病理學診斷基礎圖片

1、病理學診斷基礎圖片病理基本病變是病理診斷的基礎，這里收集了一部分但愿對初學者有一定幫助。 1、核溝2、HP感染3、腱鞘巨細胞瘤中的“多核巨細胞”及“含鐵血黃素”4、泡狀核細胞（最醒目的核呈空泡狀、核仁嗜酸的大細胞）5、菊形團（五星指示）6、泡沫細胞7、肝細胞小泡型脂肪變8、血栓9、肝細胞核空泡變性(糖原核)10、梭形細胞的柵欄狀排列11、正常鱗狀上皮細胞之間的細胞間橋12、玻璃樣變性13、子宮內(nèi)膜腺癌圖示子宮內(nèi)膜腺癌。棕褐色不規(guī)則的腫塊充滿子宮腔并向肌層浸潤。大多數(shù)病人發(fā)病年齡在5560歲之間，極少發(fā)生于40歲以下。主要危險因素是長期過多雌激素的刺激。雌激素升高導致內(nèi)膜增生，并促使癌發(fā)生。無排

2、卵性月經(jīng)周期、肥胖、分泌雌激素的卵巢腫瘤、未育、外源性雌激素治療，都能增加子宮內(nèi)膜腺癌發(fā)生的危險。高血壓、糖尿病也是其危險因素。絕經(jīng)期后不規(guī)則的陰道流血可能是其僅有的征象。子宮無明顯增大。大多數(shù)子宮內(nèi)膜腺癌局限于子宮（即期），其五年存活率為90%。The irregular tan mass filling the endometrial cavity and infiltrating into the myometrium of the uterus is an endometrial adenocarcinoma, seen to be moderately differentiated

3、microscopically. Most patients with this neoplasm are 55 to 65 years of age, and rarely younger than 40 years. The major risk factor for this carcinoma stems from prolonged estrogen stimulation. Conditions that lead to increased estogenic exposure can produce endometrial hyperplasia, from which a ca

4、ncer can arise. Anovulatory cycles, obesity, estrogen-producing ovarian tumors, low parity or nulliparity, and exogenous estrogen therapy can all increase the risk for endometrial adenocarcinoma in this manner. Hypertension and diabetes mellitus are also risk factors. Irregular postmenopausal bleedi

5、ng may be the only sign, and the uterus may not be significantly enlarged. Most endometrial adenocarcinomas are confined to the uterus (Stage I) with a 5-year survival around 90%.14膽石癥伴有膽固醇結石的膽石癥患者。圖示：剖開的膽囊內(nèi)可見大量混合石（膽石分為色素性膽石、膽固醇性膽石和混合石三種）。大多數(shù)結石由鈣、膽紅素和膽固醇組成。明顯的淺黃色與主要成分膽固醇有關。老齡化、女性、肥胖均為膽石癥的危險因素。伴結石形成的

6、慢性膽囊炎往往有膽囊粘膜及膽囊壁的慢性炎癥。雖然大多數(shù)膽石癥病人無臨床表現(xiàn)，然而膽囊炎急性發(fā)作可致右上腹痛。色素石主要由膽紅素鈣形成，主要見于溶血和膽道梗阻。A gallbladder is opened to reveal numerous composite gallstones. Most stones are mixtures of calcium, bilirubin, and cholesterol. This is cholelithiasis with "cholesterol stones." The prominent yellowish color t

7、o these stones is consistent with their predominant cholesterol component. Aging, female sex, and obesity increase the risk for gallstone formation. There can be chronic inflammation in the mucosa and wall of the gallbladder accompanying the stones-chronic cholecystitis. Though most persons with gal

8、lstones are asymptomatic, there may be episodes of acute cholecystitis marked by intense right upper quadrant pain. The so-called "pigment stones" composed mainly of dark calcium bilirubinate are seen in populations with chronic hemolysis (hemoglobinopathies) and biliary tract infections.1

9、5硬下疳梅毒螺旋體性傳播疾病梅毒患者病損硬下疳中可見梅毒螺旋體。病原體為蒼白密螺旋體。晚期妊娠患者可傳播給胎兒，從而使新生兒患先天性梅毒。病變組織學特征為動脈內(nèi)膜炎和漿細胞浸潤性炎。早期梅毒的重要特征是感染梅毒螺旋體兩周后在原始部位形成硬下疳。自愈后發(fā)生二期梅毒，持續(xù)兩個月，其特征性病變是梅毒疹，隨后進入靜止期。但經(jīng)十幾年的發(fā)展可出現(xiàn)三期梅毒的典型病損如神經(jīng)系統(tǒng)梅毒、心血管梅毒或梅毒瘤。此期很難查見病原體。Seen here are spirochetes from a lesion of primary syphilis known a chancre. The causative orga

10、nism is Treponema pallidum. This is a sexually transmitted disease (STD). Mothers who are infected may pass the spirochetes to fetuses in the third trimester, resulting in congenital syphilis. The characteristic histopathologic findings include endarteritis and inflammatory infiltrates with numerous

11、 plasma cells. The primary stage of syphilis is evident a couple of weeks after initial infection as a chancre at the site of inoculation. This spontaneously heals, and secondary syphilis ensues, lasting for a couple of months, characterized by a rash. The disease then becomes quiescent, but manifes

12、tations of tertiary syphilis may develop decades later as neurosyphilis, cardiovascular syphilis, or gummatous necrosis in visceral organs or soft tissues. In this tertiary stage, the spirochetes are difficult to demonstrate in tissues. 16腺癌淋巴道轉移腺癌淋巴道轉移。淋巴結切面可見腺樣結構，細胞多形、胞核深染。多種原發(fā)癌都可以發(fā)生此種轉移，腫瘤細胞侵入淋巴管

13、隨淋巴液運行轉移至淋巴結。體格檢查受累淋巴結質硬、無痛、腫大。This section of lymph node reveals metastases. The metastases are composed of glandular configurations with pleomorphic cells and hyperchromatic nuclei, consistent with adenocarcinoma. A wide variety of primary sites are possible. The most likely primary site is the or

14、gan from which the lymph drainage occurs-indicative of local or regional spread. A physical examination may reveal firm, non-tender, enlarged lymph nodes.17致密斑星號標記的是腎臟致密斑。致密斑是由位于入球動脈和出球動脈之間的腎小體血管極處的遠端小管上皮細胞組成。致密斑細胞緊鄰入球動脈處的近球細胞，致密斑細胞能感受遠端小管內(nèi)Na+濃度的變化。濃度降低時，促使入球動脈擴張同時近球細胞分泌腎素增加。腎素使血管腎張素生成增多，進而形成血管腎張素，不

15、但使出球動脈收縮，還可以促使腎上腺皮質球狀帶分泌醛固酮，從而增加血容量和動脈血壓。這種反饋有助于腎小球濾過率的調控。The asterisk marks the macula densa in the kidney. The macula densa is a specialized region of epithelial cells lining a portion of a distal convoluted tubule that lies between the afferent and efferent arterioles at the vascular pole of a gl

16、omerulus. The macula densa cells are in close approximation to the juxtaglomerular cells (modified smooth muscle cells) in the media of the afferent arteriole. The macula densa cells monitor sodium concentration, and when that concentration falls, they signal the afferent arteriole to dilate and the

17、 juxtaglomerular cells to secrete renin. Renin increases formation of angiotensin I, which is converted to angiotensin II, which constricts the efferent arterioles. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex, which increases blood volume and arterial pressure. This fe

18、edback loop helps to control the glomerular filtration rate.18多形性腺瘤 肉眼觀察：圓或卵圓形。有包膜（厚薄不一），切面灰白色或淡黃色，淡蘭色，半透明膠凍狀，呈實質性或有囊性變。顯微鏡觀察:實質： 1.呈現(xiàn)多樣性。由腫瘤性上皮及粘液樣組織和/或軟骨樣區(qū)構成。其中各成分比例可不同。 2.腫瘤性上皮瘤變的肌上皮或腺管細胞呈條索狀或片狀排列。腺管樣結構，有兩層細胞，內(nèi)層為立方狀或低柱狀，可擴大成囊狀，外層為多邊形、梭形或星形細胞，胞質透亮，似肌上皮細胞。腺管內(nèi)含上皮性粘液。鱗狀化生，甚至有角化珠的形成。 3.粘液樣組織與上皮團塊

19、無清楚界限。 間質：結締組織不多，有時可見玻璃樣變、鈣化或骨化。包膜大多完整，少數(shù)可見瘤細胞浸潤包膜。 同一腫瘤的不同區(qū)域，細胞和基質的比例不盡相同。多形性腺瘤：又名涎腺混合瘤，是指形態(tài)多樣，單一上皮來源的良性涎腺腫瘤。為涎腺腫瘤中最常見者。占全部涎腺上皮性腫瘤的50%以上，全部良性腫瘤的87%以上。 臨床特點：好發(fā)于中年以上（），無性別差異。最好發(fā)于腮腺，次為腭腺，頜下腺。生長緩慢，無任何自覺癥狀。質地較硬，界限清楚，與周圍組織無粘連。若生長加快，或有疼痛，或出現(xiàn)神經(jīng)功能障礙則有惡變可能。生物學特點： 此瘤生長緩慢，有包膜，局部完整切除后療效尚佳，預后一般良好但易復發(fā)。少數(shù)可惡變。19原位癌

20、(高倍鏡)當上皮全層發(fā)生非典型增生時，就已經(jīng)形成腫瘤了。如圖所示：當基底膜完整時，我們稱“原位癌”，因為腫瘤還局限在上皮內(nèi)。 原位癌(低倍鏡)When the entire epithelium is dysplastic and no normal epithelial cells are left, then the process is beyond dysplasia and is now neoplasia. If the basement membrane is still intact, as shown here, then the process is called &quo

21、t;carcinoma in situ" because the carcinoma is still confined to the epithelium. 20平滑肌瘤(低倍鏡)鏡下觀，平滑肌瘤細胞大小和形態(tài)沒有很大變化，和正常平滑肌細胞非常相似。The microscopic appearance of a leiomyoma indicates that the cells do not vary greatly in size and shape and closely resemble normal smooth muscle cells.21內(nèi)翻性乳頭狀瘤內(nèi)翻性乳頭狀瘤

22、是比較多見的鼻腔及鼻竇良性腫瘤。22結腸息肉狀腺瘤(低倍鏡)通過圖示的結腸息肉狀小腺瘤可以明確分化的概念。上方的為腺瘤上皮細胞，下方為正常結腸粘膜腺上皮。The concept of differentiation is demonstrated by this small adenomatous polyp of the colon. Note the difference in staining quality between the epithelial cells of the adenoma at the top and the normal glandular epithelium

23、 of the colonic mucosa below.23腺瘤性息肉與正常粘膜上皮比較(高倍鏡)高倍鏡：左側為正常的結腸粘膜上皮，與之相比右側為腺瘤性息肉的非典型增生上皮。腺瘤性息肉與正常粘膜上皮細胞相比細胞核染色加深、大小不一。然而它們之間的不同不是很大，因此這種良性腫瘤與正常的組織相似性較大，分化較好。At high magnification, the normal colonic epithelium at the left contrasts with the atypical epithelium of the adenomatous polyp at the right. N

24、uclei are darker and more irregularly sized and closer together in the adenomatous polyp than in the normal mucosa. However, the overall difference between them is not great, so this benign neoplasm mimics the normal tissue quite well and this, therefore, well-differentiated.24正常鱗狀上皮、高分化鱗狀細胞癌(低倍鏡)左側

25、為正常鱗狀上皮，右側為高分化鱗狀細胞癌(向深部組織浸潤)。腫瘤的鱗狀細胞與正常的鱗狀細胞結構相似，但排列紊亂。The normal squamous epithelium at the left merges into the squamous cell carcinoma at the right, which is infiltrating downward. The neoplastic squamous cells are still similar to the normal squamous cells, but are less orderly. This is a well-differentiated squamous cell carcinoma.25未分化腫瘤(高倍鏡)腫瘤分化很差，以至于很難判斷組織來源。這可能是一種源于多形性細胞的一種癌。在腫瘤細胞中核多且大。未分化腫瘤被稱為退化發(fā)育。This neoplasm is so poorly differentiated that it is difficult to tell what the cell of origin is. It is probably a carcinoma because of the polygonal natu