《乳腺病例浅谈》PPT课件

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1、乳腺病例浅谈聊城二院kkmm007乳腺肿瘤一位84的老太太由于乳腺结节做了乳腺切除及腋窝淋巴结清扫，大体检查有2个结节，一个5x3.5，另一个直径2cm。An84yearoldwomanhadatotalmastectomywithaxillarydissectionforabreastnodule. Themainmasswas5x3.5cm,anda2cmmasswasnearby.Whatisyourdiagnosis?伴有导管原位癌成份的浸润性分泌性癌Invasiveapocrinecarcinomawithaninsitucompon

2、ent浸润性分泌性癌在乳腺癌中是一个不太常见的类型，约占所有乳腺癌的1-4%，在老年妇女中比浸润性导管癌更为常见。通常显示一个囊内结节，镜下，肿瘤由界限较清的细胞组成，具有颗粒状嗜伊红的细胞质，多具有泡状细胞核和明显的核仁和可以见到的猪嘴样的腺体，这种诊断仅限于具有明显顶浆分泌改变和明显恶性的肿瘤中。Invasiveapocrinecarcinomaisanuncommonsubtypeofbreastcarcinoma,representing1-4%ofallcarcinomas. Ittypicallyaffectsolderwoment

3、haninfiltratingductalcarcinoma(BreastCancer2002;9:43). Grossly,itmaypresentasamuralnodulewithinacyst. Microscopically,thetumorsarecomposedofcellswithdistinctcellmargins,eosinophiliccytoplasmandgranules. Theyhavevesicularnucleiwithprominentnucleoli,andmayhaveglandswithapocrin

4、esnouts. Thisdiagnosisshouldbelimitedtotumorswithwidespreadapocrinechangeandobviousmalignancy.CaseoftheWeek#62一位22岁的女性伴有逐渐增大的右侧乳腺结节，2个月病史，无乳头溢液，本人否认曾用过激素或其它药物，肿块外观无炎症改变，切除肿块重540克，14x11x4cm,实性，卵圆形，边界较清，切面白色，质较硬，散在裂隙样改变，A22yearoldCaucasianwomanhadatwo-monthhistoryofanenlarging

5、rightbreastmass. Therewasnonippledischargeandshedenieduseofhormonesorotherdrugs. Themasswastendertopalpationwithoutanyexternalsignsofinflammation. Theresectedspecimenwas540grams,14x11x4cm,solid,ovoidandwell-circumscribed. Thecutsurfacewaswhite,firmandhomogenouswithafewscatte

6、redslit-likespaces(Figures1,2). Lowandmediumpowershowedlargehyperplasticlobuleswithaproliferationofductulesandacini. Fewductsweredilated(Figure3,4,5). Theenlargedlobuleswerestronglyimmunoreactiveforcytokeratin8(Figure6).中低倍观察可见到较大的扩张的小叶伴有小叶内腺管和核的增生，几乎没有导管扩张，扩张小叶组化CK8阳性。硬化似乎开

7、始于小叶的中央并向周围放射，腺泡周围纤维化明显，马氏三色染色可见小叶内纤维化，Thesclerosisseemedtostartatthecenterofthelobuleandradiatetowardstheperiphery,incarceratingtheaciniwithseverefibrosisandatrophy(Figure7,8). TheTrichromestainhighlighteddenseinterlobularfibrosisandapeculiarperiacinarsclerosiswithaglomerul

8、oidpattern(Figure9,10).Themyoepithelialcellswereprominentintheseareas,asdem