生殖系统和乳腺疾病1-子宫疾病英文-课件.pptVIP

宫颈疾病 Content Chronic cervicitis; Cervical epithelial dysplasia; Cervical carcinoma; Leiomyoma of the uterus; Endomertrial adenocarcinoma1.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 大体分型： 糜烂型 外生菜花型 内生浸润型 溃疡型 1.不规则阴道流血、接触性出血 2.白带增多 3.腰骶部疼痛 4.子宫膀胱瘘/子宫直肠瘘 5.定期脱落细胞检查－早期发现 临床分期： 0期:原位癌 I期:局限于子宫颈内 Ⅱ期:侵及盆腔和阴道 Ⅲ期:侵及盆腔壁和阴道下1/3 Ⅳ期:侵出骨盆,累及膀胱粘膜或直肠 四. 子宫平滑肌瘤 Leiomyoma of the uterus 1.最常见 2.≥30岁,70% 3.多无症状，出血，尿频，不孕， 自然流产，绝经后萎缩 4.遗传倾向 子宫体癌 (子宫内膜腺癌) （Endometrial adenocarcinoma） 1.发病率上升 2.绝经期、绝经后妇女，50-59岁 3 不规则阴道流血 4.生长缓慢,转移较晚 5.一般与雌激素长期作用有关 低分化磷癌(20%): 细胞呈小梭形，似基底细胞，异型性及核分裂都很明显，对放射线最敏感，但预后较差 2.子宫颈腺癌：占10-25% A large protruding mass is seen in cervical canal extending to the fornix of vagina. Adenocarcinoma in situ Poorly differentiated adenocarcinoma 直接蔓延: 膀胱、直肠、盆腔、阴道、宫体 淋巴道转移: 最常见，子宫旁→闭孔、髂内、 髂外、髂总、腹股沟、骶前Ln，晚期锁骨上Ln 血道转移: 肺、胃、肝 Spreading and metastasis This is a larger cervical squamous cell carcinoma which spread to the vagina. This is another pelvic exenteration for cervical squamous cell carcinoma. The irregular grey-brown tumor extends toward bladder and up into the uterus. Invasive squamous carcinoma of cervix in vascular channel. The presence of tumor cells within the lumen of a capillary-like space is evidence for aggressive growth potential in squamous carcinoma of the cervix and has been correlated with increased risk for regional lymph node metastasis. Clinical relations Pathological changes A large, solitary leiomyoma. A submucosal leiomyoma Multiple submucosal, intramural, and subserosal leiomyomas of the uterus. Red degeneration 生长部位：子宫肌层、子宫浆膜下或子宫内膜下 单发或多发：多者达数十个 大小悬殊：小者仅镜下可见，大者30cm 形态：球形或不规则形，界清，无包膜 切面观：灰白，质韧，编织状或旋涡状 继发性改变：玻璃样变、粘液变、囊性变、钙化、出血及坏死等 大体： 与正常子宫平滑肌细胞相似 瘤细胞- 核排列较密集束状或编织状排列核长杆状，两端钝圆，染色质纤细 镜下: Uterine leiomyoma is a benign connective tissue tumor of the smooth muscle cells of the myometrium. Tumor cells resemble normal cells (elongated, spindle-shaped, with a cigar-shaped nucleus) and form bundles with different directions (whirled).