宫颈疾病病理《生殖系统和乳腺疾病》优秀课件.pptxVIP

生殖系统和乳腺疾病 Diseases of genital system and mammary gland;;Here is a normal cervix with a smooth, glistening mucosal surface. The cervical os is small and round, typical for a nulliparous woman. The os will have a fish-mouth shape after one or more pregnancies.;The normal adult vaginal mucosa with a wrinkled appearance. The cervix has been opened to reveal an endocervical canal leading to the lower uterine segment at the right that has an erythematous appearance extending to the cervical os consistent with chronic inflammation.;The yellow dashed line marks the outer boundary of the transformation zone. Outside the boundary the long-established and thick stratified squamous epithelium appears white or light pink following the dilute acid treatment. Inside the boundary, the transformation zone is characterized by areas of thin epithelium, which appear red or almost inflamed. ; 1.生育期妇女最常见 2.多继发于分娩、流产等→子宫颈损伤 3.临床:白带过多 ; 常见感染: 链球菌、肠球菌、大肠杆菌、 葡萄球菌等 特殊感染: 沙眼衣原体、淋球菌、病毒 (单纯疱疹病毒、人乳头状瘤 病毒、巨细胞病毒等)、结核 菌、寄生虫及放线菌等; 肉眼：宫颈粘膜充血、肿胀， 颗粒状或糜烂状; 子宫颈粘膜充血水肿 间质单核C、淋巴C、浆C浸润 子宫颈柱状上皮、腺上皮增生或鳞状化生 子宫颈息肉(cervical polyp) 有时子宫颈囊肿 (纳博特囊肿,Nabothian cyst) ;;Squamous metaplasia of cervix ;Cervical polyp;Nabothian cyst;In the cervix, koilocytotic change with human papillomavirus (HPV) infection, with vacuolization of epithelial cells.; 子宫颈糜烂 假性糜烂-柱状上皮代替鳞状上皮，多见 真性糜烂-鳞状上皮坏死脱落 ;二、子宫颈上皮非典型增生和原位癌;异型细胞：类似正常基底细胞或体积较小，大小不等，细胞排列紊乱，可见核分裂。;Ⅰ级（轻度）→异型细胞限于上皮下1/3 ↓（CINⅠ） 多数可消退 Ⅱ级（中度）→异型细胞累及上皮下2/3 ↓（CINⅡ） Ⅲ级（重度）→异型细胞超过上皮2/3以上 ↓（CINⅢ） 原位癌 →上皮全层细胞异型，极性消失，但基底膜完整 ↓（CINⅢ） 原位癌累及腺体（仍??原位癌） ↓ 浸润癌→突破基底膜，向上皮下浸润扩展;;子宫颈上皮内瘤变 (Cervical intraepithelial neoplasia, CIN) ;2014版WHO分类： 宫颈鳞状上皮前驱病变;Cervical intraepithelial neoplasia (CIN-1 and -2);Cervical intraepithelial neoplasia (CIN-3);Cervical intraepithelial neoplasia (CIN-3);Cervical carcinoma in si