子宫内膜增生与子宫内膜癌前病变-.ppt

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1、EndometralCa1子宫内膜增生与子宫内膜癌前病变河北医大二院左宏玲EndometralCa2子宫内膜增生（endometrialhyperplasia，EH）正常子宫内膜周期性再生、分化、剥脱，依赖女性激素作用。无排卵、排卵不规则妇女因雌激素刺激，子宫内膜持续增生与长期受雌激素刺激、缺乏孕激素有关:单用雌激素一年，20%子宫内膜增生；以腺体病变为主、伴有少量间质病变，少数内膜增生可以发展成癌EndometralCa3国际妇科病理协会分期(ISGP,1987)（InternationalSocietyofGynecologyPathology）单纯增生（simpleh

2、yperplasia）良性病变,原腺囊性增生（cysitichyperplasia）复合增生（complexhyperplasia）良性病变原腺瘤性增生（adenomatoushyperplasia)非典型增生（atypicalhyperplasia）癌前病变EndometralCa4Thisisthemicroscopicappearanceofnormalproliferativeendometriuminthemenstrualcycle.Theproliferativephaseisthevariablepartofthecycle.Inthisphase,tubu

3、larglandswithcolumnarcellsandsurroundingdensestromaareproliferatingtobuilduptheendometriumfollowingsheddingwithpreviousmenstruation.Hereisearlysecretoryendometrium.Theappearancewithprominentsubnuclearvacuolesincellsformingtheglandsisconsistentwithpost-ovulatoryday2.Thehistologicchangesfoll

4、owingovulationarequiteconstantoverthe14daystomenstruationandcanbeutilizedtodatetheendometrium.正常子宫内膜增生期早期分泌期(proliferativeendometrium)(earlysecretoryendometrium)EndometralCa5Thisisnormalsecretoryphaseendometrium.Notethelargertortuousglandswithsecretions.Thesecretoryphasefollowsaset14daycou

5、rseleadingtoeitherimplantationofafertilizedovumormenstruation.晚期分泌期（月经前期）(secretoryphaseendometrium)EndometralCa6单纯增生（simplehyperplasia）子宫内膜腺体和间质增生,腺体不规则，可扩张呈囊性并有群集间质致密无细胞异型性EndometralCa7复合增生（complexhyperplasia）腺体高度增生，成芽状或乳头状，腺体不规则，呈现结构复杂和背靠背的群集，细胞呈复层或假复层无细胞异型性EndometralCa8非典型增生（atypicalh

6、yperplasia）细胞极性消失，大小不一，核深染，腺上皮细胞异行型；无间质浸润。根据腺上皮增生程度分为轻、中、重。EndometralCa9Thisisendometrialcystichyperplasiainwhichtheamountofendometriumisabnormallyincreasedandnotcyclingasitshould.Theglandsareenlargedandirregularwithcolumnarcellsthathavesomeatypia.Simpleendometrialhyperplasiascancausebleed

7、ing,butarenotthoughttobepremalignant.However,adenomatoushyperplasiaispremalignant.子宫内膜非典型增生EndometralCa10非典型增生（atypicalhyperplasia）轻度非典型增生：腺体轮廓稍不规则，腺上皮细胞轻度异行型,无间质浸润。EndometralCa11非典型增生（atypicalhyperplasia）中度非典型增生：腺体轮廓不规则，呈分支或乳头状，腺上皮细胞异行型较明显。有细胞异型性，无间质浸润Endomet