复旦大学附属肿瘤医院妇瘤科宫颈鳞.ppt

For reasons that are poorly understood, persistent HPV infection causes cancers mainly at the transformation zone between different kinds of epithelia (e.g., cervix, anus, and oropharynx) * The position of the original squamocolumnar junction is variable, lying on the ectocervix in 66%, within the endocervical canal in 30%, and on the vaginal fornices in 4% of female infants. The position of the original squamocolumnar junction determines the extent of cervical squamous metaplasia . Squamous metaplasia is a pivotal process in cervical carcinogenesis. Embryogenesis, in determining the distribution of native squamous and columnar epithelia, is an important early influence in determining future risk of neoplastic transformation. * Cervical squamocolumnar junction showing mature, glycogenized (pale) squamous epithelium, immature (dark pink) squamous metaplastic cells, and columnar endocervical glandular epithelium * * 宫颈上皮内瘤变谱:正常临床上皮作为对比 LSIL (CIN I) with koilocytic atypia; HSIL (CIN II) with progressive atypia and expansion of the immature basal cells above the lower third of the epithelial thickness; HSIL (CIN III) with diffuse atypia, loss of maturation, and expansion of the immature basal cells to the epithelial surface. * 高危型HPV感染可以引起宫颈癌及其癌前病变，但绝大多数高危型HPV感染并不会引起临床病变，并在2年内自发消退。从宫颈高级别病变发展到浸润性大概需要8-12年，由于其处于浸润前状态的时间很长，可以通过宫颈细胞学检查及HPV检测筛查癌前病变并予以干预。一般认为宫颈肿瘤是从宫颈上皮内瘤变（CIN1、CIN2、CIN3或原位癌）到浸润癌的连续病变。自然病程资料显示70%-90%的CIN1病变会自发消退，相反CIN2和CIN3持续或进展为浸润癌的几率分别为57%和70%。 * * Robbins * * Malignant squamous cells, singly and in groups, show nuclear pleomorphism. A “tadpole” cell is present on the left（Berek） * * * An axial section of a positron emission tomography-computed tomography (PET-CT) demonstrates intense metabolic activity within the cervix. The tumor extends to within several millimeters of the rectum. (b) Sagittal view demonstrating increased uptake in the urinary blad-der, not to be confused with the cervical cancer. (c) PET-CT image demonstrates multiple bilateral iliac,