生殖系统和乳腺疾病--乳腺癌及前列腺疾病

生殖系统和乳腺疾病（二） Diseases of genital system and mammary gland Department of Pathology Southern Medical University Date1 Content * Carcinoma of breast; Prostatic hyperplasia Date2 乳 腺 癌 Carcinoma of breast Date3 Date4 A A normal duct cells B B basement membrane C C lumen (center of duct) Date5 Date6 Date7 导管双层上皮 内腺上皮，外肌上皮 Normal lobule of mammary gland Date8 全球每年全球每年120120万妇女患乳腺癌，万妇女患乳腺癌，5050万死于该病万死于该病 北美、北欧高北美、北欧高 我国我国3%/3%/年，年，“第一癌症杀手第一癌症杀手” 40-6040-60岁女性，男性罕见岁女性，男性罕见1%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来自乳腺终末导管小叶单元上皮 Introduction Date9 ERER、PR (+)PR (+)：内分泌治疗好，预后好内分泌治疗好，预后好 C-erbB-2 (+), ER (-): C-erbB-2 (+), ER (-): 预后差预后差 乳腺是女性激素的靶器官乳腺是女性激素的靶器官 正常乳腺上皮细胞存在正常乳腺上皮细胞存在雌激素受体（雌激素受体（ERER） 孕激素受体（孕激素受体（PRPR） ERER、PRPR启动细胞分裂启动细胞分裂促乳癌生长促乳癌生长 Date10 The cells of this breast carcinoma are highly The cells of this breast carcinoma are highly positive for estrogen positive for estrogen receptorreceptor with this with this immunoperoxidaseimmunoperoxidase stain. Estrogen receptor stain. Estrogen receptor positivitypositivity correlates with a correlates with a better prognosisbetter prognosis. . Date11 This is progesterone receptor (PR) This is progesterone receptor (PR) positivitypositivity in a breast carcinoma. in a breast carcinoma. The usefulness of this determination is not as well established as for The usefulness of this determination is not as well established as for estrogen receptors. Carcinomas that are PR positive, but not ER estrogen receptors. Carcinomas that are PR positive, but not ER positive, may have a worse prognosis.positive, may have a worse prognosis. Date12 分类： 乳腺癌乳腺癌 非浸润性癌非浸润性癌 浸润性癌浸润性癌 导管内原位癌原位癌 小叶原位癌原位癌 粉刺癌粉刺癌 非粉刺导管内癌非粉刺导管内癌 PagetPaget病病 浸润性浸润性导管癌癌 浸润性浸润性小叶癌癌 特殊类型癌特殊类型癌 小管癌小管癌 典型髓样癌典型髓样癌 粘液癌粘液癌 Date13 属于属于原位癌原位癌 没有突破没有突破导管和腺泡的导管和腺泡的基底膜基底膜 分类分类: : 导管内原位癌 小叶原位癌 一、非浸润性癌一、非浸润性癌 Date14 1导管内原位癌 （IntraductalIntraductal carcinoma in situ carcinoma in situ） v 起于乳腺小叶的终末导管 v 限于导管内,基膜完整 v 检出率，5%15%30% v 组织学: 粉刺型,非粉刺型 v 20年，30%浸润癌 Date15 A A normal duct cells normal duct cells B B ductalductal cancer cells cancer cells C C basement membrane basement membrane D D lumen (center of duct) lumen (center of duct) Date16 IntraductalIntraductal carcinoma. The carcinoma. The neoplasticneoplastic cells are confined to cells are confined to the duct by the basement membrane. The the duct by the basement membrane. The neoplasticneoplastic cells cells are monotonous with round to oval nuclei and little are monotonous with round to oval nuclei and little pleomorphismpleomorphism. The cell borders are well demarcated The cell borders are well demarcated. Date17 （1）粉刺癌（ （ComedocarcinomaComedocarcinoma） 50%位于乳腺中央部 质硬、肿块明显，易触诊质硬、肿块明显，易触诊 查出查出 导管扩张，内含坏死物质导管扩张，内含坏死物质 挤压导管挤压导管, , 坏死物质会像坏死物质会像 粉刺一样被挤出一样被挤出 Date18 镜下: v实性排列，中央坏死特征 v癌细胞大，嗜酸，大小不一，核仁明显， 病理性核分裂多 v坏死区常见钙化 v导管周间质纤维组织，慢性炎C浸润 Date19 ComedocarcinomaComedocarcinoma is characterized by is characterized by the presence of the presence of rapidly proliferating, rapidly proliferating, high-grade malignant cells.high-grade malignant cells. The cells in The cells in the center of the ducts are often the center of the ducts are often necrotic and calcifynecrotic and calcify. This central . This central necrosis leads to the gross necrosis leads to the gross characteristic of characteristic of extrusion of cheesy extrusion of cheesy material from the ducts with pressurematerial from the ducts with pressure. . Date20 Date21 Comedocarcinoma Note central necrosis (*) and Note central necrosis (*) and pleomorphicpleomorphic nuclei. The cells do not extend nuclei. The cells do not extend beyond the basement membrane (arrow). beyond the basement membrane (arrow). Date22 The center of the duct contains calcified material surrounded by necrotic, The center of the duct contains calcified material surrounded by necrotic, mostly mostly acellularacellular debris. The debris. The neoplasticneoplastic cells exhibit nuclear cells exhibit nuclear pleomorphismpleomorphism and and hyperchromasiahyperchromasia. The basement membrane is intact. The basement membrane is intact Date23 (2)非粉刺型导管内癌 （Noncomedo intraductal carcinoma） v实性、乳头状、筛状排列，轻微 坏死 v癌细胞小，较规则 v导管周间质纤维组织增生较轻 Date24 Date25 Date26 Date27 Date28 2.小叶原位癌（Lobular carcinoma in situLobular carcinoma in situ） n n 来自来自小叶的终末导管及腺泡小叶的终末导管及腺泡 n n 癌细胞癌细胞局限于管泡内，未穿破其基底膜，局限于管泡内，未穿破其基底膜， 小叶结构存在小叶结构存在 n n 多中心性，常累及双侧，多中心性，常累及双侧，无无明显肿块明显肿块 n n 癌细胞癌细胞实性排列，小而一致实性排列，小而一致，核圆，核分，核圆，核分 裂罕见裂罕见 n n 癌细胞癌细胞无无坏死，坏死，无无间质的炎症反应、纤维间质的炎症反应、纤维 组织增生组织增生 Date29 A A normal lobular cells normal lobular cells B B lobular cancer cells lobular cancer cells C C basement membrane basement membrane Date30 Date31 Lobular carcinoma in situ consists of a Lobular carcinoma in situ consists of a neoplasticneoplastic proliferation of cells proliferation of cells in the terminal breast ducts and in the terminal breast ducts and aciniacini. The cells are small and round. . The cells are small and round. There is a 30% risk for development of invasive carcinoma in the same There is a 30% risk for development of invasive carcinoma in the same or the opposite breast.or the opposite breast. Date32 Date33 Date34 v导管内癌乳头、乳晕 v乳头、乳晕可见渗出、浅表溃疡 v又称 “湿疹样癌” v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（Paget disease) Date35 Date36 Date37 Date38 Date39 n n 癌细胞癌细胞穿破穿破乳腺导管或腺泡的乳腺导管或腺泡的基底膜基底膜而而 侵入间质侵入间质 n n 占乳腺癌占乳腺癌 85%85% n n 分类：分类：浸润性导管癌和和浸润性小叶癌 n n 两种类型可并存，占两种类型可并存，占10%10%，浸润性小叶癌，浸润性小叶癌 的预后较差的预后较差 二、浸润性癌二、浸润性癌 Date40 n n 导管内癌细胞突破管壁基底膜向导管内癌细胞突破管壁基底膜向 间质浸润间质浸润 n n 最常见（最常见（70%70%） 1.浸润性导管癌（Invasive Invasive ductalductal carcinoma carcinoma） Date41 A A normal duct cells normal duct cells B B ductalductal cancer cells cancer cells breaking through the breaking through the basement membrane basement membrane C C basement membrane basement membrane Date42 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 Pathological changes Date43 Here is a classic infiltrating Here is a classic infiltrating ductalductal carcinoma carcinoma Date44 This infiltrating This infiltrating ductalductal carcinoma of the breast is definitely infiltrating the carcinoma of the breast is definitely infiltrating the surrounding breast. The central white area is very surrounding breast. The central white area is very hardhard and and gritty,gritty, because the neoplasm is producing a because the neoplasm is producing a desmoplasticdesmoplastic reaction with lots of reaction with lots of collagen. This is often called a “collagen. This is often called a “scirrhousscirrhous“ appearance. “ appearance. Date45 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 Date46 Cords and nests of cells irregularly invade the tissue. Reactive Cords and nests of cells irregularly invade the tissue. Reactive fiborsisfiborsis (the (the desmoplasticdesmoplastic reaction) surrounds tumor cells (arrows). reaction) surrounds tumor cells (arrows). Date47 In the center is a duct lined by carcinoma cells. However, this In the center is a duct lined by carcinoma cells. However, this ductalductal carcinoma is not confined to just the duct, but infiltrates outward into the carcinoma is not confined to just the duct, but infiltrates outward into the surrounding surrounding stromastroma as an infiltrating as an infiltrating ductalductal carcinoma carcinoma Date48 The The pleomorphismpleomorphism of the carcinoma cells within the duct in the center (in of the carcinoma cells within the duct in the center (in a a cribriformcribriform pattern), as well as the pattern), as well as the neoplasticneoplastic cells infiltrating through the cells infiltrating through the stromastroma and fat, can be seen with this infiltrating and fat, can be seen with this infiltrating ductalductal carcinoma. carcinoma. Date49 The infiltrating The infiltrating ductalductal carcinoma of breast has carcinoma of breast has pleomorphicpleomorphic cells cells infiltrating through the infiltrating through the stromastroma. . Date50 The blue arrows surround The blue arrows surround a nest of a nest of neoplasticneoplastic cells cells in an infiltrating in an infiltrating ductalductal carcinoma. The green arrowheads point to carcinoma. The green arrowheads point to intervening intervening stromastroma. . Mitotic figuresMitotic figures are seen. are seen. Date51 This higher magnification shows well differentiated This higher magnification shows well differentiated duct-like structuresduct-like structures infiltrating the infiltrating the stromastroma of the breast. of the breast. Date52 Small, duct-like structuresSmall, duct-like structures are seen invading the breast are seen invading the breast stromastroma. . Some tumor cells are single. Note the Some tumor cells are single. Note the abundant abundant collagenouscollagenous stromastroma, characteristic of breast carcinomas. , characteristic of breast carcinomas. Date53 ScirrhousScirrhous carcinoma of the breast carcinoma of the breast Date54 5%5%10%10%，老年妇女多见老年妇女多见 癌细胞癌细胞突破突破基底膜向间质浸润基底膜向间质浸润 约约20%20%可累及双侧乳房，可累及双侧乳房，弥漫性多灶弥漫性多灶 性分布性分布，不易发现，不易发现 2.浸润性小叶癌（Invasive lobular carcinomaInvasive lobular carcinoma） Date55 A A normal cellsnormal cells B B lobular cancer cells lobular cancer cells breaking through the breaking through the basement membrane basement membrane C C basement membrane basement membrane Date56 * * 橡皮样橡皮样，灰白柔韧，边界不清，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： Date57 v串珠状、细条索或环形 排列正常导管周围 v癌细胞小、大小一致、 核分裂象少见 镜下： Date58 This is a closer view of linear arrays of lobular carcinoma This is a closer view of linear arrays of lobular carcinoma cells infiltrating through dense fibrous cells infiltrating through dense fibrous stromastroma. . Date59 Invasive lobular carcinoma Date60 The The neoplasticneoplastic cells are notable for eccentric nuclei set into cells are notable for eccentric nuclei set into mucinmucin rich cytoplasm. The nuclei are rich cytoplasm. The nuclei are hyperchromatichyperchromatic and and round to oval. No round to oval. No pleomorphismpleomorphism or mitoses are seen. The or mitoses are seen. The stromastroma is very dense with is very dense with accellularaccellular collagen. collagen. Date61 Single strands of malignant cells infiltrating Single strands of malignant cells infiltrating the the stromastroma (Indian filing).(Indian filing). Date62 3.特殊型癌 具有特殊形态，如粘液癌、大汗腺 样癌、腺样囊性癌、鳞状细胞癌、炎 性癌 Date63 Date64 Date65 Date66 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、外下象限和中心区外上、外下象限和中心区同侧腋窝淋巴结同侧腋窝淋巴结 内上、内下象限内上、内下象限乳内动脉旁淋巴结乳内动脉旁淋巴结 血行转移：远处任何器官远处任何器官 转移途径转移途径 Date67 前列腺增生症 Prostatic hyperplasia Date68 Date69 Date70 Date71 ProstaticProstatic Hyperplasia Hyperplasia Prostate Cancer Prostatitis Date72 Introduction n n 主要特点：主要特点：腺体、间质均增生腺体、间质均增生 n n 与激素平衡失调有关与激素平衡失调有