第5章 肿瘤_6癌前病变原位癌（课件）-高一《病理学·第4版》同步教学（科学出版社）

Section 9 癌前病变、非典型增生和原位癌 病理学 肿瘤 neoplasia 粘膜白斑 ------（口腔/外阴/食道） 乳腺增生性纤维囊性变-----小叶导管及腺泡上皮增生，导管囊性扩张，纤维增生。 结、直肠息肉状腺瘤------家族性，多发性者 慢性萎缩性胃炎-------肠上皮化生→不典型增生→癌 皮肤慢性溃疡------- 慢性溃疡性结肠炎------ 癌前病变 （precancerous lesions)：具有癌变潜在可能性的病变，长期存在有可能转变为癌。分遗传性/获得性。 病理学 肿瘤 neoplasia 不典型性增生 （ Dysplasia ） 轻度 中度 重度 基底膜 鳞状上皮/腺上皮 病理学 肿瘤 neoplasia 原位癌 （carcinoma in situ） 子宫/食管/皮肤(乳腺) 癌前病变→不典型增生→原位癌→浸润癌 病理学 肿瘤 neoplasia 病理学 肿瘤 neoplasia 5 This epithelium shows severe dysplasia: Note that dysplastic basal cells characterized by cuboidal shape, high nuclear cytoplasmic ratio, hyperchromatism, mitotic activity, and some loss of orientation to the basement membrane, occupy the lower two thirds of the surface rather than just the basal row of cells. More differentiated cells which occupy the outer third, though still retaining some dysplastic nuclear features have the appearance of maturing squamous cells rather than basal cells, and eventually become flattened on the surface. 病理学 肿瘤 neoplasia 6 Carcinoma in situ: This section shows that the dysplastic basiloid cells go all the way to the surface and never undergo significant differentistion towards more differentiated flattened squamous cells. Note however that the basement membrane is still intact. The torturingly and unnecessary insane pressure to differentiate “severe” dysplasias from carcinomas-in-situ has prompted the various “-IN” classification systems, e.g., CIN-III, VIN-III, PIN-III. Is high grade dysplasia any different from carcinoma-in-situ from a microscopic, behavioral, or medical-legal point of view? Ans: NO! Section 10 肿瘤的病因学及发病机制 外因 化学因素 物理因素 生物因素 内因 遗传因素 免疫因素 内分泌因素 其他：年龄、性别、种族、地理、精神 病理学 肿瘤 neoplasia 分子生物学基础 癌基因 抑癌基因 凋亡调节基因和DNA修复基因 端粒、端粒酶和肿瘤 Carcinogenesis 病理学 肿瘤 neoplasia 癌基因：oncogene 具有转化能力的基因 细胞癌基因 / 原癌基因 proto-oncogene 正常细胞中存在 人/猿/鸟/蛇鱼/苍蝇/酵母 重要、高度保守 激活为癌基因，编码产物发生质或量的改变，促进生长 Src、ras、myc、erbB 病毒癌基因 v-oncogene : 肿瘤病毒 抑癌基因 tumor suppressor gene / anti-oncog