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This is a second trimester fetus and uterus.

图示中期妊娠的胎儿及子宫。

 

Ectopic pregnancies occur when the fertilized ovum implants outside of the uterine fundus. About 1 in 150 pregnancies results in ectopic implantation. Most cannot be sustained at extrauterine sites. However, a tubal ectopic pregnancy, as diagrammed here, may proceed for several weeks, but the enlargement can rupture the tube and lead to acute, life-threatening bleeding, often about 6 weeks after a previous menstrual period.

当受精卵于子宫腔之外着床,便发生异位妊娠,约150例妊娠中会发生一例异位妊娠,大部分的异位妊娠不会维持很长时间,但是输卵管妊娠可持续至妊娠6周左右,输卵管妊娠破裂导致的急性出血常使患者休克,危及生命。

 

This is a ruptured tubal ectopic pregnancy. Note the twin fetuses at the lower right adjacent to the blood clot at the left. About half of ectopic pregnancies occur because of an identifiable lesion such as chronic salpingitis from pelvic inflammatory disease or adhesions from appendicitis, endometriosis, or previous laparotomy. However, in half of cases no cause can be found.

图示输卵管妊娠破裂,图左可见双胞胎胎儿,紧邻破例处的血凝块。半数的异位妊娠的病因是盆腔炎症性疾病导致的慢性输卵管炎,或由阑尾炎、子宫内膜异位症或以前的手术导致的炎症。然而也有很多病例病因不明。

 

Here is another ectopic pregnancy in a fallopian tube that was excised. This is a medical emergency because of the sudden rupture with hemoperitoneum. Ectopic pregnancy should be considered in the differential diagnosis of acute abdominal pain in a woman of childbearing age.

图示另一个输卵管妊娠的切除大体标本,输卵管妊娠破裂是急腹症,因其大量出血可导致休克。育龄女性急性腹部疼痛应该考虑与输卵管妊娠进行鉴别诊断。

A positive pregnancy test (presence of human chorionic gonadotropin), ultrasound, and culdocentesis with presence of blood are helpful in making the diagnosis of ectopic pregnancy. Seen here is tubal epithelium at the right, with rupture site and chorionic villi at the lower left.

图右示输卵管的上皮组织,有破裂出血。图左下方有胎盘绒毛。妊娠试验阳性(HCG阳性)、超声检查以及后穹隆穿刺出血液,是诊断输卵管异位妊娠的有力证据。

Sometimes blood clot and chorionic villi, as seen here, are recovered outside of the tube following rupture of an ectopic pregnancy. Other sites of ectopic implantation include ovary, abdominal peritoneum, and cornual (uterine) portion of fallopian tube.

如图中所示,输卵管妊娠处破裂后,血凝块和胎盘绒毛覆盖其上。异位妊娠还包括卵巢妊娠腹腔妊娠和输卵管间质部妊娠。

 

This is an example of a tubo-ovarian abscess from Neisseria gonorrheae. Gonorrhea leads to several complications in the female genital tract, including acute inflammation with abscess formation as well as chronic inflammation with tubal scarring (and a greater likelihood of ectopic pregnancy) and pelvic inflammatory disease. Here, there is no clear boundary between tube and ovary and the dilated tube is filled with purulent material.

图为大体所示淋球菌感染所致的输卵管卵巢脓肿。淋病可导致多种女性生殖系统病变,包括急性化脓性炎症、慢性炎症导致的输卵管瘢痕化(异位妊娠的发生率随之升高)、盆腔炎症性疾病。图中可见卵巢和输卵管分界不清,扩张的管腔内容大量脓性物质。

A remnant of tubal epithelium is seen here surrounded and infiltrated by numerous neutrophils. This is acute salpingitis. Neisseria gonorrheae was cultured.

图示:淋病急性输卵管炎
图中急性输卵管炎的病理改变,可见残留的输卵管上皮周围有大量中性白细胞浸润。细菌培养可见淋球菌。

Here is another common incidental finding: a benign paratubal cyst. Sometimes such simple cysts are found adjacent to ovary and are called parovarian cysts. They are filled with clear serous fluid and lined by flattened cuboidal epithelium.

图中大体标本示偶然发现的管周囊肿,为良性。卵巢上经常可见此种单纯性囊肿,称为卵巢冠囊肿,内容清亮液体,壁内衬扁平的立方上皮。

This is an adult ovary with two corpora lutea. The larger one at the top is a hemorrhagic corpus luteum of menstruation, and the smaller one at the bottom is involuting from a previous menstrual period. If implantation of a fertilized ovum occurs, then the corpus luteum will persist because of HCG from the placenta. Of 400,000 ovarian follicles present at birth, only about 400 will mature to the point of ovulation during childbearing years.

图示成年人卵巢,可见两个黄体。图上方大者为月经期间黄体出血。下方小者为上次月经后形成的退化的黄体。如果卵子受精,黄体便产生雌激素和孕激素,称为妊娠黄体。黄体功能于妊娠10周左右由胎盘代替,胎盘合成各种激素和酶。新生儿出生时大约有40万个卵泡,但是到生育期只有400个发育成熟并经排卵过程排出。


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