病理生理学精品课件（复旦大学）06 呼吸系统疾病.pptVIP

Interstitial pneumonia Interstitial infiltration of lymphocytes, macrophage and occasionally plasma cells 巨细胞病毒性肺炎 Centrilobular emphysema Panacinar emphysema Bullae Silicosis Clinical course Persistent hoarseness, pain, haemoptysis, dysphagia Treatment Resection and/or radiotherapy Primary lung cancer Bronchogenic carcinomas Arising from the bronchial epithelium 95% USA 1/3 of cancer deaths in men the leading cause of cancer deaths in women Peak incidence 50~ 59 years Male : female = 1.5:1 A miscellaneous group 5% Etiology and pathogenesis Cigarette smoking Environmental insults ? A stepwise accumulation of a multitude of genetic abnormalities Transformation of benign progenitor into neoplastic tissue ? Hereditary(genetic) factors P-450 monooxygenase enzyme system P-450 genes ? Inactivation of the putative tumor suppressor genes located on 3p, TP53 mutations, KRAS activation, EGFR mutations, EML4-ALK tyrosine kinase fusion genes and c-MET tyrosine kinase gene amplications. Morphology Gross Small mucosal lesions Firm, gray-white Intraluminal masses Invading the bronchial mucosa Forming large bulky masses pushing into adjacent lung parenchyma Cavitation - central necrosis Focal hemorrhage Tumors arising from large bronchus In Central zone of lung or in the hilar region A globus shape, non-capsulated, an distinct irregular boundary Tumors arising from smaller bronchi or bronchiole In peripheral region of lung Small, solitary, without capsule, lobular in contour, hazy edge Cut surface: Greyish white Glistening when containing mucous element Diffuse type Four major histological types Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Small cell carcinoma A combination of histologic patterns Adenocarcinomas 36.8～46.5%, more common in women Arising from basal cell or goblet cell line of large