病理劉勇、肖秀麗、黃娟腫瘤學(xué)習(xí)資料

二、注意：腫瘤性增殖與機(jī)體不協(xié)調(diào)，對(duì)機(jī)體有害腫瘤性增殖一般是克隆性的（clonal），即一個(gè)腫瘤中的腫瘤細(xì)胞群，是由發(fā)生了腫瘤性轉(zhuǎn)化（neoplastictransformation）的單個(gè)細(xì)胞反復(fù)分裂繁殖產(chǎn)生的子代細(xì)胞組成的腫瘤細(xì)胞的形態(tài)、代謝和功能均有異常，不同程度地失去了分化成熟的能力腫瘤細(xì)胞生長(zhǎng)旺盛，失去控制，具有相對(duì)自主性，即使引起腫瘤性增殖的初始因素已消除，仍能持續(xù)生長(zhǎng)1、腫瘤性增殖與非腫瘤性增殖有重要區(qū)別腫瘤性增生與非腫瘤性增生的區(qū)別腫瘤增生非腫瘤增生

量持續(xù)性（腫瘤細(xì)胞生長(zhǎng)旺盛，失去控制，具有相對(duì)自主性，與機(jī)體不協(xié)調(diào)）自限性

質(zhì)失分化性（瘤細(xì)胞具有異常的形態(tài)、代謝和功能，不同程度地失去分化成熟的能力；）分化成熟,一定程度恢復(fù)原有結(jié)構(gòu)

影響對(duì)機(jī)體有害無益大多有利2、腫瘤與腫塊的關(guān)系第二節(jié)腫瘤的形態(tài)數(shù)目大小形狀顏色質(zhì)

地受多種因素的影響(與組織來源，生長(zhǎng)方式，發(fā)生部位等有關(guān))，多種多樣，在一定程度上反映了腫瘤的良惡性。一、腫瘤的大體形態(tài)

1、數(shù)目多數(shù)為一個(gè)，可多個(gè)；單發(fā)多發(fā)2、大小大小不一3、形狀多種多樣形狀千姿百態(tài)Thisisatumorofovariansurfaceepithelium.Thesearethemostcommonovarianneoplasms.Suchneoplasmsmaybelinedbyepitheliumthatisserousormucinous.Picturedhereisaserouscystadenoma.Itwasfilledwithpaleyellowserousfluidinonlyasinglecavity.Mucinoustumorsarefilledwithstickymucinandtendtobemultiloculated.Benignepithelialovariantumorsarebilateralinabout20%ofcases.Lungcancer4、顏色一般為灰白色或灰紅色，可為其它顏色。Hereisaverylargeleiomyomaoftheuterusthathasundergonedegenerativechangeandisred(so-called"reddegeneration").Suchanappearancemightmakeyouthinkthatitcouldbemalignant.Rememberthatmalignanttumorsdonotgenerallyarisefrombenigntumors,whichisagoodthing,becauseleiomyomasaresocommon(20%ofwomenwillhaveatleastone).Postmenopausally,leiomyomastendtoregressinsizeandbecomefibroticThislargefleshymassaroseintheretroperitoneumandisanexampleofasarcoma.Sarcomasarisefrommesenchymaltissues.Thisonehappenedtobea"malignantfibroushistiocytoma"whichisawastebaskettermforsarcomasthatdonotresemblemesenchymalcellssuchasstriatedmuscle(rhabdomyosarcoma),smoothmuscle(leiomyosarcoma),fat(liposarcoma),bloodvessels(angiosarcoma),bone(osteosarcoma),orcartilage(chondrosarcoma).SarcomasarebigandbadThisisasquamouscellcarcinomaofthelungthatisarisingcentrallyinthelung(asmostsquamouscellcarcinomasdo).Itisobstructingtherightmainbronchus.TheneoplasmisveryfirmandhasapalewhitetotancutsurfaceThisrenalcellcarcinomademonstratesdistortionanddisplacementoftherenalparenchymabythetumormassinthelowerpole.Thismalignantneoplasmisvariegatedoncutsurface,withyellowtowhitetoredtobrownareasOfcourse,neoplasmscanbebenignaswellasmalignant,thoughitisnotalwayseasytotellhowaneoplasmwillact.Hereisabenignlipomaontheserosalsurfaceofthesmallintestine.Ithasthecharacteristicsofabenignneoplasm:itiswellcircumscribed,slowgrowing,andresemblesthetissueoforigin(fat).5、質(zhì)地(硬度)軟硬不一Hereisanosteosarcomaofbone.Thelarge,bulkymassarisesinthecortexoftheboneandextendsoutward二、腫瘤的組織形態(tài)

1、腫瘤的實(shí)質(zhì)：腫瘤細(xì)胞

決定腫瘤的一切性質(zhì)

腫瘤的分化程度、方向

腫瘤的組織學(xué)分類（一）腫瘤的組織—實(shí)質(zhì)與間質(zhì)Notethesmallnestsandinfiltratingstrandsofneoplasticcellswithprominentbandsofcollagenbetweentheminthisductalcarcinomaofthebreast.Itisthismarkedincreaseinthedensefibroustissuestromathatproducesthecharacteristichard"scirrhous"appearanceofthetypicalinfiltratingductalcarcinoma.Notethenervesurroundedbytheneoplasmatthelowerleft實(shí)質(zhì)間質(zhì)實(shí)質(zhì)間質(zhì)

營(yíng)養(yǎng)

支架（支持）

限制2、間質(zhì)：含脈管的纖維結(jié)締組織，無特異性作用：還可見淋巴細(xì)胞等浸潤(rùn)，與機(jī)體對(duì)腫瘤細(xì)胞的免疫反應(yīng)有關(guān)

腫瘤的分化與異型性第三節(jié)腫瘤的分化（differentiation）：

分化：一種幼稚的、無特殊功能的組織或細(xì)胞向著成熟的，具有特殊功能的組織和細(xì)胞生長(zhǎng)發(fā)育的過程；

腫瘤的分化：指腫瘤組織在形態(tài)和功能上與某種正常組織的相似之處。相似的程度稱為腫瘤的分化程度。

一個(gè)腫瘤的組織形態(tài)和功能比較接近某種正常組織，說明其分化程度高或分化好相似性小，說明分化程度低或分化差腫瘤缺乏與正常組織的相似之處，稱為未分化腫瘤間變（anaplasia）：腫瘤缺乏與正常組織的相似之處稱未分化/間變，異型性顯著，惡性程度高。

異型性（atypia）：腫瘤細(xì)胞形態(tài)

組織結(jié)構(gòu)與其來源的正常組織不同程度的差異。

異型性大小在病理學(xué)上是診斷和鑒別良、惡性腫瘤的重要形態(tài)學(xué)依據(jù)。1、腫瘤細(xì)胞的異型性(1)細(xì)胞的多形性（大小、形態(tài)）(2)核的多形性(核漿比、大小、形狀、染色、數(shù)目、核分裂等)

Thisneoplasmissopoorlydifferentiatedthatitisdifficulttotellwhatthecelloforiginis.Itisprobablyacarcinomabecauseofthepolygonalnatureofthecells.Notethatnucleoliarenumerousandlargeinthisneoplasm.NeoplasmswithnodifferentiationaresaidtobeanaplasticSarcomas,includingleiomyosarcomas,oftenhaveverylargebizarregiantcellsalongwiththespindlecells.Acoupleofmitoticfiguresappearattheleftandlowerleft.(3)細(xì)胞漿的改變：嗜堿性染色增強(qiáng)與來源相關(guān)的瘤細(xì)胞產(chǎn)物Thisisasignetringcellpatternofadenocarcinomainwhichthecellsarefilledwithmucinvacuolesthatpushthenucleustooneside,asshownatthearrow

圖(惡黑、粘液腺癌兒鏡下各一幅）腫瘤細(xì)胞的異型性可歸納為：大（細(xì)胞大，核大，核仁大）；多（核多，核仁多，染色質(zhì)多，產(chǎn)物多）；怪（瘤細(xì)胞和細(xì)胞核奇形怪狀）；裂（核分裂及病理性核分裂）；2、腫瘤組織結(jié)構(gòu)的異型性

細(xì)胞的極向

空間排列方式

細(xì)胞層次

腺體大小

形態(tài)

密度等發(fā)生紊亂和變化圖鏡下：

（皮膚乳頭狀瘤與皮膚鱗癌）Theinfiltratingglandsofthiscolonicadenocarcinomademonstratelessdifferentiationthantheadenomatouspolyp,althoughtheystillresembleglands.Ingeneral,lessdifferentiationmeansagreaterlikelihoodofmalignantbehavior（大腸腺瘤性息肉）與大腸癌）Theconceptofdifferentiationisdemonstratedbythissmalladenomatouspolypofthecolon.Notethedifferenceinstainingqualitybetweentheepithelialcellsoftheadenomaatthetopandthenormalglandularepitheliumofthecolonicmucosabelow（大腸腺瘤性息肉）與大腸癌）Athighmagnification,thenormalcolonicepitheliumattheleftcontrastswiththeatypicalepitheliumoftheadenomatouspolypattheright.Nucleiaredarkerandmoreirregularlysizedandclosertogetherintheadenomatouspolypthaninthenormalmucosa.However,theoveralldifferencebetweenthem