病理学——女性生殖系统和乳腺疾病(1).ppt

女性生殖系统和乳腺疾病 The Female Genital System and Breast 宫颈炎 阴道（粘液）脓性分泌物 感染性 沙眼衣原体 (40% of cases) 真菌类 淋球菌 单纯疱疹II型 人类乳头瘤状病毒 HPV 非感染性 PAP smear 流行病学 CIN高峰年龄 30y，癌高峰年龄50y Risk factors Early age at first intercourse Multiple sexual partners A male partner with multiple previous sexual partners Persistent infection by “High-risk” HPV Others 鳞癌 腺癌和腺鳞癌 小细胞癌 临床表现 Pap smear 有助于早期诊断 未能早期诊断者 不规则阴道流血 白带增多，伴有异味 性交痛，排便困难 扩散引起的症状 晚期患者化疗有效 葡萄胎 Hydatidiform Mole 一堆水肿甚至囊性扩张的绒毛 美国1/1000次妊娠，中国发病率更高 分为完全性和不完全性葡萄胎 临床表现 12-14周发现子宫过大就诊，超声可早期诊断 5个月出血流产 hCG升高 清宫后 80-90% remains benign 10% complete mole become invasive 2-3% give rise to choriocarcinoma 绒毛膜癌 Choriocarcinoma Aggressive 起源于绒毛上皮细胞或全能干细胞 1:2000 Age 20y or 40y History 50% of case follow a complete mole 25% arise after an abortion Remainder after a normal pregnancy 临床表现 阴道流血伴hCG显著升高 早期血道转移至肺 (50%)， 阴道(30-40%)， 脑，肝，肾 Chemotherapy saves almost all cases 乳腺癌 Breast carcinoma 212,920 new case, 40,940 death (USA, 2006) 全球发病率增高 发病机制 Pathogenesis 遗传 Genetic change 激素 Hormonal influence 环境 Environmental factors 乳腺癌类型 原位癌 Non-invasive Ductal carcinoma in situ (DCIS) Lobular carcinoma in situ (LCIS) 浸润性癌 Invasive (infiltrating) Invasive ductal carcinoma (硬癌) Invasive lobular carcinoma Medullary carcinoma Colloid carcinoma Tubular carcinoma Other types 导管内原位癌 DCIS 常伴坏死和钙化 (乳腺摄片) 97% long term survival 1/2 low-grade DCIS (left alone) turns invasive at the same site (Cancer 103: 2481, 2005). Architectural patterns of DCIS 粉刺癌Comedo subtype Solid, cribriform, papillary 浸润型导管癌 Invasive ductal carcinoma All carcinimas that cannot be subclassified into one of the specialized types described below. (NST) Some arise in the lobules 70-80% 浸润性乳腺癌为浸导 大部分为硬癌 患者1/4死亡 The vast majority (80%) of cancers of the cervix are squamous cell carcinomas caused by HPV. Long before HPV was understood, we knew cancer of the cervix to be a sexually transmitted disease, with the great risk factors being the number of male sexual partners, and the number of