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Adenomyosis(子宫腺肌病) occurs when endometrial glands and stroma are found in the myometrium, not just in the endometrium where they belong. This condition leads to uterine enlargement and irregular bleeding.

在子宫肌层出现子宫内膜腺体和间质,称为子宫腺肌病。临床可出现子宫增大和不规则阴道出血。

When endometrial glands and stroma are found outside the uterus, the condition is known as endometriosis. Up to 10% of women may have this condition. It can be very disabling and painful, even when just a few foci are present. Diagrammed here are typical locations for foci of endometriosis. Sometimes the old dark brown blood collects over time from repeated hemorrhage in a cystic space in the ovary and produces a so-called "chocolate cyst".

当子宫内膜腺体和间质出现在子宫以外时,称为子宫内膜移位症。近10%的女性可能都有这种情况。即使有少数病灶也可导致痛经和月经不调。左图显示了几个常见的子宫内膜移位的部位。发生在卵巢反复出血,卵巢体积增大,形成囊腔,内含粘稠的咖啡色液体,称之为巧克力囊肿。

Here, a small cluster of endometrial glands and stroma with hemorrhage are seen at the left near the surface of the fallopian tube. The lumen of the tube is at the right. This is a focus of endometriosis.

图示:子宫内膜移位症

左侧的输卵管旁可见伴有出血的少部分子宫内膜腺体和间质,右侧为输卵管腔。

Endometrial glands and stroma are seen at high magnification in the wall of the colon. Endometriosis is symptomatic during reproductive years when patients may present with dysmenorrhea, pelvic pain, and infertility.

图示:高倍镜下结肠中出现子宫内膜腺体及间质。子宫内膜移位症发生于生育期,病人多表现为痛经、月经不调和不孕。

Grossly, in areas of endometriosis the blood is darker and gives the small foci of endometriosis the gross appearance of "powder burns". Small foci are seen here just under the serosa of the posterior uterus in the pouch of Douglas(杜氏窝即直肠子宫陷窝). Such areas of endometriosis can be seen and obliterated by cauterization via laparoscopy.

肉眼观察,子宫内膜移位症病变部位血液呈黑色,相应病灶表现为火药灼伤外观。图示:在直肠子宫陷窝部位子宫后浆膜下可见小病灶。此部位的子宫内膜移位可通过腹腔镜观察并用烧灼术清除。

Upon closer view, these five small areas of endometriosis have a reddish-brown to bluish appearance. Typical locations for endometriosis may include: ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, and laparotomy scars. Endometriosis may even be found at more distant locations such as appendix and vagina.

图示:更近的子宫内膜移位外观,五个子宫内膜移位病灶呈红棕色至浅蓝色外观。子宫内膜移位症发生的典型部位是卵巢、子宫韧带、直肠阴道隔、骨盆腹膜、剖腹术瘢痕。也可能在较远的部位见到,如阑尾和阴道。

This is a section through an enlarnged 12 cm ovary to demonstrate a cystic cavity filled with old blood typical for endometriosis with formation of an endometriotic, or "chocolate", cyst. The hemorrhage from endometriosis into the ovary may give rise to a large "chocolate cyst" so named because the old blood in the cystic space formed by the hemorrhage is broken down to produce much hemosiderin and a brown to black color.

放大的卵巢切面示巧克力囊肿

子宫内膜移位症时血液流入卵巢导致巧克力囊肿的发生,因在卵巢中的陈旧血液被破坏形成含铁血黄素呈棕黑色而得名。

In the upper fundus of the uterus protruding into the endometrial cavity is a nodule that proved to be a leiomyoma. Thus, this is a submucosal leiomyoma. Such benign smooth muscle tumors of the myometrium are very common, perhaps 1 in 5 women has one. They may be the cause of irregular bleeding if placed submucosally, as seen here, or if large.

子宫底突出腔内的结节状物为平滑肌瘤。此为粘膜下(可发生于肌层、粘膜下、浆膜下)平滑肌瘤。临床较常见,可能20%的妇女可能出现。如图示发生在子宫内膜下的或更大的平滑肌瘤可能导致不规则阴道出血。

Smooth muscle tumors of the uterus are often multiple. Seen here are submucosal, intramural, and subserosal leiomyomata of the uterus.

图示:多发性子宫平滑肌瘤

可见子宫粘膜下、肌层、浆膜下平滑肌瘤。

Here is a very large leiomyoma of the uterus that has undergone degenerative change and is red (so-called "red degeneration"). Such an appearance might make you think that it could be malignant. Remember that malignant tumors do not generally arise from benign tumors, which is a good thing, because leiomyomas are so common (20% of women will have at least one). Postmenopausally, leiomyomas tend to regress in size and become fibrotic.

图示:子宫平滑肌瘤红色变性

此种外观使我们认为可能是恶性肿瘤,然而子宫平滑肌瘤很少恶变,由此看来事情并不坏,因为子宫平滑肌瘤太常见了(20%妇女有可能发生)。绝经期后,子宫平滑肌瘤开始变小并纤维化。


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