乳腺疾病课件-英文版.ppt

乳腺疾病课件-英文版.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