消化系统（二食管癌胃癌大肠癌级）.pptVIP

良、恶性溃疡的肉眼形态鉴别 良性溃疡（溃疡病） 恶性溃疡（溃疡型胃癌） 外 形 圆形或椭圆形 不整形、皿状或火山口状 大 小 2cm 2cm 深 度 较深 较浅 边 缘 整齐、不隆起 不整齐、隆起 底 部 较平坦 凹凸不平，有坏死出血 周围粘膜 皱襞向溃疡集中 皱襞中断，呈结节状肥厚 This is an example of linitis plastica, a diffuse infiltrative gastric adenocarcinoma which gives the stomach a shrunken leather bottle appearance with extensive mucosal erosion and a markedly thickened gastric wall. This type of carcinoma has a very poor prognosis. The endoscopic view of this lesion is shown below, with extensive mucosal erosion. ②镜下： 乳头状腺癌 管状腺癌 粘液腺癌； 印戒细胞癌 （二）胃癌（carcinoma of stomach） 1、病 变 （1）好发部位 （2）组织来源 1）早期胃癌 （3）类 型 2）进展期胃癌 ①肉眼： 1）息肉型/蕈伞型 2）溃疡型 3）浸润型 4）胶样型 A moderately differentiated gastric adenocarcinoma is infiltrating up and into the submucosa below the squamous mucosa of the esophagus. The neoplastic glands are variably sized. At higher magnification, the neoplastic glands of gastric adenocarcinoma demonstrate mitoses, increased nuclear/cytoplasmic ratios, and hyperchromatism. There is a desmoplastic stromal reaction to the infiltrating glands. This is a signet ring cell pattern of adenocarcinoma in which the cells are filled with mucin vacuoles that push the nucleus to one side, as shown at the arrow. 1）直接蔓延 2）转移 （二）胃癌（carcinoma of stomach） 1、病 变 2、扩散途径 At autopsy, the thoracic cavity and abdominal cavity are both opened to reveal the stomach just to the right and below the edge of liver in this photograph. Gastric adenocarcinoma has infiltrated through the wall and appears on the surface as irregular tan masses. The extensive tumor in this case caused gastric outlet obstruction. （二）胃癌（carcinoma of stomach） 3、病 因 （1）饮食因素 （２）胃的某些疾患 （３） ＨＰ（图） （４）其它：遗传、吸烟。 1、病 变 2、扩散途径 （１）胃镜 （２）胃液脱落细胞学检查 （３）免疫：胎儿硫糖蛋白（ＦＳＰ） ４、病理诊断 1、病 变 （2）组织来源：肠腺上皮 （三）大肠癌（carcinoma of large intestine） 直肠50%，乙状结肠20%， 盲肠、升结肠16%，横结肠8%，降结肠6%。 （1）好发部位： （3）肉 眼： ①隆起型 ②溃疡型 ③浸润型 ④胶样型 ① 乳头状腺癌 ② 管状腺癌 ③ 粘液腺癌 ④ 印戒细胞癌 ⑤ 未分化癌 ⑥ 腺鳞癌 ⑦ 鳞状细胞癌 （4）组织学类型 1、病 变 （三）大肠癌（carcinoma of large intestine