课件：本科泌尿系统疾病.ppt

* * 癌细胞体积较大，圆形或多边形。核小而深染。 * 约占15%，预后较透明细胞癌好。 * 核周空晕 * 分化差，肉瘤样。 * 肾细胞癌有一些它独特的生物学行为。 * * * * 间叶成分多为纤维性或黏液性，也可以出现横纹肌、骨、软骨、脂肪等分化。 * * 多边形或立方形，可形成小球或小管样结构 * * * * * * 肿瘤可以是单发也可以为多发。单发者常呈乳头状或息肉状，有蒂与膀胱粘膜相连，常为分化好的类型。 分化差的，常呈扁平状突起，宽基，无蒂，向深层浸润。 * In the bladder removed surgically, and opened here can be seen a large urothelial carcinoma. * * * 0级分化虽好，但容易多次复发，且细胞分化程度逐渐降低，甚至呈现浸润生长，发展成为癌。所以视膀胱移行细胞乳头状瘤为低度恶性。 * 5-6层，似正常尿路上皮。 * 层次增多，但极性正常，细胞核轻度增大，核分裂可见，但局限于基底层。与尿路上皮乳头状瘤的区别在于后者的上皮层次增多。PUNLMPs are characterized by a homogenous monotonous appearance, normal to slightly enlarged nuclei and inconspicuous nucleoli. Mitotic figures are uncommon and, when present, are confined to the basal layer. The major distinction between PUNLMP and urothelial papilloma is thickening of the urothelium in the former * Higher magnification view of PUNLMP. Urothelial lining is thickened. There is no cytologic atypia. Mitotic figures are absent * Low-grade papillary urothelial carcinoma shows minimal cytologic and architectural atypia. Adjacent papillary fronds may fuse, as seen in this image * High-grade papillary urothelial carcinomas display total architectural disorganization and significant cytologic atypia of urothelium that can be recognized even at low power. There is loss of nuclear polarity; considerable variation in nuclear size, shape, and chromatin content; mitoses are frequent and may be abnormal. Umbrella cells are usually absent * The base of the tumor shows small isolated tumor cell nests which are beginning to infiltrate into the lamina propria. * * * 细的纤维血管轴心 上皮层次增多7层 细胞轻度异型 切除后常复发 Papillary urothelial carcinoma, Low Grade * Papillary urothelial carcinoma, High Grade 组织结构异型性大 细胞异型性：核多形性，核浆比增大，核分裂多见 极性消失 缺乏伞细胞 * * * * * * 从受累的部位来看：主要累及肾的肾盂，间质，小管。而小球基本不受影响，但是到了晚期，也会出现小球的改变。 从病变的性质来看：化脓性炎症，主要渗出的是中性粒细胞。前面大家学习过化脓性炎症的类型有三种，本病发生在肾盂粘膜表面，属于表面化脓和积脓，中性粒细胞向粘膜表面渗出。 从它的发病人群来看：为什么女性发病远远多于男性，是由女性特殊的生理解剖特点决定的。 * 血行性感染，是指细菌随血液进入肾脏，最常见的如败血症的时候。细菌进入血流后，随血液循环，栓塞在毛细血管，引起局部组织的化脓性病变。 上行性感染