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ID:51187550
大小:5.38 MB
页数:125页
时间:2020-03-20
《子宫内膜增生与子宫内膜癌前病变-.ppt》由会员上传分享,免费在线阅读,更多相关内容在应用文档-天天文库。
1、EndometralCa1子宫内膜增生与子宫内膜癌前病变河北医大二院左宏玲EndometralCa2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EndometralCa3国际妇科病理协会分期(ISGP,1987)(InternationalSocietyofGynecologyPathology)单纯增生(simpleh
2、yperplasia)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EndometralCa4Thisisthemicroscopicappearanceofnormalproliferativeendometriuminthemenstrualcycle.Theproliferativephaseisthevariablepartofthecycle.Inthisphase,tubu
3、larglandswithcolumnarcellsandsurroundingdensestromaareproliferatingtobuilduptheendometriumfollowingsheddingwithpreviousmenstruation.Hereisearlysecretoryendometrium.Theappearancewithprominentsubnuclearvacuolesincellsformingtheglandsisconsistentwithpost-ovulatoryday2.Thehistologicchangesfoll
4、owingovulationarequiteconstantoverthe14daystomenstruationandcanbeutilizedtodatetheendometrium.正常子宫内膜增生期早期分泌期(proliferativeendometrium)(earlysecretoryendometrium)EndometralCa5Thisisnormalsecretoryphaseendometrium.Notethelargertortuousglandswithsecretions.Thesecretoryphasefollowsaset14daycou
5、rseleadingtoeitherimplantationofafertilizedovumormenstruation.晚期分泌期(月经前期)(secretoryphaseendometrium)EndometralCa6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EndometralCa7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EndometralCa8非典型增生(atypicalh
6、yperplasia)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。EndometralCa9Thisisendometrialcystichyperplasiainwhichtheamountofendometriumisabnormallyincreasedandnotcyclingasitshould.Theglandsareenlargedandirregularwithcolumnarcellsthathavesomeatypia.Simpleendometrialhyperplasiascancausebleed
7、ing,butarenotthoughttobepremalignant.However,adenomatoushyperplasiaispremalignant.子宫内膜非典型增生EndometralCa10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。EndometralCa11非典型增生(atypicalhyperplasia)中度非典型增生: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Endomet
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