《肿瘤病理学课》由会员分享，可在线阅读，更多相关《肿瘤病理学课（120页珍藏版）》请在金锄头文库上搜索。
1、肿瘤病理学 Pathology of Neoplasia,基础医学研究所病理生物学研究室陆应麟,肿瘤是目前死亡常见原因之一。 恶性肿瘤是男性第二位死因，女性第三位主要死因。 我国最常见恶性肿瘤：城市：肺癌、胃癌、肝癌、肠癌和乳癌农村：胃癌、肝癌、肺癌、食管癌、肠癌,基 本 概 念,肿瘤的慨念 肿瘤是机体中正常细胞，在不同始动与促进因素长期作用下所产生的增生与异常分化所形成的新生物。肿瘤的特点 新生物一旦形成，不因病因消除而停止增生。它不受机体生理调节，而是破坏正常组织与器官。,Introduction:,Inflammatory, Degenerative & Neoplastic Growt
2、h Increase in size due to synthesis of tissue components. Proliferatation- Cell division. Differentiation: functional and structural maturity of cells. Tumor Swelling / new growth / mass,Controls of Growth:,Cytokines: Cyclins, Cyclin dependent kinases (CDK). Growth factors PDGF, FGF Growth Inhibitor
3、s. Cancer suppressor genes p53 Oncogenes c-onc, p-onc, v-onc etc.,Non-Neoplastic Proliferation:,*Controlled & Reversible Hypertrophy 肥大 Size Hyperplasia 增生 Number Metaplasia 化生 Change Dysplasia 异常增生 Disordered,Neoplasia:,Progressive, Purposeless, Pathologic, Proliferation of cells characterized by l
4、oss of control over cell division. DNA damage at growth control genes is central to development of neoplasm. Carcinogens Chemical, physical & genetic DNA damage Neoplasm.,Pathogenesis of Neoplasia:,Normal Hyperplasia Metaplasia化生 (DNA damage) Dysplasia 异常增生 (DNA damage) (DNA damage) Anaplasia 间变 (DN
5、A damage) Infiltration 浸润 (DNA damage) Metastasis转移. Progressive DNA Damage features of neoplasia.,Pathogenesis of Neoplasia:,Non lethal DNA Damage leading to uncontrolled cell division.,病理,恶性肿瘤的发生发展过程一般致癌因素作用3040年，经10年左右的癌前阶段恶变为原位癌。 原位癌历时35年，在促癌因素作用下发展成浸润癌。 浸润癌的病程一般1年左右。,2.肿瘤细胞的分化 分为高分化、中分化、低（未）分化。
6、 组织化学的变化： (1)核酸增多(2)酶的改变(3)糖原减少,3. 生长方式： 4. 生长速度： 良性肿瘤：外生性生长 良性肿瘤生长慢 恶性肿瘤：浸润性生长 恶性肿瘤生长快,Non-Neoplastic Neoplastic(Polyclonal) (Monoclonal),Normal Adaptation Benign Malignant,Mechanism of Neoplams,Structure of Neoplasm:,Neoplastic cells parenchyma. Non-neoplastic - stroma (Connective tissue & BV) Fas
7、t growth less stroma Less stroma more necrosis,Biology of Neoplasm:,Cell of origin Rate of growth Differentiation Local Invasion Metastasis,Lung cancer Grade - low, high Well, Mod, P, Un. Staging Staging,Lung cancer: Squamus cell carcinoma. Poorly differentiated, high grade, stage 4, Liver+,Benign M
8、alignant:,Slow growing, capsulated, Non-invasive do not metastasize, well differentiated, suffix “oma” eg. Fibroma.,Fast growing, non capsulated, Invasive & Infiltrate Metastasize. poorly differentiated, Suffix “Carcinoma” or “Sarcoma”,Better Understanding of Cancer,1. Cancer Cancer cells,Cancer Res
9、earch Cancer cell research,Cancer a tissue:Cancer cellsStromal cellsVascular cells ( endothelia, pericytessmooth muscle cellsfibroblasts)Lymphatic vessel cellsImmune cells,2. Do Cancer Stem Cells Exist in Caner ?,cancer cell heterogeneity,1. genetic 2.phenotypic,different in,Morphology Growth behavi
10、or Metastasis potential Chemo / radio resistance Other phenotypes,Do Cancer stem cells exist among cancer cell population ?,Cancer cells,Cancer stem cells: ( 10-2 to 10-4)Persistent proliferationRenewalMetastatic potential Partial differentiated cancer cellsLimited number of proliferationDifferentia
11、l extent of differentiationBulk of cancer cells,If the hypothesis is trueKill the cancer stem cells Abolish the whole tumor Difficult Problems:How to identify ?How to kill ? (Cancer stem cells normal stem cells),?,Cancer stem cells reported:Breast cancer ( human )Glioma ( human )Lung cancer ( animal
12、 )Gastric cancer ( animal ),Characteristics of reported “cancer stem cells”,May be early event quiescent,3. Metastasis:,Early or late event ? Dissemination Metastasis. Dissemination: Migration of cancer cells to distant places:,Micro-satelliteLymph nodeBlood: bone marrow , other organs,4. Metastasis
13、:Disseminated cancers cells grow up to cancer tissues.,Dissemination: “ stem cell like property” Mechanism of metastasis,Cancer cell progression: mutation, aneuploidy Host neural, endocrine, Immune,4. Cancer is a systems disease,Evidence:,A large Scale cDNA Transfection Screening of Genes Related to
14、 Cancer Development and Progression,PNAS November 2, 2004 vol. 101: 15724-15729,分类,根据肿瘤的生物学行为主要分为： 良性：称为“瘤” 恶性：来源于上皮组织称为“癌”来源于间叶组织称为“肉瘤”胚胎性肿瘤称为“母细胞瘤” 某些恶性肿瘤沿用传统名称：恶性淋巴瘤，精原细胞瘤，白血病，霍奇金氏病,1. 各种肿瘤根据其组织及器官来源而冠以不同名称。 2. 相同组织器官可发生不同细胞形态肿瘤。 3. 同一细胞类型，由于细胞分化程度不同，又分为高分化、中分化、低（未）分化。,Nomenclature: Cell of origi
15、n + Suffix,Suffix - oma Fibroma Osteoma Adenoma Papilloma Chondroma,Carcinoma / Sarcoma Fibrosarcoma Osteosarcoma Adenocarcinoma Squamous cell carcinoma Chondrosarcoma,Exceptions: Leukemia, Lymphoma, Glioma,Bilateral Cystadenoma Ovary:,Lipoma Intestine:,meningioma,Lung carcinoma,Hepatic Adenoma:,Carcinoma Breast:,Carcinoma Lung:,Osteo - sarcoma:,Colon Polyp:,Hepatic Adenoma:,Normal Adenoma,Anaplasia in Sarcoma:,Anaplasia:,Hepatic Adenocarcinoma:,Hepatic Adenocarcinoma:,Liver Metastasis:,
