本科泌尿系统疾病2016ppt课件.ppt

* 多边形或立方形，可形成小球或小管样结构 * * * * * * 肿瘤可以是单发也可以为多发。单发者常呈乳头状或息肉状，有蒂与膀胱粘膜相连，常为分化好的类型。 分化差的，常呈扁平状突起，宽基，无蒂，向深层浸润。 * In the bladder removed surgically, and opened here can be seen a large urothelial carcinoma. * * * 0级分化虽好，但容易多次复发，且细胞分化程度逐渐降低，甚至呈现浸润生长，发展成为癌。所以视膀胱移行细胞乳头状瘤为低度恶性。 * 5-6层，似正常尿路上皮。 * 层次增多，但极性正常，细胞核轻度增大，核分裂可见，但局限于基底层。与尿路上皮乳头状瘤的区别在于后者的上皮层次增多。PUNLMPs are characterized by a homogenous monotonous appearance, normal to slightly enlarged nuclei and inconspicuous nucleoli. Mitotic figures are uncommon and, when present, are confined to the basal layer. The major distinction between PUNLMP and urothelial papilloma is thickening of the urothelium in the former * Higher magnification view of PUNLMP. Urothelial lining is thickened. There is no cytologic atypia. Mitotic figures are absent * Low-grade papillary urothelial carcinoma shows minimal cytologic and architectural atypia. Adjacent papillary fronds may fuse, as seen in this image * High-grade papillary urothelial carcinomas display total architectural disorganization and significant cytologic atypia of urothelium that can be recognized even at low power. There is loss of nuclear polarity; considerable variation in nuclear size, shape, and chromatin content; mitoses are frequent and may be abnormal. Umbrella cells are usually absent * The base of the tumor shows small isolated tumor cell nests which are beginning to infiltrate into the lamina propria. * * 如泌尿道粘膜的损伤，常见的如导尿膀胱镜检查及其他尿道的手术引起尿道粘膜的损伤。尿路梗阻如结石、前列腺肥大、妊辰子宫压迫等，引起尿流不畅，尿液储留。膀胱输尿管反流见于下尿路梗阻，膀胱功能紊乱等。女性尿道短而直；妊辰子宫压迫输尿管，黄体酮使输尿管张力下降等，均可引起尿储留。男性有前列腺液含抗菌物质。 全身因素如慢性消耗性疾病、长期使用激素和免疫抑制剂使机体的抵抗力下降。 * 在两种感染途径时，路径相同但方向相反。 * 肾脏体积增大，包膜紧张，表面比较充血，散在一些稍隆起的黄白色脓肿，周围见充血带，病变呈弥漫分部。多个病灶可融合，形成大脓肿。 * 黄色条纹为化脓性病灶沿肾小管延伸 * 主要分布于间质的中性粒细胞。由于肾小管内大量中性粒细胞，病人可以有脓尿。 * * 及时的治疗一般可以治愈，但严重的病人会有一些合并症，如肾乳头坏死。 * 由于严重的炎症引起肾髓质的供血障碍，特别是为肾乳头部供血的直小动脉里有炎性血栓形成者，使肾乳头发生缺血坏死。 易见于糖尿病和尿路阻塞的病人 * 伴有输尿管高位梗阻的病人，脓液不能及时排出，壅积于肾盂肾盏内形成肾盂积脓。穿破肾实质和包膜，扩展至肾周围组织产生肾周围脓肿。如果不及时治疗，肾组织最终被完全破坏，整个肾充满脓液的囊腔。 * 泌尿道炎症对膀胱和尿道的粘膜有刺激作用，产生尿频尿急尿痛的