【正文】 第一百四十七頁(yè)，共一百五十九頁(yè)。 A 39yearold female presents with a cough and increasing short ness of breath. A chest xray is interpreted by the radiologist as showing a rightlower lobe (RLL) pneumonia. No mass lesions are seen. The woman istreated with antibiotics, but her symptoms do not improve. On her return visit, the area of consolidation appears to be increased. Bronchoscopy is performed. No bronchial masses are seen, but a transbronchial biopsy is obtained in an area of mucosal erythema in the RLL. After the diagnosis is made, the RLL is removed and a section from this specimen reveals welldifferentiated mucussecreting columnar epithelial cells that infiltrate from alveolus to alveolus. 第一百五十一頁(yè)，共一百五十九頁(yè)。 ? 患者 ， 男 ， 42歲 。 CPC 第一百五十五頁(yè)，共一百五十九頁(yè)。 鼻咽活檢：粘膜慢性炎癥 ， 未見癌 。 第一百五十八頁(yè)，共一百五十九頁(yè)。新月形、足球樣或頭盔樣。 。間接鼻咽鏡檢查：鼻咽左側(cè)頂部粘膜稍粗糙，未見腫塊。 (4)敗血癥或膿毒敗血癥。 CPC 第一百五十六頁(yè)，共一百五十九頁(yè)。 間接鼻咽鏡檢查：鼻咽左側(cè)頂部粘膜稍粗糙 ， 未見腫塊 。 患者于 1年前發(fā)現(xiàn)頸左上部蠶豆大小腫塊 ， 無疼痛 ， 可推動(dòng) ， 半年后增大至雞蛋大小 ， 經(jīng)消炎治療無縮小 ， 近半年常出現(xiàn)吸涕帶血現(xiàn)象 ， 伴左耳鳴及左側(cè)頭痛 ，且漸加重 。 A 67yearold male longterm smoker presents with weight loss, a persistent cough, fever, chest pain, and hemoptysis. Physical examination reveals a cachectic male with clubbing of his fingers and dullness to percussion over his right lower lobe. A chest xray reveals a hilar mass on the right and postobstructive pneumonia of the right lower lobe. Sputum cytology is suspicious for malignant cells. Histologic examination of a transbronchial biopsy specimen reveals infiltrating groups of cells with scant cytoplasm. No glandular structures or keratin production are nuclei of these cells are about twice the size of normal lymphocytes and do not appear to have nucleoli. 第一百五十三頁(yè)，共一百五十九頁(yè)。 A 54yearold male presents with several problems involving his face and pain in his shoulder. He states that he has smoked 2 packs of cigarettes a day for almost 40 years. Physical examination reveals ptosis of his left upper eyelid, constriction of his left pupil, and lack of sweating (anhidrosis) on the left side of his face. No other neurologic abnormalities are found. 練習(xí)題 第一百四十九頁(yè)，共一百五十九頁(yè)。 第一百四十五頁(yè)，共一百五十九頁(yè)。 第一百四十一頁(yè)，共一百五十九頁(yè)。 第一百三十七頁(yè)，共一百五十九頁(yè)。 ② 腺癌 第一百三十三頁(yè)，共一百五十九頁(yè)。 第一百二十九頁(yè)，共一百五十九頁(yè)。 ②周圍型(peripheral carcinoma of the lung) ③彌漫型(diffuse carcinoma of the lung) 第一百二十五頁(yè)，共一百五十九頁(yè)。 (1) 吸煙 (2) 空氣污染 (3) 職業(yè)因素 (4) 病毒 (5) 基因的改變 第一百二十一頁(yè)，共一百五十九頁(yè)。 擴(kuò)散與轉(zhuǎn)移 : (1)直接蔓延 (2) 淋巴道轉(zhuǎn)移 * 咽后淋巴結(jié) 頸上深淋巴結(jié)群 (3)血道轉(zhuǎn)移 第一百一十七頁(yè)，共一百五十九頁(yè)。黏膜下型 (3)鏡下 : ① . 鱗狀細(xì)胞癌 : ② . 腺癌 ③ . 未分化癌 (鼻咽型未分化癌 。 病因 EB病毒 (EpsteinBarr Virus,EBV) 環(huán)境因素 遺傳因素 第一百一十三頁(yè)，共一百五十九頁(yè)。 Several coalescent collagenous silicotic nodules. 第一百零九頁(yè)，共一百五十九頁(yè)。 鏡下 : 細(xì)胞性硅結(jié)節(jié) → 纖維性 → 膠原性硅結(jié)節(jié) :由呈同心圓狀或旋