子宫肿瘤-妇产科课件.ppt
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1、Carcinoma of the uterus 子宫肿瘤,Department of Obstetrics and Gynecology 妇 产 科 Zhang Wei 张 蔚,Endometrial carcinoma 子宫内膜癌,Cervical tumors 宫颈肿瘤,Cervical intraepithelial neoplasia (CIN) 宫颈上皮内瘤样变 Cervical cancer 宫颈癌,Carcinoma of the uterus 子宫肿瘤,Cervical intraepithelial neoplasia (CIN) 宫颈上皮内瘤样变,Definition:Ce
2、rvical intraepithelial neoplasia (CIN) is a premalignant condition of the cervix. It is usually asymptomatic and is detected by routine cytological screening. The degree of severity is graded CIN、 to CIN ,定义:宫颈上皮内瘤样变是宫 颈组织的癌前病变。一般没有 症状,通常在常规的细胞学筛查 时发现。根据严重程度分为 CIN、CIN、CIN,TBS types,atypical squamous
3、 cells (ASC) 不典型鳞状上皮 Low-grade squamous intraepithelial lesion (LSIL) 轻度鳞状上皮内病变 High-grade squamous intraepithelial lesion (HSIL) 重度鳞状上皮内病变,Aetiology,The area of previously exposed columnar epithelium that undergoes squamous metaplasia is known as the transformation zone (TZ),病因学,原始鳞柱交接部和生理鳞柱交接部间的区域
4、称为移行带,It is the predilection site of cervical carcinoma,移行带为宫颈癌好发部位,Ectropion and transformation of the transformation zone 移行带区的外翻和转化,transformation mechanism 转化机制,squamous metaplasia 鳞状上皮化生 squamous epithelization 鳞状上皮化,The risk factors for CIN and cervical carcinoma CIN和宫颈肿瘤的危险因素,Young age at fir
5、st intercourse 初次性生活的年龄过小,Number of sexual partners 性伙伴的数目,Smoking 吸烟,Poor uptake of screening programme 筛查过少,Long-term use of the contraceptive pill 长期服用避孕药,Exposure to tumor promoters has a greater influence on immature cells 不成熟的细胞暴露于致癌因素会对其产生很大的影响,Increases the risk of cervical cancer four-fold;
6、 the risk remains elevated in ex-smokers 吸烟的妇女患宫颈癌的危险性会提高4倍;曾经吸烟的妇女患宫颈癌的危险性仍然存在,Pill takers do not necessarily use barrier methods - increasing exposure to seminal fluids 服用药物而没有使用屏障的方法,会增加精液的刺激,Male-related risk factors 与男性相关的危险因素,The number of the partners previous sexual relationships is relevant
7、 与以前性伙伴的数目有关,Cervical cancer risk increased if partner has penile cancer 性伙伴患阴茎癌会增加患宫颈癌的危险性,Cervical cancer risk increased if partners previous sexual contact had cervical cancer 性伙伴的前性伴患宫颈癌也会增加患宫颈癌的危险性,Immunosuppressant 免疫抑制,Risk increased with immune suppressed renal transplant patients, and in HI
8、V-positive women 免疫抑制、肾移植、HIV阳性妇女患宫颈癌危险性增加,HPV infection HPV感染,Mainly subtype 16 主要是16型,Screening for CIN is based on a cervical smear - sampling surface cells from the cervix with a spatula 筛查CIN可以利用宫颈表皮细胞涂片,Screening(筛查),To obtain a complete diagnosis the triage of cytology, colposcopy and histolo
9、gical biopsy are needed, as smears are often under reported,要想达到完整的细胞学分类诊断需要阴道镜和活检,因为细胞涂片常常取决于报告人的经验,Cytology,细胞学,dyskaryosis is a cytological term It describes features of individual cells such as size and staining of nuclei and the amount of cytoplasm,细胞核异常是细胞学特点。表现为各个细胞核的大小、染色和细胞质的数量的改变,Mild dysk
10、aryosis,轻度核异常,Moderate dyskaryosis,Severe dyskaryosis,中度核异常,重度核异常,Normal-sized nucleus,Mild nuclear abnormalities,Nucleus larger than normal but 50% of cell,细胞核大于正常,但小于细胞的50,Nucleus 50% of cell,Nucleus irregular,细胞大小正常,轻度核异常,细胞核大于细胞的50,胞核不规则,Cell border rounded,细胞边界变圆,Angular cell borders,细胞边界有角,His
11、tology,组织学,Dysplasia is a histological term. It requires a full-thickness biopsy for diagnosis. Carcinoma-in-situ and CINare more or less synonymous. The basement membrane remains intact,组织学检查发现分化异常。需 要取表皮全层活组织检查诊 断,原位癌和CIN在某种程 度上是相同的,都没有突破基 底膜,CIN,CIN,CIN,Upper 2/3 of epithelium exhibits,reasonable
12、 differentiation,2/3以上的上皮组织分化正常,Upper 1/2 of epithelium well differentiated,1/2以上的上皮组织分化正常,Maturation confined to superficial 1/3 (or absent),分化成熟的组织局限于表皮1/3或没有,Colposcopy(阴道镜检查),In dysplastic tissue the normal pattern of blood vessels becomes distorted and punctation and mosaicism are seen,在异常的组织中可
13、以看到正常结构的血管变得弯曲、极细的点、血管网围绕的镶嵌现象(镶嵌的白色或黄色的上皮块),Colposcope 阴道镜,Abnormal tissue stains white with acetic acid but will not take up the brown iodine stain. Studying the vessel patterns and staining reactions, a colposcopist gauges the degree of CIN present,异常的组织(醋酸染色白色)不会被碘溶液染成棕色,根据血管的模式和染色反应,用阴道镜可以较精确地估
14、计CIN的程度,CIN,CIN,CIN,Local treatment 局部治疗,loop diathermy 环形电热疗法,running an electric current through a thin loop of varying size and shape 电流可以通过不同大小和形状的细环,cold coagulation 冷凝法,carbon dioxide laser 二氧化碳激光器,cone biopsy 锥切,Loop diathermy apparatus 环形透热电疗仪,The process of cone biopsy 锥切的过程,Loop Electrosur
15、gical Excision Procedure (LEEP),Cervical carcinoma 宫颈肿瘤,normal cervix,Cervical carcinoma,rough and uneven in surface,smooth,凸凹不平,宫颈癌,正常宫颈,光滑,Epidemiology 流行病学,cancer of the cervix is the second most common malignancy in women after breast cancer - 77% of cases occur in developing countries,在发展中国家,宫颈
16、癌的发病率位于妇女恶性肿瘤的第二位,仅次于乳腺癌(77),Risk factors 危险因素,The main aetiological agent is infection with certain subtypes of human papilloma virus (HPV),主要的病原学因素是感染了人乳头瘤病毒的某一亚型,HPV subtype 16 appears to be the main oncological agent HPV16是肿瘤学的主要原因,Only 5% of cytologically normal women 细胞学正常的妇女中HPV16阳性占5 Up to 5
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