乳腺疾病课件-英文版.ppt
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乳腺疾病课件-英文版.ppt
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GeneralSurgeryDepartmentDr.PengMiao,BreastDisease,Anatomy,ModifiedsweatglandbetweenthesuperficialanddeeplayersofthechestwallCoopersLigamentFibrousbandoftissue,Anatomy,DuctsTerminalductulesMilkingformingglandsLobule,Anatomy,AxillarylymphnodesdefinedbypectoralisminormuscleLevel1lateralLevel2posteriorLevel3medialLongThoracicNerveSerratusanteriorThoracodorsalNerveLatissimusDorsiIntercostalbrachialNerveLateralcutaneousSensorytomedialarm&axilla,ClinicalExam,InspectionSkinSymmetryMassesPalpableGlandAxilla,SupraclavicularspacesNipple-areolacomplex,BreastCystsFluid-filled1outofevery14women50%multipleandrecurrentHormonallyinfluencedNeedleaspirated,BreastMass,BreastCyst,FibroadenomaStromalandepithelialelementsMostcommoninwomen30yoFirm,solitarytumorsMultipleIncreaseinsizeManagementBiopsyExcisionalbiopsy,BreastMass,Fibroadenoma,MastitisGeneralizedcellulitisofthebreastAscendinginfectionsubareolarductscommonlyoccursduringlactationStaph.aureusErythema,pain,tenderness,BreastInfections,Mastitis,TreatmentAbxContinuetobreastfeedClosefollow-up,AbscessBreasttissueTreatmentAbxNeedleaspirationIncisionanddrainage,BreastAbscess,BreastCancer,1.Introduction概论,Westerncountries100/100,000stableincidencedeclinedmortalityChina7-10%ofallmalignancies2ndmostcommonCain3%yearlyincreaserate(highestworldwide),2.Etiology病因,Hormonalinfluence(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)Radiationexposure(射线照射)Obesity(肥胖)Geneticpredisposition遗传倾向),3.Pathologicaltyping病理类型,Noninvasivebreastcarcinomaductalcarcinomainsitu,lobularcarcinomainsitu,PagetsdiseaseEarlyinvasivebreastcarcinomaSpecialtypesofinvasivebreastcancerpapillary,medullary,tubular,mucinousOrdinarytypesofinvasivebreastcancerinvasiveductal,invasivelobularOthers,4.转移途径,
(1).Infiltrate,localinvation直接浸润
(2).lymphaticmetastasis淋巴转移经胸肌外缘-同侧腋窝-锁骨上-胸导管经胸骨旁-锁骨上-胸导管(3).hematogenousmetastasis血行转移,alonginter-fascialspace,alongductules,Localinvasion,InvadingCoopersligamentsInvadingskinInvadingmuscles,Lymphaticmetastasis,Hematogenousmetastasis,latestageandearlystagevialymphaticdrainageordirectly,5.ClinicalFindings临床表现,Site:
Mostlyinouterupperquadrant,outerupperquadrant(外上四分之一区域)50%,Centralzone(中心区域)20%,10%outerlowerquadrant(外下四分之一区域),10%innerlowerquadrant(内下四分之一区域),innerupperquadrant(内上四分之一区域)10%,BreastAnatomySite(发病部位):
PalpablepainlesslumpLocalprotrusionChangesinskinandnippleDelleanddimplesignOrange-peelsign,peaudorangeNippleretractionandinvertednippleEczematoidchangeoverareolaornippleHugemassandulcerationInflammatorybreastcancer,Presentationinbreast,Palpablepainlesslump,hard,irregularshape,roughsurface,lowmobility80%intheupperhalfofthebreast,Localprotrusion,assymetricityofBil.Breastschangeinshape,assymetricbreast,changeinshape,Changeinskin-Delleanddimplesign,Delle:
visibleskinretraction,dimplesign:
pinchedskinretraction,invasionofCoopersligamentsandadjacentadiposeincompletefixationofskin,Changeinskin-orange-peelsign,thickeningofskindermaledemainducedbyinvasionoflymphaticvessels,Changeinnipple-nippleretractionandinversion,differentiatedfromcongenitalnippleretractioninvasionofmammaryducts,Changeinnipple&areola-eczematoidchange(Pagetsdisease),lowmalignantdegree,slowdevelopment90%accompaniedbyinvasivecancer,Hugemassandulceration-locallyadvancedcarcinoma,20%ofallcases50%inelderlywomen(70yr),Inflammatorybreastcancer,highmalignantdegree,fastdevelopment,poorprognosisyoungerwomen,5.3.Clinicalpresentation-distalmetastasis癌转移,AxillaryLymphadenectasis腋下LN肿大Bonemetastasis骨痛localpain,fractureLivermetastasis肝大liverenlargement,jaundiceLungmetastasis胸痛Chestpain,dyspnea,Clinicalpresentation-axillary,palpatedmovable,ipsilateralaxillarynodesfixedorfusedipsilateralaxillarynodesulcerativeipsilateralaxillarynodes,Mammography,ScreeningtoolAgeof40Estimatedreductioninmortality15-25%10%falsepositiverateDensities&calcifications,Ultrasound,BenignPureandintenselyhyperechoicEllipticalshape(widerthantall)LobulatedCompletetinecapsule,MalignantHypoechoic,spiculatedTallerthanwideDuctextensionmicrolobulation,Diagnosis-biopsy,FineneedlebiopsyCytology70%accuracyCoreneedlebiopsyHistology90%accuracyAvoidexcisionalbiopsy,Differentialdiagnosis,Cysticfibrosisthickeninglumpiness,Papillomacleardischarge,Howtodifferentiate?
UltrasoundMammographyDuctalendoscopyCoreneedlebiopsyFineneedlebiopsy,RationalesGuidancefortherapeuticapproachesPredictionofrecurrenceriskPredictionoftherapeuticresponseStagingcriteriaPrimarytumorsNumberofmetastaticlymphnodesDistalmetastasis,Staging,Staging,PrimarytumorTisvs.T0T1:
5cmT4:
invasiontoskinorchestwall,LymphnodesN0:
noregionallymphnodemetastasisN1:
movableipsilateralaxillary,1-3axillaryN2:
fixedormattedipsilateralaxillary,internalmammaryalone,4-9axillaryN3:
supraorinfraclavicular,axillaryandinternalmammary,10axillaryDistantmetastasisM0:
nodistantmetastasisM1:
withdistantmetastasis,Staging,8.Treatmentprinciple治疗原则:
以手术治疗为主,化疗,放疗,激素,免疫等综合(colligate,synthesize)措施的治疗为辅;Surgery:
radicalmastectomy(Halsted)modifiedradicalmastectomyExtensiveradicalmastectomyBreastconservativesurgerySentinelaxillaryLNbiopsy,8.1.Operation手术治疗,
(1)radicalmastectomy乳腺根治切除术(切除内容及范围),
(2)Extendedradicalmastectomy乳癌扩大根治切除术扩大切除的内容,(3)Segmentalmastectomy+axillarydissection改良根治术,1.anatomy乳腺解剖2.examination乳房检查3.乳腺癌
(1).Etiology病因
(2).pathology病理(3).lymphdrain淋巴输出途经(4.)clinicalfindings临床表现(5).differentialdiagnosis乳腺癌诊断及鉴别诊断(6).treatment治疗:
surgicaltreatment外科治疗化疗放疗内分泌治疗,Briefsummary总结,ThankYou!
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