1、消化系统肿瘤本科病理学课件消化系统肿瘤本科病理学课件（优选）消化系统肿瘤本科病理学课件隐伏型隐伏型糜烂型糜烂型早期食管癌早期食管癌原位癌原位癌2.2.中晚期食管癌中晚期食管癌 肉眼：髓质、蕈伞、溃疡、肉眼：髓质、蕈伞、溃疡、缩窄型。缩窄型。镜下：鳞癌、腺癌；腺棘镜下：鳞癌、腺癌；腺棘皮癌、燕麦细胞癌、皮癌、燕麦细胞癌、Barrett 食管腺癌食管腺癌高分化高分化中分化中分化低分化低分化低分化低分化-Low content of unabsorbable vegetable fiberan adenocarcinoma of the stomach.Spreading of gastric ca
2、rcinoma消瘦、贫血、便频、黏Dietary traditions:X线：食管壁轻度僵硬男，40，吞咽困难。an adenocarcinoma of the stomach.转移：（1）淋巴道（2）血道直肠、乙状结肠、盲B1 未穿透肌层，无LN转移 67鳞癌，未累肌层，无LN转移。鳞癌，未累肌层，无LN转移。早期胃癌 Early gastric carcinoma 侵犯粘膜层或粘膜下层而无论有无淋巴结转移。Adenocarcinoma of the caecum-High content of refined carbohydrates二、胃癌 carcinoma of stomach肠，
3、升结、降结和横结肠。Risk factors肝细胞或肝内胆管上皮的恶性Ulcerative carcinoma of the stomach：note the elevated margin.腺癌腺癌小细胞未分化癌小细胞未分化癌扩散扩散1.1.直接蔓延：直接蔓延：2.2.转移：转移：（1 1）淋巴道）淋巴道 （2 2）血道）血道 临床病理联系临床病理联系 1.1.早期多无症状。早期多无症状。2.2.胸骨后疼痛、烧灼胸骨后疼痛、烧灼或噎梗感或噎梗感 3.3.吞咽困难吞咽困难二、胃癌二、胃癌 carcinoma of stomach Gastric carcinoma is the most co
4、mmon malignant tumor in China,especially in the countryside.Age range is 40-60 year old；male vs fe-male ratio is 2-3:1，more frequently in antr-um of lesser curvature(75%)组织发生组织发生 1.1.胃胃腺颈部和腺颈部和胃小凹的胃小凹的干细胞：干细胞：2.2.肠上皮肠上皮化生：化生：3.3.非典型增非典型增生：生：2 2倍胃粘膜厚度，息肉状倍胃粘膜厚度，息肉状 稍隆起，稍隆起，2 2倍胃粘倍胃粘 膜厚度膜厚度与周围粘膜一齐与周围粘
5、膜一齐Advanced HCC(2000-3000g)0cm 一点癌：活检为癌，手术标本连续切片无。carcinomaAdvanced HCC(2000-3000g)Adenocarcinoma of the rectummale vs fe-male ratio is 2-3:1，more frequently in antr-um of lesser curvature(75%)Genetic factor鳞癌，未累肌层，无LN转移。an adenocarcinoma of the stomach.三、大肠癌Blood pathwayan adenocarcinoma of the sto
6、mach.HP 感染CpG 岛甲-Decreased intake of Vitamin A,C,and E局部蔓延：前列腺、膀胱和腹膜。Ulcerative carcinoma in pylorus：showing pyloric stenosis(幽门狭窄）2倍胃粘膜厚度，息肉状one or two nodules.消化系统肿瘤本科病理学课件早期胃癌 Early gastric carcinoma 侵犯粘膜层或粘膜下层而无论有无淋巴结转移。B1 未穿透肌层，无LN转移 67癌性糜烂，稍凹陷，癌性糜烂，稍凹陷，深度不超过粘膜层深度不超过粘膜层 高分化腺癌高分化腺癌镜下：镜下：原位原位；管状、
7、乳头状；未分化癌；管状、乳头状；未分化癌高分化高分化中分化中分化乳头状腺癌乳头状腺癌低分化腺癌低分化腺癌黏液腺癌黏液腺癌印戒细胞癌印戒细胞癌硬癌硬癌小细胞癌小细胞癌鳞癌，未累肌层，无LN转移。Male：female=3：1 to 8：1Gastric carcinoma is the most common malignant tumor in China,especially in the countryside.局部蔓延：前列腺、膀胱和腹膜。Dietary traditions:Risk factors肠，升结、降结和横结肠。早期胃癌 Early gastric carcinoma 侵犯粘
8、膜层或粘膜下层而无论有无淋巴结转移。male vs fe-male ratio is 2-3:1，more frequently in antr-um of lesser curvature(75%)直肠、乙状结肠、盲溃疡周边糜烂癌。Gastric carcinoma is the most common malignant tumor in China,especially in the countryside.an adenocarcinoma of the stomach.淋巴道转移：结肠上、中、旁和终末Multifocal-Decreased intake of Vitamin A,C
9、,and EB2 穿透肌层，无LN转移 54an adenocarcinoma of the stomach.中、下、上狭窄one or two nodules.鳞癌，未累肌层，无LN转移。2.2.Advanced gastric carcinoma肉眼肉眼 Polypoid Ulcerating Focal or Diffuse infiltration leather-bottlestomach)胶样癌胶样癌良、恶性溃疡大体形态鉴别良、恶性溃疡大体形态鉴别良良恶恶外形外形圆、椭圆圆、椭圆不整、皿状、火山口不整、皿状、火山口大小大小2cm2cm深度深度较深较深较浅较浅边缘边缘整齐，不隆起整齐
10、，不隆起不整齐，隆起不整齐，隆起底部底部较平坦较平坦凸凹不平，坏死，出血凸凹不平，坏死，出血周边黏膜周边黏膜皱襞向溃疡集中皱襞向溃疡集中皱襞中断，结节状肥厚皱襞中断，结节状肥厚There is a large polypoid mass in the fundes：an adenocarcinoma of the stomach.Ulcerative carcinoma of the stomach：note the elevated margin.Ulcerative carcinoma in pylorus：showing pyloric stenosis(幽门狭窄）幽门狭窄）“leath
11、er bottle”appearance：extensive mucosal erosion and a markedly thickened gastric wall.镜下镜下 管状腺癌、粘管状腺癌、粘液癌等。少见有腺液癌等。少见有腺棘皮癌、鳞癌。棘皮癌、鳞癌。“leather bottle”appearance：extensive mucosal erosion and a markedly thickened gastric wall.中年后，男女，发现晚。HP 感染CpG 岛甲B2 穿透肌层，无LN转移 54肠，升结、降结和横结肠。镜下：鳞癌、腺癌；Ulcerative cancerD
12、ietary traditions:癌性糜烂，稍凹陷，深度不超过粘膜层肝细胞或肝内胆管上皮的恶性Diffuse infiltrativeone or two nodules.Early HCC（Small HCC):carcinomaRisk factorsmale vs fe-male ratio is 2-3:1，more frequently in antr-um of lesser curvature(75%)HP 感染CpG 岛甲Gastric carcinoma is the most common malignant tumor in China,especially in th
13、e countryside.淋巴道转移：结肠上、中、旁和终末肝细胞或肝内胆管上皮的恶性Adenocarcinoma of the rectum Spreading of gastric carcinoma 1.Direct spreading to adjacent organs 2.Metastasis Lymph pathway Blood pathway Abdominal cavity(seeding)Krukenberg tumor 三、大肠癌三、大肠癌 carcinoma of large intestine 大肠粘膜上皮和腺体大肠粘膜上皮和腺体的恶性肿瘤。居第三位。的恶性肿瘤。居
14、第三位。消瘦、贫血、便频、黏消瘦、贫血、便频、黏液血便、腹痛腹块或肠梗阻。液血便、腹痛腹块或肠梗阻。Risk factors Dietary traditions:-Low content of unabsorbable vegetable fiber -High content of refined carbohydrates -High fat content food(meat,oil)-Decreased intake of Vitamin A,C,and E Genetic factor -家族腺瘤型息肉：家族腺瘤型息肉：-遗传非息肉大肠癌：遗传非息肉大肠癌：某些伴有肠粘膜增生的慢性
15、肠疾病某些伴有肠粘膜增生的慢性肠疾病 上皮逐步癌变：上皮逐步癌变：病理变化病理变化 直肠、乙状结肠、盲直肠、乙状结肠、盲肠，升结、降结和横结肠。肠，升结、降结和横结肠。50%20%16%8%6%肉眼肉眼 1.1.隆起型：息肉隆起型：息肉或盘状或盘状 2.2.溃疡型溃疡型:3.3.浸润型浸润型 4.4.胶样型胶样型Adenocarcinoma of the caecumAdenocarcinoma of the rectumUlcerative cancer组织学类型组织学类型 1.1.乳头状腺乳头状腺癌癌 2.2.管状腺癌管状腺癌 3.3.粘液腺癌粘液腺癌或印戒细胞癌或印戒细胞癌 4.4.未分
16、化癌未分化癌 5.5.腺鳞癌腺鳞癌 6.6.鳞状细胞鳞状细胞癌癌 Dukes 分期：分期：分期分期 肿瘤生长范围肿瘤生长范围 五年生存率五年生存率 A A 限于粘膜内限于粘膜内 100 100 B B1 1 未穿透肌层，无未穿透肌层，无LNLN转移转移 67 67 B B2 2 穿透肌层，无穿透肌层，无LNLN转移转移 54 54 C C1 1 未穿透肌层，有未穿透肌层，有LNLN转移转移 43 43 C C2 2 穿透肌层，有穿透肌层，有LNLN转移转移 22 22 D D 远器官转移远器官转移 极低极低 Astler-colle于于19541954年提出年提出扩散途径扩散途径 1.1.局部
17、蔓延：前列腺、膀胱和腹膜。局部蔓延：前列腺、膀胱和腹膜。2.2.淋巴道转移：结肠上、中、旁和终末淋巴道转移：结肠上、中、旁和终末 淋巴结。偶锁骨上淋巴结。偶锁骨上 3.3.血道转移：肝、肺、骨等。血道转移：肝、肺、骨等。4.4.种植转移种植转移临床病理联系临床病理联系 1.1.慢性肠梗阻表现（左）慢性肠梗阻表现（左）2.2.大便带血大便带血 3.3.右下腹肿块（右）右下腹肿块（右）四、原发性肝癌四、原发性肝癌 Primary hepatocellular carcinoma 概述概述 肝细胞或肝内胆管上皮的恶性肝细胞或肝内胆管上皮的恶性 肿瘤。肿瘤。中年后，男女，发现晚。中年后，男女，发现晚。
18、1.Much more common on the countries （Taiwan,South China）with hepatitis B infection(carriers!)2.Its precarcinomatous lesion is cirrhosis 3.Male：female=3：1 to 8：1 Lymph pathwayA 限于粘膜内 100Abdominal cavity(seeding)男，40，吞咽困难。5cm 小胃癌：0.an adenocarcinoma of the stomach.Blood pathwayGastric carcinoma is the
19、 most common malignant tumor in China,especially in the countryside.B1 未穿透肌层，无LN转移 67Advanced HCC(2000-3000g)Direct spreading to adjacent organs早期胃癌 Early gastric carcinoma 侵犯粘膜层或粘膜下层而无论有无淋巴结转移。Risk factorsmale vs fe-male ratio is 2-3:1，more frequently in antr-um of lesser curvature(75%)-Decreased i
20、ntake of Vitamin A,C,and EAdenocarcinoma of the caecuminfection(carriers!)Early HCC（Small HCC):溃疡周边糜烂癌。鳞癌，未累肌层，无LN转移。Ulcerative carcinoma in pylorus：showing pyloric stenosis(幽门狭窄）Pathologic change 1.Early HCC（Small HCC):less than 3 cm in diameter,one or two nodules.2.Advanced HCC(2000-3000g)Unifocal
21、 massive mass Multifocal Diffuse infiltrativeHepatocellular carcinoma arising from a post-necrotic cirrhosis.The satellite nodules of this hepatocellular carcinoma represent either intrahepatic spread of the tumor or multicentric origin of the tumor.淋巴道转移：结肠上、中、旁和终末carcinomaMale：female=3：1 to 8：1癌性糜
22、烂，稍凹陷，深度不超过粘膜层扁平状或稍隆起。one or two nodules.HP 感染CpG 岛甲Hepatocellular carcinoma arising from a post-肠，升结、降结和横结肠。局部蔓延：前列腺、膀胱和腹膜。微小癌：0.an adenocarcinoma of the stomach.male vs fe-male ratio is 2-3:1，more frequently in antr-um of lesser curvature(75%)转移：（1）淋巴道（2）血道Risk factors消化系统肿瘤本科病理学课件Pathologic chang
23、e（优选）消化系统肿瘤本科病理学课件Spreading of gastric carcinomaB1 未穿透肌层，无LN转移 670cm 一点癌：活检为癌，手术标本连续切片无。镜下1.肝细胞癌2.胆管细胞癌3.混合细胞肝癌梁索型肝细胞癌梁索型肝细胞癌索状梁状肝细胞癌索状梁状肝细胞癌索状腺样肝细胞癌索状腺样肝细胞癌实性型肝细胞癌实性型肝细胞癌溃疡周边糜烂癌。Dukes 分期：Gastric carcinoma is the most common malignant tumor in China,especially in the countryside.one or two nodules.o
24、ne or two nodules.男，40，吞咽困难。癌性糜烂，稍凹陷，深度不超过粘膜层Risk factorsIts precarcinomatous lesion is cirrhosis淋巴道转移：结肠上、中、旁和终末B1 未穿透肌层，无LN转移 67Gastric carcinoma is the most common malignant tumor in China,especially in the countryside.Ulcerative carcinoma of the stomach：note the elevated margin.早期胃癌 Early gastric carcinoma 侵犯粘膜层或粘膜下层而无论有无淋巴结转移。B1 未穿透肌层，无LN转移 67-Decreased intake of Vitamin A,C,and E良、恶性溃疡大体形态鉴别消化系统肿瘤本科病理学课件纤维板层型肝细胞癌纤维板层型肝细胞癌硬化型肝细胞癌硬化型肝细胞癌透明细胞型肝细胞癌透明细胞型肝细胞癌2.胆管细胞癌胆管细胞癌CK19
