(妇产科学教材）12.4（参考翻译）Endometrial Carcinoma.pptVIP

子宫内膜癌; Age 58 , G2P0 Irregular bleeding for 2 months. Menopause 更年期 at age 52. Past history: diabetes mellitus 糖尿病 for 3 years.; 1 of 3 common malignant tumors 恶性肿瘤 of female reproductive system 女性生殖系统; 7% of all malignant tumors in women 20%~30% of malignant tumors in female genital 生殖的 system peak incidence at age 58 -- 61 75% postmenopause 更年期后 25% pre-menopause 更年期前 ( 5% age 40 );Pathogenesis;Pathology; Focal lesions 局部病变 fundus 底 corner 角 ;2. Histological types 组织学类型;A. Endometriod adenocarcinoma;A. Endometriod adenocarcinoma 80%~90% 5-year survival rate: 65% the higher histological grade is, the worse prognosis of patient is.;B. Adenocarcinoma with squamous differentiation 4%~5% adenoacanthoma 腺棘皮癌 adenosquamous carcinoma 腺鳞癌 adenocarcinoma with squamous atypical hyperplasia 腺癌伴鳞状上皮非典型增生;C. Serous carcinoma papillary structures 乳头状结构, arrange irregularly 排列不规则, psammoma bodies 砂砾体 ; D. Clear-cell carcinoma plenty kytoplasm, nuclei obvious atypia easy to metastasize early, poor prognosis; D. Clear-cell carcinoma 细胞质丰富, 核异型性明显 易发生早期转移, 预后不良;Spread Patterns 扩散途径;1. Direct spread; 2. Lymphatic metastasis; 3. Hematogenous spread;Staging ;Surgical-pathological staging;Surgical-pathological staging;Clinical Findings ; Symptoms 2. Vaginal discharge 阴道分泌物 bloody 血性 discharge, serous 浆液性 discharge 3. Lower abdominal pain 下腹部疼痛 due to uterine contraction 子宫收缩; signs no specific result from pelvic examination 骨盆检查 uterus may be enlarged and soft uterus may be fixed and immobile 稳定的 in advanced cases 随病情进展;diagnosis;Ultrasound with color flow imaging Endometrial thickness ≥5mm after menopause;4. Fractional dilation and curettage (DC) 分段刮宫;5. Hysteroscopy 子宫镜 direct observe uterine cavity more accurate curettage of endometrium 更准确地刮除子宫内膜; Differential Diagnosis;Treatment ;Surgical measure