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1、第 十二 章,女性生殖系统和乳腺疾病,第 十二 章女性生殖系统和乳腺疾病,2022/11/18,2,2022/9/282,2022/11/18,3,2022/9/283,2022/11/18,4,Here is a normal cervix with a smooth, glistening mucosal surface. There is a small rim of vaginal cuff from this hysterectomy specimen. The cervical os is small and round, typical for a nulliparous wom
2、an. The os will have a fish-mouth shape after one or more pregnancies.,2022/9/284Here is a normal cer,2022/11/18,5,The normal adult vaginal mucosa with a wrinkled appearance that is seen in women of reproductive years appears at the left. The cervix has been opened to reveal an endocervical canal le
3、ading to the lower uterine segment at the right that has an erythematous appearance extending to the cervical os consistent with chronic inflammation.,2022/9/285The normal adult vag,2022/11/18,6,2022/9/286,2022/11/18,7,子宫颈疾病子宫体疾病,2022/9/287 子宫颈疾病,2022/11/18,8,一、慢性子宫颈炎,二、子宫颈上皮非典型增生和原位癌,三、子宫颈癌,子宫颈疾病,2
4、022/9/288一、慢性子宫颈炎二、子宫颈上皮非典型增生,2022/11/18,9,慢性子宫颈炎是育龄期妇女最常见的疾病。多由于细菌、病毒感染或者继发于分娩、流产等所致子宫颈损伤。 临床主要表现是白带过多。,一、慢性子宫颈炎,(chronic cervicitis),2022/9/289一、慢性子宫颈炎(chronic cer,2022/11/18,10,病理变化：肉眼观: 子宫颈粘膜 充血、肿胀，呈颗粒状或糜烂状。 白带过多,2022/9/2810,2022/11/18,11,子宫颈粘膜充血水肿，间质有炎症细胞：单核细胞、淋巴细胞及浆细胞浸润； 子宫颈柱状上皮和腺上皮伴不同程度增生或鳞状
5、上皮化生。 子宫颈息肉(cervical polyp)：良性瘤样病变， 恶变率很低。 有时子宫颈腺囊肿(Nabothian cyst) 。,镜下: （子宫颈非特殊性炎症）,2022/9/2811镜下: （子宫颈非特殊性炎症）,2022/11/18,12,慢性宫颈炎,This is normal cervical non-keratinizing squamous epithelium. The squamous cells show maturation from basal layer to surface.,正常宫颈上皮,2022/9/2812慢性宫颈炎This is normal,202
6、2/11/18,13,Endocervical polyp由子宫颈粘膜、腺体、间质纤维结缔组织局限性增生而成,2022/9/2813Endocervical polyp,2022/11/18,14,真性 假性糜烂：,子宫颈阴道部鳞状上皮的真性糜烂被子宫颈管内柱状上皮快速生长外移所取代。（由于所覆盖的单层柱状上皮很薄，使上皮下血管容易暴露而呈红色，看上去像糜烂，实际上所看到的是子宫颈内膜组织。）,Small round dark lymphocytes are seen in the submucosa, and there is also hemorrhage.,2022/9/2814 真性
7、假性糜烂： 子宫颈阴道,2022/11/18,15,二、子宫颈上皮非典型增生和原位癌,子宫颈上皮非典型增生：子宫颈上皮被不同程度异型性的细胞所取代，属癌前病变。 异型细胞增生从基底层开始，逐渐向表层发展。原位癌： 上皮全层为异型细胞所替代，未突破基底膜。,(Cervical epithelial dysplasia),好发部位： 子宫颈 鳞-柱 上皮交界带(移行带)。,2022/9/2815二、子宫颈上皮非典型增生和原位癌 (C,2022/11/18,16,非典型增生 原位癌 分级： 近年来将子宫颈上皮非典型增生至原位癌这一系列癌前病变的连续过程统称为子宫颈上皮内瘤变(Cervical int
8、raepithelial neoplasia, CIN)。根据非典型增生的程度和范围，可将CIN分为： (CIN )： 轻度非典型增生 (CIN )： 中度非典型增生 (CIN )： 重度非典型增生及原位癌,2022/9/2816非典型增生 原位癌 分级：,2022/11/18,17,轻度非典型增生(CIN )： 异型细胞局限于上皮层的下1/3区。 中度非典型增生(CIN )： 异型细胞占上皮层下1/32/3； 细胞异型明显，核质比例增加，极性稍乱。 重度非典型增生及原位癌 (CIN )： 异型细胞显著增多，超过上皮层的下2/3， 核异型性大，深染； 上皮细胞层次消失，仅表层尚见少量成熟扁平
9、细胞覆盖于表面。 原位癌： 异型细胞占据上皮厚度的全部， 未突破基底膜。,病理变化：,2022/9/2817 轻度非典型增生(CIN )：病,2022/11/18,18,重度非典型增生和原位癌没有明显界限， 原位癌的异型细胞多形性更显著，核分裂多见。,2022/9/2818 重度非典型增生和原位癌没有明显界,2022/11/18,19,The marked maturation delay in this tissue can be identified by the presence of immature cells oriented perpendicular to the baseme
10、nt membrane (BM, blue dotted line) in the lower 2/3 of the epithelium (blue arrow). Mitotic figures can be seen at inappropriately high levels in the epithelium. Partial maturation is identified in the upper 1/3 by the cells that lie parallel to the BM (green arrow) and begin to acquire more cytopla
11、sm. (The nuclei are widely spaced.),2022/9/2819The marked maturati,2022/11/18,20,异型细胞：类似正常基底细胞或体积较小，大小不等，细胞核较大深染，细胞浆稀少，细胞排列紊乱，可见核分裂。,2022/9/2820 异型细胞：类似正常基底细胞或体积较,2022/11/18,21,预后： （1）非典型增生级别与浸润癌的机会成正比。轻度非典型增生多数可自然消退， 2%发展为浸润癌 。CIN 至少有20% 在10年内发展为浸润癌。 （2）非典型增生 原位癌平均时间： 约10年。 （3）非典型增生 + 16、18或33型高危型人
12、乳头状瘤 病毒(HPV)合并感染 较高恶变倾向。,早诊断，早治疗 醋酸染色 Schiller实验，脱落细胞学检查，组织病理学检查,2022/9/2821 预后：早诊断，早治疗,2022/11/18,22,三、子宫颈癌,子宫颈癌是女性生殖系统常见的恶性肿瘤之一。发病年龄以4060岁为多，发病最高峰年龄为45岁。 临床表现多变： 阴道不规则流血 阴道排泄物带血 接触性出血等,(Carcinoma of the cervix),2022/9/2822三、子宫颈癌 子宫颈癌是女性生,2022/11/18,23,（1）早婚、多产、性生活过早、性生活紊乱、子宫颈裂伤、包皮垢、感染等因素有关。 （2）通常继
13、发于CIN. （3）与人类乳头状瘤病毒(HPV)16、18型， 31、33型的感染有关。,病因：,2022/9/2823 病因：,2022/11/18,24,组织来源：子宫颈阴道部或移行带：鳞状上皮子宫颈管粘膜柱状上皮柱状上皮下的储备细胞,2022/9/2824组织来源：,2022/11/18,25,鳞状细胞癌 约 80%95%腺 癌 腺鳞癌 未分化癌,类型：,早期浸润癌浸润癌,2022/9/2825类型：早期浸润癌,2022/11/18,26,1）子宫颈鳞状细胞癌,(Squamous cell carcinoma of the cervix),早期浸润癌,（微灶浸润型鳞状细胞癌）,浸润癌,少
14、数肿瘤细胞突破基底膜 浸润间质的深度不超过基底膜下5mm 没有血管浸润也无淋巴结转移 常无明显临床症状,癌组织突破基底膜 明显浸润间质，深度超过基底膜下5mm 伴有临床症状者,2022/9/28261）子宫颈鳞状细胞癌 (Squamou,2022/11/18,27,肉眼观： 内生浸润型 溃疡型 外生菜花型 糜烂型,病理变化：,2022/9/2827肉眼观： 病理变化：,2022/11/18,28,Here is another cervical squamous cell carcinoma. Note the IUD string protruding from the cervix. Th
15、is implies that someone could have done a Pap smear when it was inserted. There is a natural history of progression of dysplasia to carcinoma, so dont leave dysplasias alone.,2022/9/2828Here is another cer,2022/11/18,29,2022/9/2829,2022/11/18,30,高分化鳞癌 （ 20%） 癌细胞主要为多角形，似鳞状上皮的棘细胞 有癌巢、角化及癌珠形成 核分裂不多,镜下：
16、,按其分化程度可分为三型,At high magnification, nests of neoplastic squamous cells are invaded through a chronically inflamed stroma. This cancer is well- differentiated, as evidenced by keratin pearls.,2022/9/2830高分化鳞癌 （ 20%） 镜下：按其,2022/11/18,31,中分化鳞癌 （60%）多为大细胞型， 癌细胞为椭圆形或大梭形无明显角化和癌珠形成，会有不规则和条型癌巢形成核分裂和细胞异型性较明显
17、,Invasive moderately differentiated squamous cell carcinoma of uterine cervix,2022/9/2831中分化鳞癌 （60%）Invasiv,2022/11/18,32,低分化磷癌 （20%） 多为小细胞型，细胞呈小梭形，似基底细胞，异型性 及核分裂都很明显，对放射线最敏感，但预后较差。,2022/9/2832低分化磷癌 （20%）,2022/11/18,33,近年来子宫颈腺癌的发病率有上升趋势，约占子宫颈癌的10%20%。,2）子宫颈腺癌 (cervical adenocarcinoma),多数为高分化或中分化，腺体结
18、构,2022/9/2833 近年来子宫颈腺癌的发病,2022/11/18,34,直接蔓延，极少侵犯宫体经淋巴道转移血行转移（较少）,临床分5期(staging system)： 0-IV期 0-II期: 原位和子宫颈，累及阴道但未达到阴道下1/3 III-IV期： 盆腔及腹腔器官,子宫颈癌的扩散和转移,主要途径：,2022/9/2834临床分5期(staging syste,2022/11/18,35,Invasive squamous carcinoma of cervix in vascular channel. The presence of tumor cells within the
19、 lumen of a capillary-like space (arrow) is evidence for aggressive growth potential in squamous carcinoma of the cervix and has been correlated with increased risk for regional lymph node metastasis.,2022/9/2835Invasive squamous c,2022/11/18,36,子宫体疾病,一、子宫内膜增生症二、子宫内膜癌三、子宫平滑肌瘤及平滑肌肉瘤,2022/9/2836子宫体疾病一
20、、子宫内膜增生症,2022/11/18,37,病理变化大体： 子宫内膜增厚-弥漫性或局灶性镜下：1、单纯性增生 2、复杂性增生 3、非典型增生 ，1/3的病人发展为癌,子宫内膜增生症,2022/9/2837病理变化子宫内膜增生症,2022/11/18,38,Simple hyperplasia单纯性增生,2022/9/2838Simple hyperplasia,2022/11/18,39,Complex hyperplasia without atypia 复杂性增生,2022/9/2839Complex hyperplasia,2022/11/18,40,Complex hyperplas
21、ia with atypia不典型增生,2022/9/2840Complex hyperplasia,2022/11/18,41,子宫内膜癌是女性生殖道常见的肿瘤之一 多发生在绝经期和绝经期后的妇女，尤其是5565岁 主要症状：白带增多和不规则阴道流血。 病因未明，可能与雌激素长期刺激有关。,（二）子宫内膜癌,（Endometrial carcinoma）,2022/9/2841 子宫内膜癌是女性生殖道,2022/11/18,42,部位：多见于宫底及后壁，少数在侧壁、宫角、前壁 、子宫下段。生长方式： 局部生长：占多数，肿瘤局限于某一部位； 弥漫生长：肿瘤可累及整个宫腔。形态：肿块状、息肉状、
22、乳头状或菜花状，灰白色，质脆。表面可有坏死、溃疡浸润性：可有可无，不一定。,病理变化,肉眼：,2022/9/2842部位：多见于宫底及后壁，少数在侧壁、宫,2022/11/18,43,2022/9/2843,2022/11/18,44,子宫内膜样腺癌（常见约85%）： 根据癌细胞的分化程度可分： 高分化腺癌（级）： 结构类似子宫内膜腺体，但管状腺排列拥挤、紊乱， 腺体间极少有间质相隔，细胞轻度异型性； 中分化腺癌（级）： 腺体不规则，有较多腺体或微腺体结构，细胞不规 则、复层，核异型，可见核分裂； 低分化腺癌（级）： 大部分区域为实心片状或条索状，细胞异型性大， 分裂像多，腺体结构很少。,镜
23、下：,2022/9/2844镜 下：,2022/11/18,45,grade I,grade II,grade III,2022/9/2845grade I grade II gr,2022/11/18,46,直接蔓延：输卵管、卵巢、子宫颈、阴道等。种植： 腹膜、子宫直肠窝及大网膜等。转移： 早期淋巴道转移 腹主动脉旁和盆腔淋巴结 晚期血道转移 肺、肝、骨等根据子宫内膜癌侵犯的范围，临床上分14期： 期，癌局限于子宫体； 期，癌侵犯子宫及子宫颈； 期，癌扩散至子宫以外，但未超过真骨盆； IV期，癌超出真骨盆或明显侵犯膀胱或直肠粘膜。,浸润及转移,2022/9/2846直接蔓延：输卵管、卵巢、子
24、宫颈、阴道等,2022/11/18,47,子宫平滑肌瘤(leiomyoma),子宫平滑肌瘤是女性生殖器官中最常见的一种良性肿瘤 多见于3050岁妇女，发病率高达75% 50% 平滑肌瘤有症状： 盆腔疼痛 压迫感 子宫出血等,2022/9/2847子宫平滑肌瘤(leiomyoma),2022/11/18,48,生长部位：子宫任何部位。子宫肌层内、子宫浆膜 下或子宫内膜下； 单发或多发：多发性平滑肌瘤可多达数十个； 大小悬殊：小者在显微镜下才能见，大者如成人拳 头或更大； 形态： 多呈球形或不规则形，质较韧； 界限明显，但无明显包膜； 切面观： 瘤组织常呈编织状或旋涡状。 继发性改变：玻璃样变、粘
25、液变、囊性变、水肿、 出血及坏死等。,病理变化,肉眼：,2022/9/2848 生长部位：子宫任何部位。子宫肌层内、,2022/11/18,49,2022/9/2849,2022/11/18,50,瘤细胞与正常子宫平滑肌细胞相似 肌瘤细胞的特点： 核排列比较密集 常成纵横交错的不规则束状或编织状 核长杆状，两端钝圆，染色质纤细,镜下：,Normal myometrium,leiomyoma,2022/9/2850 瘤细胞与正常子宫平滑肌细胞相似镜下,2022/11/18,51,病名性质病因,水泡状胎块葡萄胎Hydatidiform mole潜在恶性与妊娠有关 1/150,侵袭性水泡状胎块恶性葡
26、萄胎Invasive mole低度恶性继葡萄胎后少数一开始具侵袭性,绒毛膜癌绒癌Choriocarcinoma高度恶性葡萄胎后50%，流产后25%，分娩后25%，极少数与妊娠无关,滋养层细胞疾病,2022/9/2851病名水泡状胎块侵袭性水泡状胎块绒毛膜癌,2022/11/18,52,病变,仅在宫腔内，绒毛水泡状形似葡萄，绒毛间质高度水肿，绒毛血管消失，滋养细胞增生，可有异型,子宫肌层内水泡状组织，形态同葡萄胎，但异型较明显侵及子宫肌层,子宫肌壁出血性肿块，不见绒毛结构，癌组织两种细胞构成，无间质、无血管、无绒毛结构，出血、坏死明显,2022/9/2852病变仅在宫腔内，绒毛水泡状形似葡萄，绒
27、,2022/11/18,53,转移预后,极少或无完全性水泡状胎块发展为恶性葡萄胎10%；恶变为绒癌2.5%；部分性者不恶变,可转移良好，化疗效果较好,易经血道转移差，化疗有效,2022/9/2853转移极少或无可转移易经血道转移,2022/11/18,54,葡 萄 胎,2022/9/2854葡 萄 胎,2022/11/18,55,绒毛膜癌,2022/9/2855绒毛膜癌,2022/11/18,56,乳腺疾病,2022/9/2856乳腺疾病,2022/11/18,57,乳腺癌（Carcinoma of the breast）,妇女常见的恶性肿瘤之一,全球每年120万妇女罹患乳腺癌，且有50万死于
28、该病。 北美、北欧高发。我国逐年上升。一些大城市，居妇女恶性肿瘤的第2位。乳腺癌约半数发生于乳腺外上象限，其次为乳腺中央区，其他部位较少。乳腺癌偶尔发生于男性，预后较差。癌组织多数起源于导管上皮，少数来自乳腺小叶。,2022/9/2857乳腺癌（Carcinoma of th,2022/11/18,58,2022/9/2858,2022/11/18,59,A normal duct cells B basement membrane C lumen (center of duct),2022/9/2859A normal duct cells,2022/11/18,60,Lobule, gla
29、nds, duct,2022/9/2860Lobule, glands, duc,2022/11/18,61,Mammary collecting duct,Mammary lobule : The basement membrane and the columnar lumen,2022/9/2861Mammary collecting,2022/11/18,62,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病伴导管原位癌,浸润性导管癌,浸润性小叶癌,特殊类型癌,乳头Paget病伴导管浸润癌,典型髓样癌,胶样癌,2022/9/2862
30、分类：乳腺癌非浸润性癌浸润性癌导管内,2022/11/18,63,属于原位癌 没有突破导管和腺泡的基底膜 分: 导管内原位癌 小叶原位癌,非浸润性癌,2022/9/2863 属于原位癌 非浸润性癌,2022/11/18,64,1导管内原位癌（intraductal carcinoma in situ）,癌细胞局限于乳腺中、小导管内，管壁基底膜完整。 占乳腺癌 15%30% 。 可分为粉刺癌及非粉刺型导管内原位癌,2022/9/28641导管内原位癌（intraduct,2022/11/18,65,A normal duct cellsB ductal cancer cellsC basemen
31、t membraneD lumen (center of duct),2022/9/2865A normal duct cells,2022/11/18,66,This a portion of a duct containing intraductal carcinoma. The neoplastic cells are confined to the duct by the basement membrane (black arrows). The neoplastic cells are monotonous with round to oval nuclei and little p
32、leomorphism (white arrows). The cell borders are well demarcated (yellow arrows) unlike benign duct proliferations when the cells pile up on top of each other.,2022/9/2866This a portion of a,2022/11/18,67,粉刺癌,可见扩张的导管，内含坏死物质。 挤压导管, 坏死物质会像粉刺一样被挤出,在切面上可见。,（comedocarcinoma）,2022/9/2867粉刺癌 可见扩张的导管，内含坏死物质
33、。,2022/11/18,68,癌细胞体积较大，多形性，有丰富的嗜酸性胞浆, 核不规则，核仁明显细胞排列常呈实心团块中央有大的坏死灶是其特征，也可以是单个瘤细胞坏死。坏死区常见粗大钙化灶围绕癌导管常出现间质纤维化及慢性炎细胞浸润。,镜下：,2022/9/2868镜下：,2022/11/18,69,Here is a comedocarcinoma pattern of intraductal carcinoma, which is characterized by the presence of rapidly proliferating, high-grade malignant cells
34、. The cells in the center of the ducts with comedocarcinoma are often necrotic and calcify, as shown here. This central necrosis leads to the gross characteristic of extrusion of cheesy material from the ducts with pressure (comedone-like).,2022/9/2869Here is a comedocar,2022/11/18,70,癌细胞比粉刺癌细胞小 细胞有
35、异型 失去双层结构，常呈单层排列 排列成多种结构(原位乳头状癌、筛状导管原位癌、实性导管原位癌、管状型导管内原位癌） 周围无明显间质纤维化,非粉刺型导管内癌（noncomedo intraductal carcinoma）,病理特点：,2022/9/2870 癌细胞比粉刺癌细胞小非粉刺型导管内癌,2022/11/18,71,The classic cribriform pattern of intraductal carcinoma of the breast is shown here. The neoplastic epithelial cells within the duct show
36、 minimal hyperchromatism and pleomorphism, but they have holes with sharp margins as though punched out by a cookie cutter.,筛状导管原位癌,2022/9/2871The classic cribrif,2022/11/18,72,Predominantly solid growth pattern (hematoxylin-eosin, x 100).,实性导管原位癌,2022/9/2872Predominantly solid,2022/11/18,73,Micropa
37、pillary pattern (hematoxylin-eosin, x 100).,原位乳头状癌,癌细胞表现呈乳头状突向扩张管腔,2022/9/2873Micropapillary patt,2022/11/18,74,30%的患者20年后可能会发展成浸润癌（导管原位癌）粉刺癌更具侵袭性，约75%的患者4年中发展为浸润癌。,结局：,2022/9/2874结局：,2022/11/18,75,2小叶原位癌,（lobular carcinoma in situ）,来自小叶的终末导管及腺泡， 主要累及小叶 癌细胞局限于管泡内，未穿破其基底膜，小叶结构存在,2022/9/28752小叶原位癌（lob
38、ular car,2022/11/18,76,A normal lobular cellsB lobular cancer cellsC basement membrane,2022/9/2876A normal lobular ce,2022/11/18,77,无明显特征70%为多中心性双侧乳腺患者30%40%,病理特点：,肉眼：,镜下：,小叶体积增大，结构紊乱 小管高度扩张，其中大量癌细胞形成 实性巢 癌细胞较小，大小一致，圆形核 基底膜完整,约25%30%可发展为浸润癌,2022/9/2877无明显特征病理特点：肉眼：镜下： 小叶,2022/11/18,78,Lobular carcin
39、oma in situ (LCIS) is seen here. LCIS consists of a neoplastic proliferation of cells in the terminal breast ducts and acini. The cells are small and round. Though these lesions are low grade, there is a 30% risk for development of invasive carcinoma in the same or the opposite breast.,2022/9/2878Lo
40、bular carcinoma i,2022/11/18,79,This close up of the lobule shows acini distended by a relatively monomorphic populations of cells. The nuclei are round and regular,2022/9/2879This close up of th,2022/11/18,80,癌细胞穿破乳腺导管或腺泡的基底膜而侵入间质 占乳腺癌 85% 分：浸润性导管癌和浸润性小叶癌 约有10%浸润性导管癌与浸润性小叶癌并存 浸润性小叶癌的预后较差,浸润性癌,2022/
41、9/2880 癌细胞穿破乳腺导管或腺泡的基底膜而,2022/11/18,81,导管内癌细胞 突破管壁基底膜向间质浸润。 乳腺癌中最常见的一种类型（70%）,1浸润性导管癌（Invasive ductal carcinoma）,2022/9/28811浸润性导管癌（Invasive d,2022/11/18,82,A normal duct cellsB ductal cancer cells breaking through the basement membraneC basement membrane,2022/9/2882A normal duct cells,2022/11/18,83
42、,界限不清，灰白灰黄色、坚硬 切面有硬粒感 放射状小梁：从癌实质向四周脂肪伸展，呈明显星状 或蟹足状 乳头下癌肿累及大导管又伴纤维组织增生时，会由于纤维组织收缩，可使乳头下陷 癌组织如在真皮淋巴管内扩散，可阻塞淋巴管，导致 皮肤水肿，毛囊汗腺处的皮肤因受皮肤附件牵引而相 对下陷，造成皮肤呈桔皮样外观 晚期侵犯深筋膜、胸膜和胸壁肌肉，使肿块固定,病理特点：,肉眼：,2022/9/2883 界限不清，灰白灰黄色、坚硬病理特点：,2022/11/18,84,The tumor occupies the top portion of the specimen. Note the white strea
43、ks coursing through the lesion and contrast it with the normal adipose tissue of the breast.,2022/9/2884The tumor occupies,2022/11/18,85,Here is a classic infiltrating ductal carcinoma,2022/9/2885Here is a classic i,2022/11/18,86,This mastectomy specimen demonstrates the gross findings of inflammato
44、ry carcinoma of breast. This is not a specific histologic type of breast cancer, but rather it implies dermal lymphatic invasion by some type of underlying breast carcinoma. Such involvement of dermal lymphatics gives the grossly thickened, erythematous, and rough skin surface with the appearance of
45、 an orange peel,2022/9/2886This mastectomy spe,2022/11/18,87,癌组织及癌细胞形态多样 致密的纤维组织间质中可见癌组织排 列成不规则巢状或条索状浸润性生长 腺管结构可有可无 核分裂多见 常见灶性坏死或钙化,镜下：,2022/9/2887镜下：,2022/11/18,88,In the center is a duct lined by carcinoma cells. However, this ductal carcinoma is not confined to just the duct, but infiltrates outw
46、ard into the surrounding stroma as an infiltrating ductal carcinoma,2022/9/2888In the center is a,2022/11/18,89,At high magnification, the infiltrating ductal carcinoma of breast has pleomorphic cells infiltrating through the stroma.,2022/9/2889At high magnificati,2022/11/18,90,浸润性导管癌可分为：,单纯癌：癌主质与间质
47、大致相等，癌细胞呈实性 条索，小梁或巢团块，可有少量腺样结构 硬癌： 癌实质少、间质成分多而致密，质硬， 很少形成腺样结构 不典型髓样癌：癌实质多，间质成分少，癌呈片状 或巢状，中央有坏死，间质无淋巴细胞浸润 腺癌： 癌组织管样结构占半量以上,根据癌的实质/纤维间质的比例、腺管形成的不同,2022/9/2890 单纯癌：癌主质与间质大致相等，癌细胞,2022/11/18,91,Scirrhous carcinoma of the breast,2022/9/2891Scirrhous carcinoma,2022/11/18,92,This infiltrating ductal carcin
48、oma of breast at low magnification appears to radiate from a central area of desmoplasia. This collagenous component gives the neoplasm a hard scirrhous consistency that is palpable. Such an invasive carcinoma may be fixed to underlying chest wall, making it non-mobile.,2022/9/2892This infiltrating
49、d,2022/11/18,93,小叶原位癌的癌细胞突破了基底膜向间质浸润性生长多见于老年妇女占乳腺浸润性癌5%10%，约20%浸润性小叶癌可累及双侧乳房,2浸润性小叶癌（Invasive lobular carcinoma）,2022/9/28932浸润性小叶癌（Invasive,2022/11/18,94,A normal cellsB lobular cancer cells breaking through the basement membraneC basement membrane,2022/9/2894A normal cells,2022/11/18,95,切面呈橡皮样，灰白色
50、 边界不清 质坚硬,肉眼：,2022/9/2895肉眼：,2022/11/18,96,单行癌细胞呈线状浸润于纤维间质中“列兵样”排列 癌细胞较小，大小一致，核大小也较一 致，胞浆很少，核仁不明显 核分裂少,镜下：,2022/9/2896镜下：,2022/11/18,97,This is a closer view of linear arrays of lobular carcinoma cells (blue arrows) infiltrating through dense fibrous stroma.,2022/9/2897This is a closer vi,The blue a
