子宫内膜增生与子宫内膜癌前病变

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1、子宫内膜增生与子宫内膜癌前病变北京医科大学人民医院妇产科魏丽惠1EndometralCa子宫内膜增生（endometrialhyperplasia，EH）正常子宫内膜周期性再生、分化、剥脱，依赖女性激素作用。无排卵、排卵不规则妇女因雌激素刺激，子宫内膜持续增生与长期受雌激素刺激、缺乏孕激素有关:单用雌激素一年，20%子宫内膜增生；以腺体病变为主、伴有少量间质病变，少数内膜增生可以发展成癌2EndometralCa国际妇科病理协会分期(ISGP,1987)（InternationalSocietyofGynecologyPathology）单纯增生（s

2、implehyperplasia）良性病变,原腺囊性增生（cysitichyperplasia）复合增生（complexhyperplasia）良性病变原腺瘤性增生（adenomatoushyperplasia)非典型增生（atypicalhyperplasia）癌前病变3EndometralCaThisisthemicroscopicappearanceofnormalproliferativeendometriuminthemenstrualcycle.Theproliferativephaseisthevariablepartofthecycl

3、e.Inthisphase,tubularglandswithcolumnarcellsandsurroundingdensestromaareproliferatingtobuilduptheendometriumfollowingsheddingwithpreviousmenstruation.Hereisearlysecretoryendometrium.Theappearancewithprominentsubnuclearvacuolesincellsformingtheglandsisconsistentwithpost-ovulator

4、yday2.Thehistologicchangesfollowingovulationarequiteconstantoverthe14daystomenstruationandcanbeutilizedtodatetheendometrium.正常子宫内膜增生期早期分泌期(proliferativeendometrium)(earlysecretoryendometrium)4EndometralCaThisisnormalsecretoryphaseendometrium.Notethelargertortuousglandswithsecre

5、tions.Thesecretoryphasefollowsaset14daycourseleadingtoeitherimplantationofafertilizedovumormenstruation.晚期分泌期（月经前期）(secretoryphaseendometrium)5EndometralCa单纯增生（simplehyperplasia）子宫内膜腺体和间质增生,腺体不规则，可扩张呈囊性并有群集间质致密无细胞异型性6EndometralCa复合增生（complexhyperplasia）腺体高度增生，成芽状或乳头状，腺体不规则，呈现结

6、构复杂和背靠背的群集，细胞呈复层或假复层无细胞异型性7EndometralCa非典型增生（atypicalhyperplasia）细胞极性消失，大小不一，核深染，腺上皮细胞异行型；无间质浸润。根据腺上皮增生程度分为轻、中、重。8EndometralCaThisisendometrialcystichyperplasiainwhichtheamountofendometriumisabnormallyincreasedandnotcyclingasitshould.Theglandsareenlargedandirregularwithcolumnar

7、cellsthathavesomeatypia.Simpleendometrialhyperplasiascancausebleeding,butarenotthoughttobepremalignant.However,adenomatoushyperplasiaispremalignant.子宫内膜非典型增生9EndometralCa非典型增生（atypicalhyperplasia）轻度非典型增生：腺体轮廓稍不规则，腺上皮细胞轻度异行型,无间质浸润。10EndometralCa非典型增生（atypicalhyperplasia）中度非典型增生：

8、腺体轮廓不规则，呈分支或乳头状，腺上皮细胞异行型较明显。有细胞异型性，无间质浸润11EndometralCa