病理学 8年制2版10消化系统.pptVIP

Appendicitis ETIOLOGY AND PATHOGENESIS Bacterial invasion Luminal obstruction Classification and Morphology Acute appendicitis Acute simple appendicitis Acute phlegmonous appendicitis Acute gangrenous appendicitis Complication: abscess around appendix acute diffuse peritonitis Chronic appendicitis 图10-7 急性蜂窝织性阑尾炎 Inflammatory Bowel Disease (IBD) Crohn disease and ulcerative colitis are chronic relapsing inflammatory disorders of unknown origin, collectively known as idiopathic inflammatory bowel disease (IBD), which share many common features. They result from an abnormal local immune response against the normal flora of the gut, and probably against some self antigens, in genetically susceptible individuals. Crohn disease may affect any portion of the gastrointestinal tract from esophagus to anus but most often involves the ileum; about half of cases exhibit noncaseating granulomatous inflammation. Ulcerative colitis is a nongranulomatous disease limited to the colon. 图10-8 Crohn病 小肠壁（浆膜）内非干酪样坏死性肉芽肿，由上皮样细胞、多核巨细胞及增生的纤维母细胞组成，周围有淋巴、浆细胞浸润，肉芽肿中心无干酪样坏死。 图10-9 溃疡性结肠炎 结肠黏膜弥漫性炎细胞浸润，可见隐窝脓肿形成（箭头），并有黏膜表浅糜烂。 Esophageal carcinoma Squamous cell carcinomas are usually preceded by a long prodrome of mucosal epithelial dysplasia followed by carcinoma in situ and, ultimately, by the emergence of invasive cancer. Early overt lesions appear as small, gray-white, plaquelike thickenings or elevations of the mucosa. In months to years, these lesions become tumorous, taking one of three forms: (1) polypoid exophytic masses that protrude into the lumen; (2) necrotizing cancerous ulcerations that extend deeply and sometimes erode into the respiratory tree, aorta, or elsewhere; and (3) diffuse infiltrative neoplasms that cause thickening and rigidity of the wall and narrowing of the lumen. Whichever the pattern, about 20% arise in the cervical and upper thoracic esophagus, 50% in the middle third, and 30% in the lower third. Morphology Clinical Features