呼腫第四節(jié)呼吸系統(tǒng)腫瘤

1、第四節(jié) 呼吸系統(tǒng)腫瘤 肺癌鼻咽癌喉癌肺癌carcinoma of the lung1 概述 常見(jiàn) 發(fā)病高峰 性別2 病因吸煙空氣污染職業(yè)：有害粉塵 電離輻射遺傳因素？ 3 病理變化 組織發(fā)生 支氣管粘膜上皮 鱗化 鱗癌 腺上皮 腺癌 肺泡上皮 肺泡細(xì)胞癌 支氣管粘膜內(nèi)Kultschitzky細(xì)胞 神經(jīng)內(nèi)分泌癌肉眼（1） 中央型（2） 周圍型（3 ）彌漫型 早期肺癌 2cm 局限于支氣管內(nèi)或浸潤(rùn)管壁 無(wú)淋巴結(jié)轉(zhuǎn)移 隱性肺癌 臨床和X線 陰性；痰 陽(yáng)性； 并經(jīng)病理證實(shí)為原位癌或早浸癌但無(wú)LN轉(zhuǎn)移 This is a squamous cell carcinoma of the lung that

2、is arising centrally in the lung (as most squamous cell carcinomas do). It is obstructing the right main bronchus. The neoplasm is very firm and has a pale white to tan cut surface. This is a peripheral adenocarcinoma of the lung. Adenocarcinomas and large cell anaplastic carcinomas tend to occur mo

3、re peripherally in lung. Adenocarcinoma is the one cell type of primary lung tumor that occurs more often in non-smokers and in smokers who have quit. If this neoplasm were confined to the lung (a lower stage), then resection would have a greater chance for cure. The solitary appearance of this neop

4、lasm suggests that the tumor is primary rather than metastatic. This is another less common type of adenocarcinoma of lung known as a bronchioloalveolar carcinoma. Seen here is variant that appears grossly (and on chest radiograph) as a less well-defined area resembling pneumonic consolidation. An p

5、oorly defined mass involving the upper lobe toward the right here has a pale tan to grey appearance. 組織學(xué)類型（1） 鱗狀細(xì)胞癌（2） 小細(xì)胞癌（燕麥細(xì)胞癌）（3） 腺癌（肺泡細(xì)胞癌）（4） 大細(xì)胞癌（5） 其它： 腺鱗癌 肉瘤化癌 類癌 唾液腺癌 The glandular structures formed by this neoplasm are consistent with a moderately differentiated adenocarcinoma. Peripheral

6、lung cancers that have not metastasized can be easily resected.This is a small cell anaplastic (oat cell) carcinoma in which small dark blue cells with minimal cytoplasm are packed together in sheets. Oat cell carcinomas, which are a highly malignant form of neuroendocrine tumor, are often associate

7、d with paraneoplastic syndromes from hormonal effects. The ectopic ACTH syndrome and the syndrome of inappropriate ADH are two such syndromes.4 擴(kuò)散途徑直接蔓延 中央型 縱隔 大血管 周圍型 胸膜 胸壁轉(zhuǎn)移 常見(jiàn) 快 淋巴道 肺門(mén)淋巴結(jié) 縱隔 鎖骨上 血道 腦 腎上腺 骨 肝5 臨床病理聯(lián)系 咳嗽 痰中帶血 氣急 胸痛阻塞支氣管 局限性肺不張 肺氣腫異位內(nèi)分泌作用：5-OH 痙攣 潮紅肺性骨關(guān)節(jié)病預(yù)后不良 6 檢查方法 X光 痰涂片 纖支鏡活檢 術(shù)后病

8、理檢查鼻咽癌nasopharngeal carcinoma1 概述 發(fā)病率 8位 地區(qū) 年齡 性別 臨床 2 病因病毒 EBV環(huán)境 亞硝胺遺傳 家族集聚性 易感性 3 病理變化 來(lái)源 粘膜柱狀上皮 部位 鼻咽頂部 外側(cè)壁和咽隱窩 肉眼 粗糙 結(jié)節(jié) 菜花 潰瘍組織學(xué)類型 （1）角化性鱗癌（2）非角化性鱗癌 分化型 未分化：泡狀核細(xì)胞癌 泡狀核細(xì)胞癌 細(xì)胞：大 界不清核：大 圓 空；核仁大（大圓細(xì)胞癌）癌巢：界不清 癌細(xì)胞間大量淋巴細(xì)胞放療敏感 4 擴(kuò)散和轉(zhuǎn)移直接蔓延 上- 顱底骨 腦神經(jīng) 側(cè)- 咽鼓管(中耳) 前- 鼻腔 眼眶 后- 頸椎 轉(zhuǎn)移 淋巴道- 頸淋巴結(jié) 血道 - 肝 肺 骨 5 臨床病理聯(lián)系 鼻塞