泌尿生殖系統(tǒng)疾病病理學(xué)Genitourinarysystem腎盂腎炎（pyelonephritis）急性腎小管壞死第三節(jié)腎小管和腎間質(zhì)疾病腎盂腎炎（pyelonephritis）急性腎小管壞死第三節(jié)腎小管和腎間質(zhì)疾病腎盂腎炎（pyelonephritis）病因病機(jī)：主要由細(xì)菌感染引起的腎盂、腎小管、腎間質(zhì)的化膿性炎主要為G陰性細(xì)菌，大腸桿菌最多見(jiàn)血源性感染逆行性感染

血源性感染：敗血癥或感染性心內(nèi)膜炎時(shí)，金葡菌最常見(jiàn)，常雙側(cè)受累

上行性感染：下尿路感染時(shí)，細(xì)菌逆行上行，大腸桿菌最多見(jiàn)，可單側(cè)受累腎盂腎炎易感因素：尿道粘膜損傷、（不）完全尿路梗阻膀胱輸尿管返流、腎內(nèi)返流醫(yī)療操作女性尤其易感急性腎盂腎炎：肉眼：

大彩腎

急性腎盂腎炎：

LM：

灶狀間質(zhì)性化膿性炎，或膿腫形成腎小管上皮細(xì)胞壞死，腔內(nèi)NBC集聚急性腎盂腎炎：并發(fā)癥：腎乳頭壞死、腎盂積膿、腎周膿腫

急性腎盂腎炎：臨床病理聯(lián)系：起病急，寒戰(zhàn)高熱，常有腰部酸痛和腎區(qū)叩痛，并尿路刺激癥狀。輔檢WBC升高，WBC管型尿慢性腎盂腎炎：肉眼：一側(cè)或雙側(cè)腎臟體積縮小，出現(xiàn)不規(guī)則瘢痕，腎盂腎盞變形，腎盂粘膜粗糙慢性腎盂腎炎：

LM：腎盂、腎小管、腎間質(zhì)的非特異性慢性炎癥部分小管擴(kuò)張，其中充滿紅染的膠樣管型慢性腎盂腎炎：臨床病理聯(lián)系：長(zhǎng)期反復(fù)發(fā)作腰酸、發(fā)熱、膿尿、菌尿等腎小管功能障礙出現(xiàn)早而明顯生殖系統(tǒng)及乳腺疾病Thefemalegenitalsystemandbreast子宮頸疾病Diseaseofcervix慢性宮頸炎Chroniccervicitis宮頸上皮內(nèi)瘤變

Cervicalintraepithelialneoplasia宮頸癌Cervicalcancer

慢性宮頸炎Chroniccervicitis：Position：宮頸口鱗柱交界面

SquamocolumnarjunctionatexocervixCause：

ChangesinthevaginalpH

MicrofloraofthevaginaPathologicchanges：Grossly,

宮頸糜爛cervicalerosion,

nabothiancyst,cervicalpolyp…LM:NonspecificinflammationEpithelialhyperplasia

鱗狀上皮化生Squamousmetaplasia宮頸上皮內(nèi)瘤變Cervicalintraepithelialneoplasia，CINcervicalepithelialdysplasiacarcinomainsituClassification：CINⅠ：milddysplaisa；CINⅡ：moderatedysplasia；CINⅢ：severedysplasiaandcarcinomainsituCINⅠ:Regression:60%ProgressiontoCINⅢ:10%Invasivecancer:1-2%CINⅡ-Ⅲ:Regression:30%Invasivecancer:10%in10yearsRobinBasicPathology9th

子宮頸浸潤(rùn)癌

InvasivecarcinomaofthecervixProgressedfromCINOncethemostfrequentformofcancerinwomenaroundtheworldHPVinfectioninvolvedSexualactivityHPVinfection(106/yr)Condyloma(102-103/yr)Low-riskHPV(6,11)PersistentinfectionHigher-gradeCIN(300,000/yr)Invasivecancer(10500/yr)Metastasis(5000/yr)CIN(106/yr)High-riskHPV(16,18,others)RobinBasicPathology9thPathologicchangesSquamouscellcarcinoma:75-90%Adenocarcinomaandothers:10-25%LM:Squamouscellcarcinoma：ProgressedfromCIN早期浸潤(rùn)癌Microinvasivecarcinoma:≤5mm浸潤(rùn)癌Invasivecarcinoma：>5mmSpreadInvasionSpreadMetastasis:Lymphaticmetastasis:Hematogenousspread:rare,lung,bone,liverClinicalcourse:Earlystage:nosymptomLater:vaginalbleeding,Prognosis:tumorextent妊娠滋養(yǎng)細(xì)胞疾病

Gestationaltrophoblasticdisease葡萄胎Hydatidiformmole侵襲性葡萄胎Invasivemole絨毛膜上皮癌choriocarcinoma葡萄胎hydatidiformmole:Benigndiseases,Swollen,cysticallydilatedvilliGrapelikestructures

Pathogenesis：unknown

完全性completemole

部分性partialmole

Morphologicchanges:LM：絨毛高度水腫

Hydropicswellingvilli；血管缺失

Absenceofvascularization；滋養(yǎng)層細(xì)胞增生

Trophoblastproliferation

特征完全性葡萄胎部分性葡萄胎核型

46,XXor46,XY69,XXY絨毛水腫allvillisomevilli滋養(yǎng)層細(xì)胞diffusedfocal,slight

增生異型性oftenpresentabsent血清中hCGelevatedlesselevated組織中hCG+++++預(yù)后2%cancerationrarecancerationFeaturesofcompleteversuspartialmolePrognosis:80-90%,remainbenign10%ofcompletemoles,becomeinvasive2-3%,developchoriocarcinoma侵襲性葡萄胎Invasivemole：

交界性腫瘤

Completemolesthataremoreinvasivelocallybutdonothavethepotentialofachoriocarcinoma

Pathologicchanges：Grossly,

絨毛侵襲子宮壁，出血、壞死、栓塞

Hydropic

villi

penetratetheuterinewall,causingruptureandbleeding

sometimes,

localspread

Villimaycauseembolism,butnometastasis

LM：

滋養(yǎng)層細(xì)胞增生與異型

Trophoblastproliferationanddysplasia

VilliremainedTreatment：chemotheraphy

絨毛膜上皮癌Choriocarcinoma:VeryaggressivemalignanttumorarisedfromchorionicepitheliumPrevalence:westernworld:1/30000AsiaandAfrica:1/2000Pathologicchanges:Grossly,

Novilliveryhemorrhagic,necroticmassesinvadingmyometriumintovessles

LM：

只見(jiàn)滋養(yǎng)層細(xì)胞增生，高度異型

大量出血壞死

Purelyepithelial,Composedofanaplastic

cytotrophoblastandsyncytiotrophoblastSpread:

Hematogenousspread,

Lung:50%vagina:30-40%brain,liverandkidneysClinicalcourses:Bleedingafterabortionofcompletemoleorpregnance

Prognosis:GoodchemotherapyBreastdiseasesRepresentationoffindingsinaseriesofwomenseekingevaluationofapparentbreast“l(fā)umps”.乳腺癌CarcinomaofbreastthemalignanttumorarisedfromterminalductallobularunitinbreastWorldCancerReport2014WorldCancerReport2014CancerStatistics2015In2010,morethan200,000invasivebreastcancerswerediagnosedinwomenintheUnitedStates,andaround40,000womendiedofthisdisease,makingthisscourgesecondonlytolungcancerasacauseofcancer-relateddeathinwomen.Thelifetimeriskofdevelopingbreastcanceris1in8forwomenintheUnitedStates.RobinBasicPathology9th2014中國(guó)腫瘤登記年報(bào)Pathogenesis：

Geneticfactors：BRCA1/2,Her2Hormonalinfluences：estrogenEnvironmentalfactors：

High-fatdiet,alcohol,smoking…Precancerouschange:ProliferativediseaseswithatypicalhyperplasiaMorphology：

InvasiveductalcarcinomaInvasivelobularcarcinomaMedullarycarcinomaTubularcarcinomaMuciouscarcinomaOthertypesDuctalCarcinomaInSituLobularCarcinomaInSitu15-30%70-85%Noninvasivecarcinoma：導(dǎo)管原位癌Ductalcarcinomainsitu(DCIS)：

Thelesionsconfinedinducts,TheBMintact

Ductalintraepithelialneoplasia（DIN）粉刺癌Comedocarcinoma：

牙膏樣壞死，伴鈣化

Thetoothpaste-likenecrotictissueCalcificationFibrosisinmesenchyma

DCIS：非粉刺樣導(dǎo)管內(nèi)原位癌

Noncomedo

intraductalcarcinoma：

LM：Nonecrosis

PrognosisofDCIS：預(yù)后極佳

over97%long-termsurvival1/3patientsdevelopedinvasivecarcinomain20yearsPagetdisease：

specialnoninvasivecarcinoma小葉原位癌LCIS：uniformappearanceInvasivecarcinoma：浸潤(rùn)性導(dǎo)管癌

Invasiveductalcarcinoma：

70%casesUsuallyassociatedwithDCISGrossly:grey,hard,infiltrating-typemasesLM：腫瘤細(xì)胞分化不一，組織分界不清常伴間質(zhì)纖維化

IrregulartumormarginHeterogeneousappearanceFibrosis乳腺硬癌浸潤(rùn)性小葉癌

Lobularinvasivecarcinoma：多中心，鈣化與纖維化多不明顯易轉(zhuǎn)移，腦脊液、漿膜表面、卵巢、子宮、骨髓

2/3casesa