四医大本科-泌尿系统疾病.pptVIP

2021/2/6 * 2021/2/6 * 2021/2/6 * 2021/2/6 * （二） 慢性肾盂肾炎(chronic pyelonephritis) 1 病理改变: 特点:肾小管和间质活动性炎症,有纤维疤痕形成,肾盂、肾盏变形。 大体:双侧肾不对称,体积减小,质硬,有不规则凹陷性瘢痕,间或有小脓肿。 镜下:肾小管、间质浸润较多慢性炎细胞及多少不等的中性粒细胞。肾小管萎缩、间质纤维化、胶样管型,肾小球可硬化。 2021/2/6 * 2 结局: 广泛累及双肾? 高血压、肾衰。 ***如何与硬化性肾炎区别? 2021/2/6 * 2021/2/6 * 2021/2/6 * 二 、药物引起的肾小管-间质性肾炎 抗生素等诱发免疫反应,引起急性过敏性间质性肾炎。 2021/2/6 * （一）急性药物性间质性肾炎 间质炎细胞浸润 肾小管变性坏死 2021/2/6 * （二）镇痛药性肾炎 肾乳头坏死和慢性肾小管—间质性炎 2021/2/6 * 第三节 肾和膀胱肿瘤 一、肾细胞癌（renal cell carcinoma） 二、肾母细胞瘤（nephroblastoma） 三、膀胱尿路上皮癌（urothelial carcinoma) 2021/2/6 * 一、肾细胞癌（renal cell carcinoma） 肾脏最常见的恶性肿瘤 男:女=2-3:1 散发性和遗传性两种类型 2021/2/6 * 分类和病理变化 普通型肾细胞癌 乳头状 嫌色细胞癌 集合管癌 未分类 2021/2/6 * This is a renal cell carcinoma arising in the lower pole of the kidney. It is fairly circumscribed. 2021/2/6 * This is the classic histologic appearance of a renal cell carcinoma: the neoplastic cells have clear cytoplasm and are arranged in nests with intervening blood vessels. This microscopic appearance is why they are often called clear cell carcinomas. 2021/2/6 * 临床病理联系 症状:腰痛、肾区肿块和血尿 预后较差,广泛转移,骨和肺转移最常见。 2021/2/6 * 二、肾母细胞瘤(nephroblastoma) 又称Wilms,起源于后肾胚基组织; 儿童肾脏最常见的恶性肿瘤; 散发性和家族性; 2021/2/6 * 病理变化 大体:单个、实性肿物,边界清,有假包膜。 组织学特点:不同发育阶段的肾小球和肾小管样结构。 2021/2/6 * This small kidney from a 4 year old child contains a l obulated tan-white mass. This is Wilms tumor of the kidney. Many are now known to be associated with genetic defects on chromosome 11. 2021/2/6 * Wilms tumor resembles the fetal nephrogenic zone of the kidney. The tumor shows attempts to form primitive glomerular and tubular structures 2021/2/6 * 临床病理联系 儿童肿瘤的特点: 肿瘤发生与先天性畸形多有关系; 组织结构与起源组织胚胎期的结构类似; 临床疗效较好。 2021/2/6 * 三、膀胱尿路上皮癌 泌尿系统最常见的恶性肿瘤; 男:女=2-3:1 发生与接触染料等化学物质有关; 2021/2/6 * 病理变化: 大体:膀胱侧壁和膀胱三角区; 单发或多发; 乳头状或息肉状突起; 2021/2/6 * In the bladder removed surgically and opened here can be seen a large urothelial carcinoma. These neoplasms arise from the urothelium. 2021/2/6 * the urothelial carcinoma does resemble urothelium, but