第12章生殖系统和乳腺疾病1子宫疾病.pptVIP

张三，女，58岁，五年前绝经，近一月来出现阴道不规则流血，B超发现子宫底部见一菜花状肿物，病理活检见灰白色质脆组织，显微镜下腺体排列拥挤、紊乱，细胞异性，似增生的内膜腺体。 病理诊断：? ? Case discuss 子宫内膜腺癌 第63页/共63页 Here is the microscopic appearance of a benign leiomyoma. Normal myometrium is at the left, and the neoplasm is well-differentiated so that the leiomyoma at the right hardly appears different. Bundles of smooth muscle are interlacing in the tumor mass. HPF high power field 高倍镜视野 FIGO grade I endometrial carcinoma. Well-differentiated endometrial cells from glandular structures are seen, which are cribriform in this case. There are no solid masses of tumor cells (hematoxylin-eosin stain). FIGO grade II endometrial adenocarcinoma. The tumor consists of moderately well-differentiated malignant glands, with areas of solid tumor interspersed with glandular tumor elements (hematoxylin-eosin stain). FIGO grade III adenocarcinoma of the endometrium. The tumor consists of solid sheets of malignant cells with no attempt to form glandular structures (hematoxylin-eosin stain). 低分化磷癌(20%): 细胞呈小梭形，似基底细胞，异型性及核分裂都很明显，对放射线最敏感，但预后较差 第31页/共63页 2.子宫颈腺癌：占10-25% A large protruding mass is seen in cervical canal extending to the fornix of vagina. 第32页/共63页 Adenocarcinoma in situ 第33页/共63页 第34页/共63页 Poorly differentiated adenocarcinoma 第35页/共63页 直接蔓延: 膀胱、直肠、盆腔、阴道、宫体 淋巴道转移: 最常见，子宫旁→闭孔、髂内、 髂外、髂总、腹股沟、骶前Ln，晚期锁骨上Ln 血道转移: 肺、胃、肝 Spreading and metastasis 第36页/共63页 This is a larger cervical squamous cell carcinoma which spread to the vagina. This is another pelvic exenteration for cervical squamous cell carcinoma. The irregular grey-brown tumor extends toward bladder and up into the uterus. 第37页/共63页 Invasive squamous carcinoma of cervix in vascular channel. The presence of tumor cells within the lumen of a capillary-like space is evidence for aggressive growth potential in squamous carcinoma of the cervix and has been correlated with increased risk for regional lymph node metastasis. 第38页/共63页 1.不规则阴道流血、接触性出血 2.白带增多 3.腰骶部疼痛 4.子宫膀胱瘘/子宫直肠瘘 5.定期