1、會計學1子宮內(nèi)膜增生與子宮內(nèi)膜癌前病變子宮內(nèi)膜增生與子宮內(nèi)膜癌前病變234This is the microscopic appearance of normal proliferative endometrium in the menstrual cycle. The proliferative phase is the variable part of the cycle. In this phase, tubular glands with columnar cells and surrounding dense stroma are proliferating to build up

2、the endometrium following shedding with previous menstruation.Here is early secretory endometrium. The appearance with prominent subnuclear vacuoles in cells forming the glands is consistent with post-ovulatory day 2. The histologic changes following ovulation are quite constant over the 14 days to

3、menstruation and can be utilized to date the endometrium. 正常子宮內(nèi)膜正常子宮內(nèi)膜 增生期增生期 早期分泌期早期分泌期(proliferative endometrium) (early secretory endometrium)5This is normal secretory phase endometrium. Note the larger tortuous glands with secretions. The secretory phase follows a set 14 day course leading to ei

4、ther implantation of a fertilized ovum or menstruation.晚期分泌期（月經(jīng)前期）晚期分泌期（月經(jīng)前期）(secretory phase endometrium)6789This is endometrial cystic hyperplasia in which the amount of endometrium is abnormally increased and not cycling as it should. The glands are enlarged and irregular with columnar cells that

5、 have some atypia. Simple endometrial hyperplasias can cause bleeding, but are not thought to be premalignant. However, adenomatous hyperplasia is premalignant.子宮內(nèi)膜非典型增生子宮內(nèi)膜非典型增生10111213141516171819202122232425262728293031323334353637383940This adenocarcinoma of the endometrium is more obvious. Irre

6、gular masses of white tumor are seen over the surface of this uterus that has been opened anteriorly. The cervix is at the bottom of the picture. This enlarged uterus was no doubt palpable on physical examination. Such a neoplasm often present with abnormal bleeding.The endometrial adenocarcinoma is

7、 present on the lumenal surface of this cross section of uterus. Note that the neoplasm is superficially invasive. The cervix is at the right. 子宮內(nèi)膜癌子宮內(nèi)膜癌 III 期期 侵肌全層、宮頸、附件侵肌全層、宮頸、附件 侵肌侵肌 4142This is endometrial adenocarcinoma which can be seen invading into the smooth muscle bundles of the myometria

8、l wall of the uterus. This neoplasm has a higher stage than a neoplasm that is just confined to the endometrium or is superficially invasive.子宮內(nèi)膜癌侵肌子宮內(nèi)膜癌侵肌43The endometrial adenocarcinoma in the polyp at the left is moderately differentiated, as a glandular structure can still be discerned. Note the

9、 hyperchromatism and pleomorphism of the cells, compared to the underlying endometrium with cystic atrophy at the right. 子宮內(nèi)膜增生子宮內(nèi)膜增生子宮內(nèi)膜子宮內(nèi)膜 癌（息肉樣）癌（息肉樣） 子宮內(nèi)膜增生子宮內(nèi)膜增生4445464748495051525354555657585960616263646566676869707172737475Normal cavityHysteroscopyPolyp7677 陰道流血、排液或?qū)m腔積膿、積液者陰道流血、排液或?qū)m腔積膿、積液者 婦

10、科檢查婦科檢查 細胞學檢查細胞學檢查 腹部或陰道腹部或陰道B B超檢查超檢查 宮腔鏡檢查宮腔鏡檢查 分段刮宮分段刮宮 病理組織學檢查確診病理組織學檢查確診 圖圖 子宮內(nèi)膜癌的診斷步驟子宮內(nèi)膜癌的診斷步驟7879808182838485全子宮切除全子宮切除筋膜外子宮切除筋膜外子宮切除次廣泛子宮切除次廣泛子宮切除廣泛子宮切除廣泛子宮切除8687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127This is endometrial adenocarcinoma which can be seen invading into the smooth muscle bundles of the myometrial wall of