第13周妇产科endometrial carcinoma

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1、EndometrialCarcinoma子宫内膜癌carcinomaofcorpusuteri子宫体癌corpusuteri子宫体cervix子宫颈StructureofuterusendometriummyometriumSerouslayerPrevalencefourthmostmalignancyinwomen（女性恶性肿瘤中第四位）ranksthirdinthemalignanttumorsoffemalereproductivesystem（女性生殖系统恶性肿瘤中第3位）Epidemiology55-69yea

2、rs75%postmenopausal绝经后25%pre-menopausal绝经前(5%<40years)Riskfactors*unopposedestrogenexposureendogenous~ovariangranulosacelltumorexogenous~estrogentreatment*obesityhypertensionendometrialcancertriaddiabetes子宫内膜癌三联症*anovulationcycles无排卵月经DaysProliferativephasesecreto

3、ryphasemenseovaryendometriumestrogenestrogen/progestroneovulationEffectofestrogen/progesteronefunctionuponendometriumEndometrialHyperplasiaandEndometrialCancerSimplehyperplasiawithnuclearatypiawithout~Complexhyperplasiawithnuclearatypiawithout~SimplehyperplasiaCo

4、mplexhyperplasia单纯增生过长复杂性增生过长NuclearAtypia(核异型性）Nuclearenlargement核增大Increaseinnuclear/cytoplasmratio核/浆比例增大Prominentnucleoli核仁明显Coarseabundantchromatin染色体粗大RiskofHyperplasiatoEndometrialCarcinoma____________________________________________TypesofHyperplasiaProgr

5、essingtoCancer(%)__________________________________________Simple(cystic)withoutatypia1Complex(adenomatous)withoutatypia3Simplewithatypia8Complexwithatypia29___________________________________________hyperplasiawithnuclearatypiaisconsideredthepre-malignantdiseases

6、PathologyDiffuselesionsFocallesionHistologicaltypestypeIestrogen-dependentEndometrioidadenocarcinoma（宫内膜样腺癌）80~90%,G1typeIIestrogen-independenthigh-gradeendometrioidcancer,G2/3papillaryserouscarcinomaclearcellcarcinomaCelldifferentiation（细胞分化）G1（I级）:fairlygooddiff

7、erentiation分化较好G2（II级）:moderatedifferentiation中等分化G3（III级）:poordifferentiation分化差G1G2G3Withsolidcomponent≤5%5-50%>50%Serous~Clear-cell~SpreadPatterns转移方式Directextension（直接蔓延）Lymphaticspread（淋巴转移）Hematogenousspread（血行播散）Transtubalpassageofexfoliatedcells（脱落细胞经输卵管转移

8、）DirectextensionCervicalinvolvement宫颈受累Myometriuminvasion肌层浸润LymphaticspreadingPelviclymphnode,盆腔淋巴结，PLNPara-aorticlymphnode,腹主动脉旁淋巴结，PANClinicalFinding