原发性肝癌（Primary_Carcinoma of the Liver课件.ppt

Primary Carcinoma of the Liver 云南省肿瘤医院内科教研室 何文杰 Tel 8185656-2595 Pathogenesis Pathology HCC Hepatitis Cirrhosis Med Clin N Am 89 (2005) 371–389 N Engl J Med. 1997 Dec 11;337(24):1733-45 预后 Pathogenesis 乙肝病毒 丙肝病毒 酒精 黄曲霉素 B1 损伤 肝细胞增殖停止 慢性肝脏疾病 肝硬化 异常肝结节 弥漫性疤痕(胶原) 中度基因不稳定性 显著的基因不稳定性 P53缺失 肝细胞癌 不典型增生结节 肝增生性结节 分化良好 中度分化 分化不良 增生 坏死 Farazi PA, DePinho RA. Nat Rev Cancer. 2006;6:674-687. HBV HCV Alcohol Aflatoxin B1 Injury HepatocyteproliferativearrestStellate cellactivation Chronic liver disease Liver cirrhosis Abnormal livernodules Extensive scarring(collagen) Moderate genomicinstability Marked genomicinstability Loss of p53 Hepatocellularcarcinoma Dysplasticnodule Hyperplasticnodule Well differentiated Moderately differentiated Poorly differentiated Proliferation Necrosis 肝星形细胞活化 Pathology General classification Bulky Nodular Diffuse Diffuse 最少见 Pathology Tissue typing Hepatocellular carcinoma Cholangio carcinoma Mixed carcinoma Hepatocellular carcinoma 最为多见。占90%，其中85%-90%有乙型肝炎后肝硬化史。 Cholangiocarcinoma 胆管细胞癌占5%，多有中华分支睾吸虫感染的病史 Mixed carcinoma of liver 肝细胞型和胆管细胞型混合存在 Summary Primary liver cancer is the process which hepatitis - cirrhosis - liver cancer is occurred and developed General classification Bulky Nodular Diffuse Tissue typing Hepatocellular carcinoma 　 Cholangio carcinoma Mixed carcinoma 　 Questions What is the difference clinical manifestations with different histological types of primary liver cance. 流行病学 病因 病理 临床表现 诊断 治疗