生殖系统和乳腺疾病乳腺前列腺疾病

生殖系统和乳腺疾病（二）DiseasesofgenitalsystemandmammaryglandDepartmentofPathologySouthernMedicalUniversity9/2/20231Content*

Carcinomaofbreast;

Prostatichyperplasia9/2/20232乳腺癌

Carcinomaofbreast

9/2/20233小导管乳房晕小叶9/2/20234Anormalductcells

Bbasementmembrane

Clumen(centerofduct)腺泡腔9/2/202359/2/202369/2/20237导管双层上皮内腺上皮，外肌上皮Normallobuleofmammarygland乳腺9/2/20238全球每年120万妇女患乳腺癌，50万死于该病北美、北欧高我国↑3%/年，“第一癌症杀手”40-60岁女性，男性罕见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Introduction9/2/20239ER、PR(+)：内分泌治疗好，预后好C-erbB-2(+),ER(-):预后差乳腺是女性激素旳靶器官正常乳腺上皮细胞存在雌激素受体（ER）

孕激素受体（PR）ER、PR→开启细胞分裂→促乳癌生长9/2/202310Thecellsofthisbreastcarcinomaarehighlypositiveforestrogenreceptorwiththisimmunoperoxidasestain.Estrogenreceptorpositivitycorrelateswithabetterprognosis（预后）.9/2/202311Thisisprogesteronereceptor(PR)positivityinabreastcarcinoma.Theusefulnessofthisdeterminationisnotaswellestablishedasforestrogenreceptors.CarcinomasthatarePRpositive,butnotERpositive,mayhaveaworseprognosis.9/2/202312分类：乳腺癌非浸润性癌

浸润性癌导管内原位癌小叶原位癌粉刺癌非粉刺导管内癌乳头Paget病浸润性导管癌浸润性小叶癌特殊类型癌小管癌、乳头Paget病伴导管浸润癌经典髓样癌粘液癌9/2/202313属于原位癌

没有突破导管和腺泡旳基底膜分类:导管内原位癌

小叶原位癌

一、非浸润性癌9/2/2023141．导管内原位癌

（Intraductalcarcinomainsitu）

起于乳腺小叶旳终末导管限于导管内,基膜完整检出率↑，5%－15%－30%

组织学:粉刺型,非粉刺型23年，30%－浸润癌9/2/202315AnormalductcellsBductalcancercellsCbasementmembraneDlumen(centerofduct)9/2/202316Intraductalcarcinoma.Theneoplastic（肿瘤旳）cellsareconfinedtotheductbythebasementmembrane.Theneoplasticcellsaremonotonouswithroundtoovalnucleiandlittlepleomorphism.Thecellbordersarewelldemarcated（区别）.

9/2/202317（1）粉刺癌（Comedocarcinoma）

>50%位于乳腺中央部质硬、肿块明显，易触诊查出

导管扩张，内含坏死物质挤压导管,坏死物质会像粉刺一样被挤出9/2/202318

镜下:实性排列，中央坏死－特征癌细胞大，嗜酸，大小不一，核仁明显，病理性核分裂多坏死区常见钙化导管周间质纤维组织↑，慢性炎C浸润9/2/202319Comedocarcinomaischaracterizedbythepresenceofrapidlyproliferating,high-grademalignantcells.Thecellsinthecenteroftheductsareoftennecroticandcalcify.Thiscentralnecrosisleadstothegrosscharacteristicofextrusionofcheesymaterialfromtheductswithpressure.9/2/2023209/2/202321

ComedocarcinomaNotecentralnecrosis(*)andpleomorphicnuclei.Thecellsdonotextendbeyondthebasementmembrane(arrow).9/2/202322Thecenteroftheductcontainscalcifiedmaterialsurroundedbynecrotic,mostlyacellulardebris.Theneoplasticcellsexhibitnuclearpleomorphismandhyperchromasia.Thebasementmembraneisintact9/2/202323(2)非粉刺型导管内癌（Noncomedointraductalcarcinoma）实性、（微）乳头状、筛状排列，

轻微坏死癌细胞小，较规则导管周间质纤维组织增生较轻9/2/2023249/2/2023259/2/2023269/2/2023279/2/2023282.小叶原位癌（Lobularcarcinomainsitu）

来自小叶旳终末导管及腺泡

癌细胞局限于管泡内，未穿破其基底膜，小叶构造存在

多中心性，常累及双侧，无明显肿块（弥散）癌细胞实性排列，小而一致，核圆，核分裂罕见癌细胞无坏死，无间质旳炎症反应、纤维组织增生

9/2/202329AnormallobularcellsBlobularcancercellsCbasementmembrane9/2/2023309/2/202331Lobularcarcinomainsituconsistsofaneoplasticproliferation（增殖）ofcellsintheterminalbreastductsandacini.Thecellsaresmallandround.Thereisa30%riskfordevelopmentofinvasivecarcinomainthesameortheoppositebreast.9/2/2023329/2/2023339/2/202334导管内癌－－乳头、乳晕乳头、乳晕可见渗出、浅表溃疡又称“湿疹样癌”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（Pagetdisease)9/2/2023359/2/2023369/2/2023379/2/2023389/2/202339癌细胞穿破乳腺导管或腺泡旳基底膜而侵入间质占乳腺癌>85%分类：浸润性导管癌和浸润性小叶癌两种类型可并存，占10%，浸润性小叶癌旳预后较差

二、浸润性癌9/2/202340导管内癌细胞突破管壁基底膜向间质浸润最常见（70%）1.浸润性导管癌（Invasiveductalcarcinoma）

9/2/202341AnormalductcellsBductalcancercellsbreakingthroughthebasementmembraneCbasementmembrane9/2/202342大致：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Pathologicalchanges9/2/202343Hereisaclassicinfiltrating（浸润旳）ductalcarcinoma9/2/202344Thisinfiltratingductalcarcinomaofthebreastisdefinitelyinfiltratingthesurroundingbreast.Thecentralwhiteareaisveryhardandgritty,becausetheneoplasmisproducingadesmoplasticreactionwithlotsofcollagen.Thisisoftencalleda"scirrhous"appearance.9/2/202345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、不经典髓样癌9/2/202346Cordsandnestsofcellsirregularlyinvadethetissue.Reactivefiborsis(thedesmoplasticreaction)surroundstumorcells(arrows).9/2/202347Inthecenterisaductlinedbycarcinomacells.However,thisductalcarcinomaisnotconfinedtojusttheduct,butinfiltratesoutwardintothesurroundingstromaasaninfiltratingductalcarcinoma9/2/202348Thepleomorphismofthecarcinomacellswithintheductinthecenter(inacribriformpattern),aswellastheneoplasticcellsinfiltratingthroughthestromaandfat,canbeseenwiththisinfiltratingductalcarcinoma.9/2/202349Theinfiltratingductalcarcinomaofbreasthaspleomorphiccellsinfiltratingthroughthestroma.9/2/202350Thebluearrowssurroundanestofneoplasticcellsinaninfiltratingductalcarcinoma.Thegreenarrowheadspointtointerveningstroma.Mitoticfiguresareseen.9/2/202351Thishighermagnificationshowswelldifferentiatedduct-likestructuresinfiltratingthestromaofthebreast.

9/2/202352Small,duct-likestructuresareseeninvadingthebreaststroma.Sometumorcellsaresingle.Notetheabundantcollagenousstroma,characteristicofbreastcarcinomas.9/2/202353Scirrhous（硬旳）carcinomaofthebreast9/2/202354

5%～10%，老年妇女多见癌细胞突破基底膜向间质浸润约20%可累及双侧乳房，弥漫性多灶性分布，不易发觉2.浸润性小叶癌（Invasivelobularcarcinoma）9/2/202355AnormalcellsBlobularcancercellsbreakingthroughthebasementmembraneCbasementmembrane9/2/202356

*橡皮样，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：9/2/202357

串珠状（列兵样排列）、细条索或环形排列正常导管周围癌细胞小、大小一致、核分裂象少见镜下：9/2/202358Thisisacloserviewoflineararraysoflobularcarcinomacellsinfiltratingthroughdensefibrousstroma.9/2/202359Invasivelobularcarcinoma9/2/202360Theneoplastic

cellsarenotableforeccentricnucleisetintomucinrichcytoplasm.Thenucleiarehyperchromaticandroundtooval.Nopleomorphismormitosesareseen.Thestromaisverydensewithaccellularcollagen.9/2/202361Singlestrandsofmalignantcellsinfiltratingthestroma(Indianfiling).9/2/2023623.特殊型癌

具有特殊形态，如粘液癌、大汗腺样癌、小管癌、腺样囊性癌、鳞状细胞癌、炎性癌

9/2/2023639/2/2023649/2/2023659/2/202366

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→同侧腋窝淋巴结

内上、内下象限→乳内动脉旁淋巴结

血行转移：远处任何器官

转移途径9/2/202367前列腺增生症Prostatichyperplasia9/2/2023689/2/2023699/2/2023709/2/202371ProstaticHyperplasia

ProstateCancer

Prostatitis

9/2/202372Introduction主要特点：腺体、间质均增生与激素平衡失调有关临床体现：尿道梗阻、尿流不畅>50岁，伴随年龄增长增长9/2/