宫颈肿瘤-妇科教学.pptVIP

病理显微镜检01镜下早期浸润癌：原位癌的基础上，穿破基底膜。02宫颈浸润癌：03细胞分化程度：I级：角化性大细胞型；04II级：非角化性大细胞型：05III级：小细胞型。06病理01腺癌：占15％－20％02巨检：来自宫颈管，并浸润宫颈管壁。癌灶向宫颈管内生长，宫颈外观完全正常，但宫颈管膨大如桶状。癌灶呈乳头状、芽状、溃疡或浸润型。病理粘液腺癌：最常见，来源于宫颈粘膜柱状粘液细胞。鳞腺癌：来源于宫颈粘膜柱状细胞，较少见。显微镜检：宫颈恶性腺瘤：又称微偏的腺癌。肿瘤细胞貌似良性，腺体由柱状上皮覆盖，细胞无异型性，表皮为正常宫颈管粘膜腺体，腺体多，大小不一，形态多变，常含点状突起，浸润深肌层。直接蔓延最常见。癌组织局部浸润，向邻近器官及组织扩散。淋巴转移一级组：包括宫旁、宫颈旁、或输尿管旁、闭孔、髂内、髂外、髂总淋巴结二级组：包括腹股沟深浅、腹主动脉旁淋巴结。血行转移少见。可转移至肺、肾或脊柱Icarcinomaconfinedtocervix01IAInvasivecanceronlymicroscopically.02Allgrosslesions,stageIB03TheFIGOStagingSystemforCervixCancerstromalinvasionwithamaximumdepthof5mmandnowiderthan7mm.Vascularspaceinvolvement,eithervenousorlymphatic,notalterthestaging.)IA1invasionstromanogreaterthan3mmindepthandnowiderthan7mm.IA2invasionstromagreaterthan3mmandnogreaterthan5mmindepthandnowiderthan7mm.IBlesionsgreaterthanIA.12345IB2lesionsgreaterthan4cminsize.IB1lesionsnogreaterthan4cminsize.IIThecarcinomaextends，notextendedontothepelvicwall;involvesthevagina,notasfarasthelowerthird.IIaNoobviousparametrialinvolvement.IIbObviousparametrialinvolvementIIIextendedontothepelvicwall;involvesthelowerthirdofthevagina;withahydronephrosisornonfunctioningkidneyshouldbeincludedIIIainvolvementthelowerthirdofthevagina.IIIbExtensiontothepelvicwallorhydronephrosisornonfunctioningkidney.IVextendedbeyondthetruepelvisorhasinvolvedthemucosaofthebladderorrectum.01IVaSpreadofthegrowthtoadjacentorgans.02IVbSpreadtodistantorgans.03临床表现阴道流血尤其接触性出血，发生在性生活后或妇科检查后。AEBDC早期：流血量少；晚期：流血量大。外生型癌：出血早，血量多。内生型癌：出血晚，血量少。年轻患者也可表现月经失调；老年患者绝经后阴道流血。症状阴道排液阴道排液增多，白色或血性，稀薄如水样或米泔状，有腥臭。晚期癌的症状：侵犯症状：尿频、尿急、肛门坠胀、大便秘结、里急后重、下肢肿痛等；压迫症状：严重时导致输尿管梗阻、肾盂积水，最后尿毒症。疾病末期：恶液质。体征早期病变，无明显病灶，宫颈光滑或轻度糜烂。内生型：宫颈肥大、质硬，宫颈管膨大如桶状。外生型：宫颈赘生物呈息肉状或乳头状突起，继而形成菜花状赘生物，易触血。如阴道浸润，则阴道