乳腺解剖教学文案.ppt

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1、乳腺解剖The portion of the breast that extends toward or into the underarm or axilla is referred to as the axillary tail of the breast or the tail of Spence.乳房延伸至腋下部分称为腋尾。Axillary tail(Tail of Spence)Lymph is a fluid that filters between the cells of tissue and then drains into its own set of transport

2、channels.Lymph fluid may carry infectious organisms,toxins or cancerous cells.The channels that carry the lymph fluid are referred to as lymphatics.These lymphatics usually travel near or with the vascular supply of a tissue.Small lymphatics drain into larger lymphatics and eventually all the lympha

3、tic fluid empties into one of the large veins in the thoracic cavity.Along the course of these lymphatic channels are soft tissue structures called lymph glands or nodes.The lymph glands act as filters to remove harmful substances from the lymph fluid.淋巴是在组织间进行过滤的液体,它流入自己的输送渠道.淋巴液载送感染性有机物,毒素和癌细胞.载送淋

4、巴液的渠道称为淋巴管。这些淋巴管通常在组织周围流动并且将组织维管联结。小的淋巴管流入大的淋巴管，并且最终所有的淋巴液流入胸腔的某个大血管。在这些淋巴管道的路程中有一些软组织称为淋巴腺或淋巴结。这些淋巴结象过滤器一样过滤淋巴液中的有害物质。Lymph nodesLymphaticsThe majority of the lymphatic fluid from a breast drains to the ipsilateral axilla.The axilla is rich in both lymphatic channels and lymph nodes.A small portion

5、 of the lymphatic drainage from the inferomedial breast parenchyma will drain to the lymphatic system associated with the internal thoracic vessels.乳腺的大部分淋巴液流入腋窝淋巴。腋窝富含淋巴管和淋巴结。小部分乳腺内下侧淋巴液引流入胸内脉管的淋巴系统。Parasternal(internal thoracic)nodesSubclavian(apical axillary)nodesInterpectoral(Rotters)nodesCentra

6、l axillarynodesBrachial(lateral axillary)nodesSubscapular(posterior axillary)nodesPectoral(anterior axillary)nodesFor convention the axillary lymph nodes are divided into three groups:1.Pectoral or level 1(inferior to pectoralis minor attachment)第一站淋巴结（胸小肌下）2.Central or level 2(posterior to pectoral

7、is minor attachment)第二站淋巴结（胸小肌后）3.Apical or level 3(superior to pectoralis minor attachment)第三站淋巴结（胸小肌上）It is believed that the majority of the lymph drainage from the breast toward the axilla travels to the level 1 axillary nodes then to the level 2 axillary nodes and then to the level 3 axillary n

8、odes.普遍认为大部分的乳腺的腋窝淋巴引流都是从第一站到第二站到第三站。The glands of the breast are arranged into collections called lobules.The secretions of the glands of each lobule drain into a tube called a lobular duct.乳房的腺体结合成小叶.小叶腺体的分泌物流入小叶管LobuleLobular ductMany lobules together form a lobe of the breast.The duct that carri

9、es the secretions from all the lobules in a lobe is referred to as a lobar duct.许多个小叶汇聚成乳叶.小叶分泌物汇聚流入乳管.Lobar ductLactiferous sinus(ampulla)LobeA breast contains 15-18 lobes and therefore 15-18 lobar ducts.The lobar ducts are also referred to as lactiferous ducts.Each lactiferous duct has an opening

10、on the surface of the nipple.There is a dilated region in each lactiferous duct just deep to the surface of the nipple.This dilated area is referred to as the ampulla.一个乳房有15-18个乳叶和15-18个乳管.乳管也称为乳汁输送管.每个乳汁输送管在其乳头处有一个开口.在乳头深处,每个乳汁输送管都有一个膨胀部位,称为壶腹.Lobular ductLobar duct(Lactiferous duct)LobuleAmpullaN

11、ippleOver time,due to factors scientist poorly understand,the cells in the breast lobules and ducts may undergo changes.Some of these changes increase a womans risk of developing breast cancer while other changes are cancerous.To understand these changes lets look at a duct in cross section.This vie

12、w is what it would be seen if a piece of breast tissue were removed from the breast and then examined under a microscope.随着时间推移,由于某些无法解释的原因,乳腺小叶和乳管会发生变化.有些变化会增加妇女罹患乳腺癌的风险.而有些变化本身就是癌变.要了解这些变化,让我们来看一看乳腺的横截面.In a normal duct the cells lining the duct will be one or two layers thick.These cells will hav

13、e similar size and shape.正常的乳管有12层细胞。这些细胞有相似的大小和形状In some women,extra cells will grow in the duct.The latin term for excess is hyper and the term for growth is plasia,so a condition with excess growth is referred to as hyperplasia.In this case the specific term would be ductal hyperplasia This condi

14、tion confers no increase risk for developing breast cancer.有些妇女，乳管内生长了额外的细胞。这称为增生，乳管内增生。乳管内增生Sometimes the excess growth within the duct includes some very abnormal or atypical cells.This condition is referred atypical ductal hyperplasia or ADH.The presence of this condition in a womans breast incre

15、ases her risk of developing a breast cancer in her lifetime.Individually,these atypical cells may resemble cancer cells.The more abnormal and atypical an individual cell the more it resembles a cancer cell.有时，额外的细胞包括不正常或不典型的细胞。这些细胞增加了妇女得乳腺癌的风险。单个来说，这些不典型细胞类似癌细胞。不典型增生If there are many atypical cells

16、the entire duct may be filled with these abnormal,atypical cells.This condition is actually an early breast cancer.It is referred to as ductal carcinoma in situ or DCIS.Theoretically,the cancer cells are only located within the duct and have not spread out of the affected duct.Some physicians refer

17、to this condition as a“pre-cancer”.This is incorrect,this is indeed a localized breast cancer.如果乳管内有许多不典型细胞，直至整个乳管都充满了不正常不典型的细胞。这其实是早期的乳腺癌。称为乳管内原位癌。乳管内原位癌 DCISIf DCIS is not treated the cancer cells will eventually break out of the duct and invade the breast tissue.This is referred to as invasive du

18、ctal carcinoma.如果原位癌没有得到治疗，癌细胞会最终突破乳管，侵犯乳腺组织。称为浸润性乳管癌。浸润性乳管癌If excess growth occurs in the lobules the condition is referred to as lobular hyperplasia.Atypical lobular hyperplasia may also develop.If Atypical lobular hyperplasia progresses in severity a condition referred to as lobular carcinoma in

19、situ or LCIS may develop.This condition is very different from DCIS.也会发生小叶增生以及不典型小叶增生。小叶增生发展到严重程度称为小叶内原位癌。Lobular hyperplasiaAtypical lobular hyperplasiaBIRADS*乳腺影像报告数据系统乳腺影像报告数据系统(Breast Imaging Reporting Data System)Standard descriptors to identify findings of辨别影像发现的标准描述辨别影像发现的标准描述Masses 肿块肿块Calci

20、fications钙化钙化Abnormalities 不正常影像发现不正常影像发现Impression and assessment印象和评估印象和评估Categories:0-5012345评估不足评估不足 阴性阴性良性良性可能良性可能良性怀疑恶性怀疑恶性高度怀疑恶性高度怀疑恶性更多的诊断方法更多的诊断方法常规摄片常规摄片常规摄片常规摄片短期随访短期随访立即活检立即活检采取相应行动采取相应行动CategoryAssessmentRecommendationsBIRADS乳腺癌的外科治疗乳腺癌的外科治疗Lumpectomy肿块切除术肿块切除术Quadrantectomy象限切除术象限切除术ModifiedRadicalMastectomy乳房改良根治术乳房改良根治术RadicalMastectomy乳房根治术乳房根治术结束语结束语谢谢大家聆听！谢谢大家聆听！23