呼肿第四节呼吸系统肿瘤

1、第四节 呼吸系统肿瘤 肺癌鼻咽癌喉癌肺癌carcinoma of the lung1 概述 常见 发病高峰 性别2 病因吸烟空气污染职业：有害粉尘 电离辐射遗传因素？ 3 病理变化 组织发生 支气管粘膜上皮 鳞化 鳞癌 腺上皮 腺癌 肺泡上皮 肺泡细胞癌 支气管粘膜内Kultschitzky细胞 神经内分泌癌肉眼（1） 中央型（2） 周围型（3 ）弥漫型 早期肺癌 2cm 局限于支气管内或浸润管壁 无淋巴结转移 隐性肺癌 临床和X线 阴性；痰 阳性； 并经病理证实为原位癌或早浸癌但无LN转移 This is a squamous cell carcinoma of the lung that

2、is arising centrally in the lung (as most squamous cell carcinomas do). It is obstructing the right main bronchus. The neoplasm is very firm and has a pale white to tan cut surface. This is a peripheral adenocarcinoma of the lung. Adenocarcinomas and large cell anaplastic carcinomas tend to occur mo

3、re peripherally in lung. Adenocarcinoma is the one cell type of primary lung tumor that occurs more often in non-smokers and in smokers who have quit. If this neoplasm were confined to the lung (a lower stage), then resection would have a greater chance for cure. The solitary appearance of this neop

4、lasm suggests that the tumor is primary rather than metastatic. This is another less common type of adenocarcinoma of lung known as a bronchioloalveolar carcinoma. Seen here is variant that appears grossly (and on chest radiograph) as a less well-defined area resembling pneumonic consolidation. An p

5、oorly defined mass involving the upper lobe toward the right here has a pale tan to grey appearance. 组织学类型（1） 鳞状细胞癌（2） 小细胞癌（燕麦细胞癌）（3） 腺癌（肺泡细胞癌）（4） 大细胞癌（5） 其它： 腺鳞癌 肉瘤化癌 类癌 唾液腺癌 The glandular structures formed by this neoplasm are consistent with a moderately differentiated adenocarcinoma. Peripheral

6、lung cancers that have not metastasized can be easily resected.This is a small cell anaplastic (oat cell) carcinoma in which small dark blue cells with minimal cytoplasm are packed together in sheets. Oat cell carcinomas, which are a highly malignant form of neuroendocrine tumor, are often associate

7、d with paraneoplastic syndromes from hormonal effects. The ectopic ACTH syndrome and the syndrome of inappropriate ADH are two such syndromes.4 扩散途径直接蔓延 中央型 纵隔 大血管 周围型 胸膜 胸壁转移 常见 快 淋巴道 肺门淋巴结 纵隔 锁骨上 血道 脑 肾上腺 骨 肝5 临床病理联系 咳嗽 痰中带血 气急 胸痛阻塞支气管 局限性肺不张 肺气肿异位内分泌作用：5-OH 痉挛 潮红肺性骨关节病预后不良 6 检查方法 X光 痰涂片 纤支镜活检 术后病

8、理检查鼻咽癌nasopharngeal carcinoma1 概述 发病率 8位 地区 年龄 性别 临床 2 病因病毒 EBV环境 亚硝胺遗传 家族集聚性 易感性 3 病理变化 来源 粘膜柱状上皮 部位 鼻咽顶部 外侧壁和咽隐窝 肉眼 粗糙 结节 菜花 溃疡组织学类型 （1）角化性鳞癌（2）非角化性鳞癌 分化型 未分化：泡状核细胞癌 泡状核细胞癌 细胞：大 界不清核：大 圆 空；核仁大（大圆细胞癌）癌巢：界不清 癌细胞间大量淋巴细胞放疗敏感 4 扩散和转移直接蔓延 上- 颅底骨 脑神经 侧- 咽鼓管(中耳) 前- 鼻腔 眼眶 后- 颈椎 转移 淋巴道- 颈淋巴结 血道 - 肝 肺 骨 5 临床病理联系 鼻塞