的靶器官正常乳腺上皮具有雌激素受体 (ER) 及孕激素受体 (PR) 癌变后的细胞可有可无上述两种受体, 目前临床上对此两种受体的检测已成为常规

第一篇細胞循環因子與乳癌之基因體不穩定的相關

第一篇細胞循環因子與乳癌之基因體不穩定的相關 (Hanahan and Weinberg, 2000) (Kelsey and Bernstein, 1996) (mammary ductal epithelium) (mammary lobular) (Kelsey and Horn-Ross, 1993) (World Health Organization) 1981 3-1 (non-invasive) (invasive) Paget