Content乳腺癌Carcinomaofbreast小导管AnormalductcellsBbasementmembraneClumen(centerofduct)2024/9/112024/9/11导管双层上皮内腺上皮，外肌上皮全球每年120万妇女患乳腺癌，50万死于该病北美、北欧高我国↑3%/年，“第一癌症杀手”40-60岁女性，男性罕见1%乳腺外上象限>中央区>内上象限来自乳腺终末导管小叶单元上皮ER、PR(+)：内分泌治疗好，预后好C-erbB-2(+),ER(-):预后差Thecellsofthisbreastcarcinomaarehighlypositiveforestrogenreceptorwiththisimmunoperoxidasestain.Estrogenreceptorpositivitycorrelateswithabetterprognosis（预后）.Thisisprogesteronereceptor(PR)positivityinabreastcarcinoma.Theusefulnessofthisdeterminationisnotaswellestablishedasforestrogenreceptors.CarcinomasthatarePRpositive,butnotERpositive,mayhaveaworseprognosis.分类：属于原位癌没有突破导管和腺泡的基底膜分类:导管内原位癌小叶原位癌1．导管内原位癌（Intraductalcarcinomainsitu）AnormalductcellsBductalcancercellsCbasementmembraneDlumen(centerofduct)Intraductalcarcinoma.Theneoplastic（肿瘤的）cellsareconfinedtotheductbythebasementmembrane.Theneoplasticcellsaremonotonouswithroundtoovalnucleiandlittlepleomorphism.Thecellbordersarewelldemarcated（区分）.（1）粉刺癌镜下:实性排列，中央坏死－特征癌细胞大，嗜酸，大小不一，核仁明显，病理性核分裂多坏死区常见钙化导管周间质纤维组织↑，慢性炎C浸润Comedocarcinomaischaracterizedbythepresenceofrapidlyproliferating,high-grademalignantcells.Thecellsinthecenteroftheductsareoftennecroticandcalcify.Thiscentralnecrosisleadstothegrosscharacteristicofextrusionofcheesymaterialfromtheductswithpressure.2024/9/11ComedocarcinomaNotecentralnecrosis(*)andpleomorphicnuclei.Thecellsdonotextendbeyondthebasementmembrane(arrow).(2)非粉刺型导管内癌（Noncomedointraductalcarcinoma）2024/9/112024/9/112024/9/112024/9/112.小叶原位癌AnormallobularcellsBlobularcancercellsCbasementmembrane2024/9/11Lobularcarcinomainsituconsistsofaneoplasticproliferation（增殖）ofcellsintheterminalbreastductsandacini.Thecellsaresmallandround.Thereisa30%riskfordevelopmentofinvasivecarcinomainthesameortheoppositebreast.2024/9/112024/9/11导管内癌－－乳头、乳晕乳头、乳晕可见渗出、浅表溃疡又称“湿疹样癌”表皮内：瘤细胞孤立散在、成簇分布大而异型，胞质透明2024/9/112024/9/112024/9/112024/9/11癌细胞穿破乳腺导管或腺泡的基底膜而侵入间质占乳腺癌>85%分类：浸润性导管癌和浸润性小叶癌两种类型可并存，占10%，浸润性小叶癌的预后较差导管内癌细胞突破管壁基底膜向间质浸润最常见（70%）Anormalductcel