病理学-生殖系统和乳腺疾病.pptx

生殖系统和乳腺疾病;主讲内容;知识回顾：女性生殖系统组成;Anatomy of the uterus and cervix;鳞－柱上皮移行带;宫颈复层扁平上皮;一、慢性子宫颈炎 chronic cervicitis;病理变化;慢性子宫颈炎基本病变;慢性子宫颈炎（镜下）;慢性子宫颈炎基本病变;宫颈糜烂 cervical erosion;宫颈糜烂肉眼观;真性糜烂 宫颈阴道部鳞状上皮坏死脱落，形成表浅缺损 炎症反应重 假性糜烂 颈管内柱状上皮增生下移取代鳞状上皮。 炎症反应轻 部分与雌激素升高有关，可自行消退。部分在糜烂愈复过程中出现非典型增生;;;子宫颈腺囊肿 Nabothian cyst;镜下观 囊壁被覆柱状、立方、或扁平上皮 囊内有液体;子宫颈息肉 cervical polyp;二、子宫颈上皮内瘤变和子宫颈癌cervical intraepithelial neoplasia ,CIN and cervical carcinoma ;鳞状细胞肿瘤及前驱病变Squamous cell tumours and precursors;子宫颈上皮内瘤变;A：轻度非典型增生 B：中度非典型增生 C：原位癌;Spectrum of cervical intraepithelial neoplasia (CIN), with normal squamous epithelium for comparison: CIN I with koilocytotic atypia; CIN II with progressive atypia in all layers of the epithelium; and CIN III (carcinoma in situ) with diffuse atypia and loss of maturation.;;原位癌累及腺体：癌细胞侵入腺体将其填充,但未突破腺体的基底膜。在子宫颈原位癌中这种现象可高达66-75%;Carcinoma in situ (glands involved);子宫颈上皮内肿瘤cervical intraepithelial neoplasia ,CIN;CIN分级;检　查;;阴道镜检查;PAP smear;;;;;Cytologic features of cervical intraepithelial neoplasia (CIN) in a Papanicolaou smear. Superficial squamous cells may stain either red or blue. A, Normal exfoliated superficial squamous epithelial cells. B, CIN 1—low-grade squamous intraepithelial lesion (LSIL). C and D, CIN II and CIN III, respectively—both high-grade squamous intraepithelial lesions (HSILs). Note the reduction in cytoplasm and the increase in the nucleus-to-cytoplasm ratio as the grade of the lesion increases. This observation reflects the progressive loss of cellular differentiation on the surface of the cervical lesions from which these cells are exfoliated.;预后及治疗;子宫颈癌 cervical carcinoma;Sexual activity;病理变化;糜烂型;子宫颈鳞状细胞癌squamous cell carcinoma of the cervix;早期浸润癌;浸润型鳞状细胞癌 invasive SCC 浸润深度超过5mm，有明显间质浸润 按分化程度分： 高(20%)：棘细胞型，有角化珠、放射线X 中(60%)：大细胞型，异型较明显、放射线√ 低(20%)：小细胞型，异型很明显、放射线√√ 伴有临床症状（出血）;高分化鳞状细胞;子宫颈腺癌cervical adenocarcinoma;子宫颈腺癌;宫颈腺癌（高分化）;(3)宫颈腺鳞癌;宫颈癌的扩散;Spreading ;;阴道出血：早期主要为接触性出血（如同房或妇科检查后）；晚期可因癌侵犯大血管引起致命的大出血 阴道排液：早期为无臭的浆液性分泌物；晚期因癌组织坏死、溃烂及合并感染可出现大量脓性或米汤