生殖系統(tǒng)和乳腺疾病1子宮疾病課件

生殖系統(tǒng)和乳腺疾?。ㄒ唬〥iseasesofgenitalsystemandmammarygland

DepartmentofPathologySouthernMedicalUniversity4/24/20231

子宮子宮頸4/24/20232宮頸疾病Content

Chroniccervicitis;

Cervicalepithelialdysplasia;

Cervicalcarcinoma;

Leiomyomaoftheuterus;

Endomertrialadenocarcinoma4/24/20233宮頸疾病Theyellowdashedlinemarkstheouterboundaryofthetransformationzone.Outsidetheboundarythelong-establishedandthickstratifiedsquamousepitheliumappearswhiteorlightpinkfollowingthediluteacidtreatment.Insidetheboundary,thetransformationzoneischaracterizedbyareasofthinepithelium,whichappearredoralmostinflamed.4/24/20235宮頸疾病

1.生育期婦女最常見2.多繼發(fā)于分娩、流產(chǎn)等→子宮頸損傷3.臨床:白帶過多

一、慢性子宮頸炎(Chroniccervicitis)4/24/20236宮頸疾病

常見感染:鏈球菌、腸球菌、大腸桿菌、葡萄球菌等

特殊感染:沙眼衣原體、淋球菌、病毒(單純皰疹病毒、人乳頭狀瘤病毒、巨細胞病毒等)、結(jié)核菌、寄生蟲及放線菌等Etiology4/24/20237宮頸疾病

子宮頸粘膜充血水腫間質(zhì)單核C、淋巴C、漿C浸潤子宮頸柱狀上皮、腺上皮增生或鱗狀化生

子宮頸息肉(cervicalpolyp)

有時子宮頸囊腫(納博特囊腫,Nabothiancyst)鏡下：4/24/20239宮頸疾病Thisisnormalcervicalnon-keratinizingsquamousepithelium.Thesquamouscellsshowmaturationfrombasallayertosurface.Thisischroniccervicitisatthesquamo-columnarjunctionofthecervix.Smallrounddarklymphocytesareseeninthesubmucosa,andthereisalsohemorrhage.4/24/202310宮頸疾病Squamousmetaplasiaofcervix

4/24/202311宮頸疾病Nabothiancyst4/24/202313宮頸疾病Inthecervix,koilocytoticchangewithhumanpapillomavirus(HPV)infection,withvacuolizationofepithelialcells.4/24/202314宮頸疾病

子宮頸糜爛

假性糜爛-柱狀上皮代替鱗狀上皮，多見

真性糜爛-鱗狀上皮壞死脫落

Cervicalerosionoccurswhenthesurfaceofthecervixisreplacedwithinflamedtissuefromthecervicalcanal.Theconditionmaybecausedbytrauma,infectionorchemicals.4/24/202315宮頸疾病異型細胞：類似正常基底細胞或體積較小，大小不等，細胞排列紊亂，可見核分裂。4/24/202317宮頸疾病Ⅰ級（輕度）→異型細胞限于上皮下1/3↓（CINⅠ）多數(shù)可消退Ⅱ級（中度）→異型細胞累及上皮下2/3↓（CINⅡ）Ⅲ級（重度）→異型細胞超過上皮2/3以上↓（CINⅢ）原位癌

→上皮全層細胞異型，極性消失，但基底膜完整↓（CINⅢ）原位癌累及腺體（仍為原位癌）↓浸潤癌→突破基底膜，向上皮下浸潤擴展4/24/202318宮頸疾病

重度非典型增生和原位癌沒有明顯界限，原位癌的異型細胞多形性更顯著，核分裂多見。4/24/202319宮頸疾病Cervicalintraepithelialneoplasia(CIN-1and-2)4/24/202321宮頸疾病Cervicalintraepithelialneoplasia(CIN-3)4/24/202322宮頸疾病Cervicalcarcinomainsituwithglands4/24/202323宮頸疾病三、子宮頸癌

1.女性高發(fā)惡性腫瘤之一，開展普查→晚期癌↓，5年生存率和治愈率↑2.40-60歲高發(fā)3.臨床:陰道不規(guī)則流血、接觸性出血、白帶↑

(Carcinomaofthecervix)

4/24/202325宮頸疾病

*與早婚、多產(chǎn)、性生活紊亂、子宮頸裂

傷、包皮垢、感染等因素有關(guān)*通常繼發(fā)于CIN

*與人類乳頭狀瘤病毒(HPV)16、18型，其次31、33型的感染有關(guān)Etiology4/24/202326宮頸疾病1.子宮頸鱗狀細胞癌：占90%

早期浸潤癌（微小浸潤型鱗狀細胞癌）浸潤癌少數(shù)腫瘤細胞突破基底膜浸潤間質(zhì)的深度不超過基底膜下5mm沒有血管浸潤也無淋巴結(jié)轉(zhuǎn)移常無明顯臨床癥狀癌組織突破基底膜明顯浸潤間質(zhì)，深度超過基底膜下5mm伴有臨床癥狀者組織分型4/24/202329宮頸疾病高分化鱗癌(20%):

癌巢、角化珠,核分裂不多鏡下:4/24/202330宮頸疾病中分化鱗癌(60%):無明顯角化和癌珠形成，不規(guī)則和條型癌巢,核分裂和細胞異型性較明顯4/24/202331宮頸疾病低分化磷癌(20%):細胞呈小梭形，似基底細胞，異型性及核分裂都很明顯，對放射線最敏感，但預(yù)后較差4/24/202332宮頸疾病2.子宮頸腺癌：占10-25%

Alargeprotrudingmassisseenincervicalcanalextendingtothefornixofvagina.4/24/202333宮頸疾病Adenocarcinomainsitu

4/24/202334宮頸疾病4/24/202335宮頸疾病Poorlydifferentiatedadenocarcinoma

4/24/202336宮頸疾病直接蔓延:膀胱、直腸、盆腔、陰道、宮體淋巴道轉(zhuǎn)移:

最常見，子宮旁→閉孔、髂內(nèi)、髂外、髂總、腹股溝、骶前Ln，晚期鎖骨上Ln

血道轉(zhuǎn)移:肺、胃、肝Spreadingandmetastasis4/24/202337宮頸疾病Thisisalargercervicalsquamouscellcarcinomawhichspreadtothevagina.Thisisanotherpelvicexenterationforcervicalsquamouscellcarcinoma.Theirregulargrey-browntumorextendstowardbladderandupintotheuterus.4/24/202338宮頸疾病Invasivesquamouscarcinomaofcervixinvascularchannel.Thepresenceoftumorcellswithinthelumenofacapillary-likespaceisevidenceforaggressivegrowthpotentialinsquamouscarcinomaofthecervixandhasbeencorrelatedwithincreasedriskforregionallymphnodemetastasis.4/24/202339宮頸疾病1.不規(guī)則陰道流血、接觸性出血2.白帶增多3.腰骶部疼痛4.子宮膀胱瘺/子宮直腸瘺5.定期脫落細胞檢查－早期發(fā)現(xiàn)Clinicalrelations4/24/202340宮頸疾病臨床分期：0期:原位癌I期:局限于子宮頸內(nèi)Ⅱ期:侵及盆腔和陰道Ⅲ期:侵及盆腔壁和陰道下1/3Ⅳ期:侵出骨盆,累及膀胱粘膜或直腸4/24/202341宮頸疾病四.子宮平滑肌瘤

Leiomyomaoftheuterus1.最常見2.≥30歲,70%3.多無癥狀，出血，尿頻，不孕，自然流產(chǎn)，絕經(jīng)后萎縮4.遺傳傾向4/24/202342宮頸疾病PathologicalchangesAlarge,solitaryleiomyoma.Asubmucosalleiomyoma4/24/202343宮頸疾病Multiplesubmucosal,intramural,andsubserosalleiomyomasoftheuterus.

Reddegeneration4/24/202344宮頸疾病生長部位：子宮肌層、子宮漿膜下或子宮內(nèi)膜下單發(fā)或多發(fā)：多者達數(shù)十個大小懸殊：小者僅鏡下可見，大者>30cm形態(tài)：球形或不規(guī)則形，界清，無包膜切面觀：灰白，質(zhì)韌，編織狀或旋渦狀繼發(fā)性改變：玻璃樣變、粘液變、囊性變、鈣化、出血及壞死等大體：4/24/202345宮頸疾病與正常子宮平滑肌細胞相似瘤細胞-

核排列較密集束狀或編織狀排列核長桿狀，兩端鈍圓，染色質(zhì)纖細

鏡下:4/24/202346宮頸疾病Uterineleiomyomaisabenignconnectivetissuetumorofthesmoothmusclecellsofthemyometrium.Tumorcellsresemblenormalcells(elongated,spindle-shaped,withacigar-shapednucleus)andformbundleswithdifferentdirections(whirled).Thetumoriswellcircumscribed,butnotencapsulated.4/24/202347宮頸疾病4/24/202348宮頸疾病

良、惡性之間的區(qū)別取決于四個標準：

壞死

分裂像

細胞異型性浸潤腫瘤核分裂像10個/10HP，有細胞異型性及浸潤者為惡性

子宮平滑肌肉瘤

（Leiomyosarcoma）4/24/202349宮頸疾病Thisisaleiomyosarcomaprotrudingfrommyometriumintotheendometrialcavityofthisuterus.4/24/202350宮頸疾病Muchmorecellularandthecellshavemuchmorepleomorphismandhyperchromatismthanthebenignleiomyoma.Anirregularmitosisisseeninthecenter.4/24/202351宮頸疾病4/24/202352宮頸疾病子宮體癌(子宮內(nèi)膜腺癌)（Endometrialadenocarcinoma）1.發(fā)病率上升2.絕經(jīng)期、絕經(jīng)后婦女，50-59歲3不規(guī)則陰道流血4.生長緩慢,轉(zhuǎn)移較晚5.一般與雌激素長期作用有關(guān)4/24/202353宮頸疾病肉眼：局部型：多見，多位于子宮底或子宮角，息肉狀、乳頭狀彌漫型：內(nèi)膜彌漫性增厚，灰白質(zhì)脆，伴出血、壞死、潰瘍Pathologicalchanges4/24/202354宮頸疾病鏡下：高分化：多見，腺管排列擁擠、紊亂，輕度異型，似增生的內(nèi)膜腺體中分化：腺體不規(guī)則，排列紊亂，乳頭或篩狀，異型明顯，核分裂易見低分化：實體片狀，無腺樣結(jié)構(gòu)，異型明顯，核分裂多見4/24/202355宮頸疾病gradeIgradeIIgradeIII4/24/202356宮頸疾病Adenocarcinoma,endometrium,uterus,welldifferentiated.Thetallcolumnarepitheliumandwell-definedglandformationillustrateawell-differentiatedadenocarcinoma.4/24/202357宮頸疾病Thisisendometrialadenocarcinomawhichcanbeseeninvadingintothesmoothmusclebundlesofthemyometrial