不典型增生

1、乳腺病理要點(diǎn),紀(jì)小龍,(8)不典型增生,已講過(guò),09-06-03 乳腺病理要點(diǎn)（7）冰凍09-03-11 乳腺病理要點(diǎn)（6）假浸潤(rùn) 08-12-03 乳腺病理系列講座(5) 囊性病變 08-04-09 乳腺病理系列講座(4) 增生08-03-12 乳腺病理系列講座(3) 血管腫瘤08-01-09 乳腺病理系列講座(2) 先天異常與炎癥07-10-24 乳腺病理系列講座（1）組織學(xué)基礎(chǔ),女性癌癥新發(fā)病例前五位,American

2、 Cancer Society, Surveillance Research, 2003,http://tv.people.com.cn/GB/14644/9224889.html,我國(guó)女性乳癌的特點(diǎn),近20余年來(lái)發(fā)病迅速上升發(fā)病年齡較西方年輕，約提前10～15年高峰年齡為45～49歲，且有雙峰趨勢(shì)乳腺較小而致密，不利X線(xiàn)檢查,病理的作用,有無(wú)癌明確的癌—不難明確無(wú)癌—不難夠不夠癌—難治療相關(guān)有條件—不難無(wú)條件—轉(zhuǎn)診,

3、Sir James Paget1st Baronet (11 January 1814 – 30 December 1899) a British surgeon and pathologist who is best remembered for Paget's disease and who is considered, together with Rudolf Virchow, as one of the founde

4、rs of scientific medical pathology. three diseases named after him: Paget's disease of bonePaget's disease of the nipple (a form of intraductal breast cancer spreading into the skin around the nipple), and Ext

5、ramammary Paget's diseaseAlso named for him is Paget's abscess.,乳腺增生病上皮細(xì)胞不典型增生程度分級(jí),Ⅰ級(jí)，導(dǎo)管或腺泡上皮細(xì)胞增生2~4層，分化良好；Ⅱ級(jí)，上皮細(xì)胞增生超過(guò)4層，突向管腔內(nèi)相互橋接或充滿(mǎn)管腔，但極性存在，伴有輕度異型性的不典型增生；Ⅲ級(jí)，是導(dǎo)管擴(kuò)張，細(xì)胞簇集成乳頭狀或完全充滿(mǎn)管腔，排列緊密，有明顯異型性的不典型增生。Ⅰ級(jí)為一般性增生

6、Ⅱ、Ⅲ級(jí)為不典型增生。,Page, 1986,David L. Page, M.D.,Professor of Pathology and Preventive MedicineVICC MemberPathologistContact Information:Vanderbilt University Medical CenterC-3311 Medical Center NorthNashville, TN 37232

7、-2561615-322-3759Research Specialty:Breast Cancer,,Dr. Susan Love’s Breast Book, 2005. S. Love,,Atlas of Breast Cancer, 2nd 2000. Hayes, ed.,乳腺增生癥——譜系,小葉增生 腺病纖維腺病 纖維化腺病 硬化性腺病 纖維硬化

8、癥,,,,,,DCIS,Ductal carcinoma in situ (DCIS)1. Solid type*2. Cribiform type3. Papillary type4. Comedo type*,增生,原位癌,,？,Tavassoli ：,“We are strong advocates, however, of the ductal intraepithelial neoplasia (DIN) and

9、 lobular intraepithelial neoplasia (LIN) terminology. ”“In summary, the terms DCIS and LCIS should be abandoned in favor of the more logical DIN and LIN terminology. ”理由：臨床醫(yī)生、病人都不明白“原位癌”的含義而多數(shù)過(guò)治療+精神壓力其它部位已經(jīng)采用the term

10、 ‘intraepithelial neoplasia’ ，乳腺也不能例外,從dysplasia 到 intraepithelial neoplasia(IN),Dysplasiamild moderate severe dysplasia( carcinoma-in-situ )intraepithelial neoplasia(IN)low-grade (L-IN) 單純性增生（simple hyperplasia）

11、不典型增生（atypical hyperplasia）再生性增生（regenerative hyperplasia） 未定型異型增生(indefinite for dysplasia)high-grade (H-IN)high-grade adenoma/dysplasianoninvasive carcinoma (carcinoma in situ）suspected invasive carcinoma,intrae

12、pithelial neoplasia (IN,IEN )上皮內(nèi)瘤(變),Cervical intraepithelial neoplasia (CIN )Vulvar intraepithelial neoplasia (VIN )Gastric intraepithelial neoplasias (GIN) Pancreatic Intraepithelial Neoplasia (PIN )Prostatic in

13、traepithelial neoplasia (PIN )角結(jié)膜上皮內(nèi)腫瘤(conjunctiva-cornea intraepithelial neoplasia，CCIN )呼吸道、消化道、胰腺及膽管、乳腺、前列腺、泌尿道、女性生殖道和皮膚等器官組織腫瘤,輕度異型增生 中度異型增生 重度異型增生 原位癌,L- IN H- IN,1970s,1990

14、s,Fattaneh A Tavassoli,Our first question is: If these conditions are not cancer (as stated by the authors), why are they designated as cancers? The term 'cancer' has a tremendous impact on the patient and her fa

15、mily. Should all these women go through life thinking they have cancer for lesions that are curable, and never metastasize or kill them? Our second question is: What does the term 'precancerous' mean? Essential

16、ly all breast tissue is 'precancerous' or 'pre-neoplastic' given the fact that there is a potential for the development of breast carcinoma in most post-pubertal breast tissue—a potential that may never b

17、e realized and a risk that continuously increases with age. Are these lesions not proliferations that serve no physiologic purpose (i.e. not reversible), but display a risk (albeit of variable magnitude) for subsequent d

18、evelopment of carcinoma? If so, then why not use the term 'intraepithelial neoplasia' of ductal, lobular or papillary types?,,In all other body parts and organs, the term 'in situ carcinoma' has been repl

19、aced by the term 'intraepithelial neoplasia'. We have cervical intraepithelial neoplasia, vulvar intraepithelial neoplasia, prostatic intraepithelial neoplasia, pancreatic intraepithelial neoplasia, etc. Most pat

20、hologists who are using intraepithelial neoplasia for other sites would not object to the term intraepithelial neoplasia for breast lesions. Breast surgeons and oncologists who have not been exposed to this terminology a

21、nd its justifications may not realize its value. These practitioners, however, follow guidelines set by societies and committees that introduce novel terms and concepts. There should not be any difficulty with the logica

22、l terminology of LIN and DIN.,,In summary, the terms DCIS and LCIS should be abandoned in favor of the more logical DIN and LIN terminology.,Ductal intraepithelial neoplasia (DIN),DIN 1A: flat epithelial atypiaDIN 1B: a

23、typical ductal hyperplasiaDIN 1C: DCIS grade 1DIN2:    DCIS grade 2DIN3:    DCIS grade 3,Adopted by new WHO book on Tumors of the Breast and Female Genital Organs,Intraductal Epithelial P

24、roliferations,Multilayered， no atypia,florid ductal epithelial hyperplasia,腔面上皮 CK7, CK8, CK18, CK19基底上皮 CK5/6, CK14, CK17肌上皮 CK5, CK14, CK17, SMA, calponin, p63,肌上皮myoepithelial cell, MEC,80年代  90年代 2000年代現(xiàn)

25、在,S-100actin (肌動(dòng)蛋白) muscle-specific actin,MSA(肌特異性肌動(dòng)蛋白)α-smooth muscle actin,α-SMA (α-平滑肌肌動(dòng)蛋白)calponin CD10 P63(CK14和CK17 , GFAP ),smooth muscle actin (SMA),smooth muscle actin (SMA),CD10,CD10,p63,p63,p63,cal

26、ponin,calponin,,The hyperplastic enlarged lobular unit (HELU),小導(dǎo)管不典型增生,乳頭實(shí)性篩狀低乳頭,增生 不典型增生Usual ductal hyperplasia(UDH) ---Atypical ductal hyperplasia(ADH),不同細(xì)胞混合腔面上皮基底上皮肌上皮admixture of cell types luminal