乳腺疾病课件-英文版PPT文件格式下载.ppt
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GeneralSurgeryDepartmentDr.PengMiaoBreastDiseaseAnatomyModifiedsweatglandbetweenthesuperficialanddeeplayersofthechestwallCoopersLigamentFibrousbandoftissueAnatomyDuctsTerminalductulesMilkingformingglandsLobuleAnatomyAxillarylymphnodesdefinedbypectoralisminormuscleLevel1lateralLevel2posteriorLevel3medialLongThoracicNerveSerratusanteriorThoracodorsalNerveLatissimusDorsiIntercostalbrachialNerveLateralcutaneousSensorytomedialarm&@#@axillaClinicalExamInspectionSkinSymmetryMassesPalpableGlandAxilla,SupraclavicularspacesNipple-areolacomplexBreastCystsFluid-filled1outofevery14women50%multipleandrecurrentHormonallyinfluencedNeedleaspiratedBreastMassBreastCystFibroadenomaStromalandepithelialelementsMostcommoninwomen100/100,000stableincidencedeclinedmortalityChina7-10%ofallmalignancies2ndmostcommonCain3%yearlyincreaserate(highestworldwide)2.Etiology病因病因Hormonalinfluence(激素影响激素影响):
@#@Longdurationofreproductivelife(育龄的长时间持续)Nulliparity(,nliprti未产妇)Lateageatfirstchild(老龄生育)Functioningovariantumor(卵巢肿瘤影响)Fibrocysticdisease(乳腺纤维囊性病乳腺纤维囊性病)Radiationexposure(射线照射射线照射)Obesity(肥胖肥胖)Geneticpredisposition遗传倾向遗传倾向)3.Pathologicaltyping病理类型病理类型Noninvasivebreastcarcinomaductalcarcinomainsitu,lobularcarcinomainsitu,PagetsdiseaseEarlyinvasivebreastcarcinomaSpecialtypesofinvasivebreastcancerpapillary,medullary,tubular,mucinousOrdinarytypesofinvasivebreastcancerinvasiveductal,invasivelobularOthers4.转移途径转移途径
(1).Infiltrate,localinvation直接浸润直接浸润
(2).lymphaticmetastasis淋巴转移淋巴转移经胸肌外缘经胸肌外缘-同侧腋窝同侧腋窝-锁骨上锁骨上-胸导管胸导管经胸骨旁经胸骨旁-锁骨上锁骨上-胸导管胸导管(3).hematogenousmetastasis血行转移血行转移alonginter-fascialspacealongductulesLocalinvasionInvadingCoopersligamentsInvadingskinInvadingmusclesSupraclavicularnodesSubclavicularnodesInternalmammarynodessubareolarplexusLymphaticmetastasisHematogenousmetastasislatestageandearlystagevialymphaticdrainageordirectly5.ClinicalFindings临床表现临床表现Site:
@#@Mostlyinouterupperquadrantouterupperquadrant(外上四分之一区域外上四分之一区域)50%Centralzone(中心区域中心区域)20%20%10%outerlowerquadrant(外外下四分之一区域下四分之一区域)10%innerlowerquadrant(内下四分之一区域内下四分之一区域)innerupperquadrant(内上四分之一区域内上四分之一区域)10%BreastAnatomySite(发病部位发病部位):
@#@PalpablepainlesslumpLocalprotrusionChangesinskinandnippleDelleanddimplesignOrange-peelsign,peaudorangeNippleretractionandinvertednippleEczematoidchangeoverareolaornippleHugemassandulcerationInflammatorybreastcancerPresentationinbreastPalpablepainlesslumphard,irregularshape,roughsurface,lowmobility80%intheupperhalfofthebreastLocalprotrusionassymetricityofBil.BreastschangeinshapeassymetricbreastchangeinshapeChangeinskin-DelleanddimplesignDelle:
@#@visibleskinretractiondimplesign:
@#@pinchedskinretractioninvasionofCoopersligamentsandadjacentadiposeincompletefixationofskinChangeinskin-orange-peelsignthickeningofskindermaledemainducedbyinvasionoflymphaticvesselsChangeinnipple-nippleretractionandinversiondifferentiatedfromcongenitalnippleretractioninvasionofmammaryductsChangeinnipple&@#@areola-eczematoidchange(Pagetsdisease)lowmalignantdegree,slowdevelopment90%accompaniedbyinvasivecancerHugemassandulceration-locallyadvancedcarcinoma20%ofallcases50%inelderlywomen(70yr)Inflammatorybreastcancerhighmalignantdegree,fastdevelopment,poorprognosisyoungerwomen5.3.Clinicalpresentation-distalmetastasis癌转移癌转移AxillaryLymphadenectasis腋下腋下LN肿大肿大Bonemetastasis骨痛骨痛localpain,fractureLivermetastasis肝大肝大liverenlargement,jaundiceLungmetastasis胸痛胸痛Chestpain,dyspneaClinicalpresentation-axillarypalpatedmovable,ipsilateralaxillarynodesfixedorfusedipsilateralaxillarynodesulcerativeipsilateralaxillarynodesMammographyScreeningtoolAgeof40Estimatedreductioninmortality15-25%10%falsepositiverateDensities&@#@calcificationsUltrasoundBenignPureandintenselyhyperechoicEllipticalshape(widerthantall)LobulatedCompletetinecapsuleMalignantHypoechoic,spiculatedTallerthanwideDuctextensionmicrolobulationDiagnosis-biopsyFineneedlebiopsyCytology70%accuracyCoreneedlebiopsyHistology90%accuracyAvoidexcisionalbiopsyDifferentialdiagnosisCysticfibrosisthickeninglumpinessPapillomacleardischargeHowtodifferentiate?
@#@UltrasoundMammographyDuctalendoscopyCoreneedlebiopsyFineneedlebiopsyRationalesGuidancefortherapeuticapproachesPredictionofrecurrenceriskPredictionoftherapeuticresponseStagingcriteriaPrimarytumorsNumberofmetastaticlymphnodesDistalmetastasisStagingStagingPrimarytumorTisvs.T0T1:
@#@5cmT4:
@#@invasiontoskinorchestwallLymphnodesN0:
@#@noregionallymphnodemetastasisN1:
@#@movableipsilateralaxillary,1-3axillaryN2:
@#@fixedormattedipsilateralaxillary,internalmammaryalone,4-9axillaryN3:
@#@supraorinfraclavicular,axillaryandinternalmammary,10axillaryDistantmetastasisM0:
@#@nodistantmetastasisM1:
@#@withdistantmetastasisStaging8.Treatmentprinc