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女性生殖系统和乳腺疾病 The Female Genital System and Breast

第十三章. 女性生殖系统和乳腺疾病 The Female Genital System and Breast. 子宫颈疾病. 慢性宫颈炎 Chronic cervicitis 宫颈上皮内瘤变 Cervical intraepithelial Neoplasia (CIN) 宫颈上皮不典型增生 Cervical epithelial dysplasia 宫颈原位癌 Carcinoma in situ 宫颈癌 Cervical carcinoma. Normal cervix. Normal cervix. 宫颈炎.

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女性生殖系统和乳腺疾病 The Female Genital System and Breast

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  1. 第十三章 女性生殖系统和乳腺疾病 The Female Genital System and Breast

  2. 子宫颈疾病 • 慢性宫颈炎 Chronic cervicitis • 宫颈上皮内瘤变 Cervical intraepithelial Neoplasia (CIN) 宫颈上皮不典型增生 Cervical epithelial dysplasia 宫颈原位癌 Carcinoma in situ • 宫颈癌 Cervical carcinoma

  3. Normal cervix

  4. Normal cervix

  5. 宫颈炎 • 阴道（粘液）脓性分泌物 • 感染性 • 沙眼衣原体 (40% of cases) • 真菌类 • 淋球菌 • 单纯疱疹II型 • 人类乳头瘤状病毒 HPV • 非感染性

  6. Nabothian cyst at 5 o'clock

  7. 宫颈肿瘤 • 癌前病变 • CIN （组织学） • SIL （脱落细胞学） • 浸润型癌

  8. CIN I：Mild dysplasia CIN II：Moderate dysplasia CIN III: Severe dysplasia and CIS • Cytologic smears • SILlow-grade: CINI or flat condylomas • SILhigh-grade: CINII or CINIII，癌

  9. Cervical conization

  10. PAP smear

  11. A normal Pap smear picture

  12. LSIL

  13. HSIL

  14. Normal cervical squamous epithelium

  15. CIN I

  16. CIN I

  17. CIN II

  18. CIN III

  19. CIN III

  20. Carcinoma in situ (glands involved)

  21. It is important to emphasize that most (perhaps all) invasive cervical squamous cell carcinoma arise from precursor epithilial changes referred to as CIN. However, not all cases of CIN progress to invasive cancer, and indeed many persist without change or even regress.

  22. CINI Regression 50-60% Persistence 30% Progression to CIN III 20% Progression to invasive cancer 1-5% CINIII Regression 33% Progression 6-74%

  23. 流行病学 • CIN高峰年龄 30y，癌高峰年龄50y • Risk factors • Early age at first intercourse • Multiple sexual partners • A male partner with multiple previous sexual partners • Persistent infection by “High-risk” HPV • Others

  24. The Death of Eva Peron Eva Peron ("Evita"), wife of Argentina's left-wing dictator Juan Peron, died in January 1952 of cervical cancer.

  25. 宫颈癌 75-90% • 糜烂型 • 外生菜花型 • 内生浸润型 • 溃疡型 • 鳞癌 • 腺癌和腺鳞癌 • 小细胞癌 20% <5% • "Microinvasive carcinoma"

  26. Squamous cells carcinoma

  27. Squamous cells carcinoma

  28. Immunostaining for keratin

  29. Spreading

  30. 临床表现 • Pap smear 有助于早期诊断 • 未能早期诊断者 • 不规则阴道流血 • 白带增多，伴有异味 • 性交痛，排便困难 • 扩散引起的症状 • 晚期患者化疗有效

  31. 宫颈癌分期 (FIGO,1985) 0 Preinvasive carcinoma Ⅰ Carcinoma strictly confined to the cervix Ⅱ Carcinoma that extends beyond the cervix, but does not extend into the pelvic wall Ⅲ Carcinoma that has extended into the pelvic sidewall Ⅳ Carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum

  32. 五年生存率 Stage 0 100% Stage I 90% Stage II 82% Stage III 35% Stage IV 10%

  33. 滋养层细胞疾病 Gestational trophoblastic disease • Hydatidiform mole HCG↑ • Invasive mole • Choriocarcinoma

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