1、Endometral Ca 1子宫内膜增生子宫内膜增生与与子宫内膜癌前病变子宫内膜癌前病变河北医大二院河北医大二院 左宏玲左宏玲Endometral Ca 2子宫内膜增生子宫内膜增生 （ endometrial hyperplasia， EH） 正常子宫内膜周期性再生、分化、剥脱，正常子宫内膜周期性再生、分化、剥脱，依赖女性激素作用。依赖女性激素作用。 无排卵、排卵不规则妇女因雌激素刺激，无排卵、排卵不规则妇女因雌激素刺激，子宫内膜持续增生子宫内膜持续增生 与长期受雌激素刺激、缺乏孕激素有关与长期受雌激素刺激、缺乏孕激素有关 :单用雌激素一年，单用雌激素一年， 20%子宫内膜增生；子宫内膜增生
2、； 以腺体病变为主、伴有少量间质病变，少以腺体病变为主、伴有少量间质病变，少数内膜增生可以发展成癌数内膜增生可以发展成癌Endometral Ca 3国际妇科病理协会分期国际妇科病理协会分期 (ISGP,1987) （ International Society of Gynecology Pathology） 单纯增生（单纯增生（ simple hyperplasia）良性病变）良性病变 , 原腺囊性增生（原腺囊性增生（ cysitic hyperplasia ） 复合增生（复合增生（ complex hyperplasia）良性病变）良性病变原腺瘤性增生（原腺瘤性增生（ adenomato
3、us hyperplasia) 非典型增生（非典型增生（ atypical hyperplasia）癌前病变癌前病变Endometral Ca 4This is the microscopic appearance of normal proliferative endometrium in the menstrual cycle. The proliferative phase is the variable part of the cycle. In this phase, tubular glands with columnar cells and surrounding dense s
4、troma are proliferating to build up the endometrium following shedding with previous menstruation.Here is early secretory endometrium. The appearance with prominent subnuclear vacuoles in cells forming the glands is consistent with post-ovulatory day 2. The histologic changes following ovulation are
5、 quite constant over the 14 days to menstruation and can be utilized to date the endometrium.正常子宫内膜增生期 早期分泌期(proliferative endometrium) (early secretory endometrium)Endometral Ca 5This is normal secretory phase endometrium. Note the larger tortuous glands with secretions. The secretory phase follows
6、 a set 14 day course leading to either implantation of a fertilized ovum or menstruation.晚期分泌期（月经前期）(secretory phase endometrium)Endometral Ca 6单纯增生单纯增生（ simple hyperplasia） 子宫内膜腺体和间质增生子宫内膜腺体和间质增生, 腺体不规则，腺体不规则，可扩张呈囊性并有群集间可扩张呈囊性并有群集间质致密质致密 无细胞异型性无细胞异型性Endometral Ca 7复合增生复合增生（ complex hyperplasia） 腺体高
7、度增生，成芽状腺体高度增生，成芽状或乳头状，或乳头状，腺体不规则，呈现结构腺体不规则，呈现结构复杂和背靠背的群集，复杂和背靠背的群集，细胞呈复层或假复层细胞呈复层或假复层 无细胞异型性无细胞异型性Endometral Ca 8非典型增生（非典型增生（ atypical hyperplasia） 细胞极性消失，大小不一，核深染，细胞极性消失，大小不一，核深染，腺上皮细胞异行型；腺上皮细胞异行型； 无间质浸润。无间质浸润。 根据腺上皮增生程度分为轻、中、重。根据腺上皮增生程度分为轻、中、重。 Endometral Ca 9This is endometrial cystic hyperplasia
8、 in which the amount of endometrium is abnormally increased and not cycling as it should. The glands are enlarged and irregular with columnar cells that have some atypia. Simple endometrial hyperplasias can cause bleeding, but are not thought to be premalignant. However, adenomatous hyperplasia is premalignant.子宫内膜非典型增生Endometral Ca 10非典型增生（非典型增生（ atypical hyperplasia）轻度非典型增生：轻度非典型增生： 腺体轮廓稍不规则，腺体轮廓稍不规则， 腺上皮细胞轻度异腺上皮细胞轻度异行型行型 , 无间质浸润。无间质浸润。
