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Any increase in tissue size is not necessarily neoplasia. Here is an example of left ventricular cardiac hypertrophy in which there has been an increase in the size of the myocardial fibers in response to an increased pressure load from hypertension. With hypertrophy, the cells increase in size, but the cells do not increase in number. Except for being larger, the cells are normal in appearance.

圖示:左心室肥大

并不是所有的組織體積增大的病變都屬于腫瘤。為了適應高血壓時過重的壓力負荷左心室發生了這種變化。心肌纖維數量沒有增加,體積增大了,但結構正常。

The large fronds of endometrium seen in this uterus opened to reveal the endometrial cavity are a result of hyperplasia. This resulted from increased estrogen. With hyperplasia, there is an increase in cell numbers to produce an increase in tissue size. However, the cells are normal in appearance. Sometimes hyperplasias can be "atypical" and the cells not completely normal. Such conditions can be premalignant.

圖示:子宮腔打開后的子宮內膜過度增生

這是由于雌激素升高引起的,這種增生表現為細胞數目的增多,結果可以使組織體積增大,但細胞結構正常。并非所有的過度增生都是正常的,有時候可以是非典型增生,非典型增生有時可以惡化,稱其為癌前病變。

The first step toward neoplasia(腫瘤形成) is cellular transformation(變化、轉化、轉換). Here, there is metaplasia (化生)of normal respiratory(呼吸的) laryngeal(喉的) epithelium on the right to squamous(鱗狀的) epithelium on the left in response to chronic irritation of smoking. The two forms of cellular transformation that are potentially reversible, but may be steps toward a neoplasm, are:

  • Metaplasia(化生): the exchange of normal epithelium for another type of epithelium. Metaplasia is reversible when the stimulus for it is taken away.
  • Dysplasia(非典型增生): a disordered growth and maturation of an epithelium, which is still reversible if the factors driving it are eliminated.

腫瘤形成首先是細胞發生變化,圖示是右側正常喉部呼吸上皮向鱗狀上皮化生,左側化生是由于慢性抽煙損傷。 這兩類細胞變化潛在可逆,也可能向腫瘤發展。
化生:正常上皮轉變成另一類上皮細胞。當刺激撤消后,化生可逆
非典型增生:上皮的異常增生和分化,如果刺激因子去除后,仍然可逆。

This biopsy(活檢) of the lower esophagus(食管) in a patient with chronic gastroesophageal(胃食管的) reflux (逆流)disease shows columnar(柱狀的)metaplasia (化生)(Barrett's esophagus), and the goblet cells(杯狀細胞) are typical of an intestinal(腸的) type of epithelium. Squamous(鱗狀的) epithelium typical of the normal esophagus (食管)appears at the right.

圖示是慢性胃食管返流征病人Barrett食管柱狀上皮化生的下段食管活檢結果。杯狀細胞是腸上皮的典型細胞,右側是正常食管的鱗狀上皮細胞。

The best way to make the diagnosis of Pneumocystis carinii(卡氏肺孢子蟲) pneumonia(肺炎) is to perform a Gomori(戈莫里法—染磷酸酶及脂酶) methenamine(烏洛托品)silver(環六亞甲基四胺銀)(GMS) stain on the lung tissue or bronchoalveolar(支氣管肺泡的) lavage(灌洗)(BAL) fluid(液體). The cyst (包囊)wall is stained, and the organisms(生物體) appear as crushed (變形的)ping-pong balls, or crescent(新月形的) shapes, or folded spheres(球), or flattened (變平的)beach(海灘) balls, or deflated(放氣的) tennis
balls, or....

診斷卡氏肺孢子蟲肺炎最好的方法是肺組織或支氣管肺泡灌洗液進行GMS染色。染色后蟲體壁著色,蟲體表現為變形的乒乓球樣、新月形、壓迫的球形等不規則形狀。

This is the next step toward neoplasia. Here, there is normal cervical(子宮頸的) squamous epithelium at the left, but dysplastic(非典型增生) squamous epithelium at the right. Dysplasia is a disorderly growth of epithelium, but still confined to the epithelium. Dysplasia is still reversible.

非典型增生可以發展為腫瘤。圖示:左側是正常子宮頸鱗狀上皮,右側屬非典型增生。非典型增生是上皮細胞的異常增生,局限于上皮內,可逆。

 

At high magnification, the normal cervical squamous epithelium at the left merges into the dysplastic(非典型增生) squamous epithelium at the right in which the cells are more disorderly.

高倍鏡圖示:左側為正常子宮頸鱗狀上皮,右側為非典型增生的鱗狀上皮,表現為細胞排列紊亂。

Some epithelia are accessible enough, such as the cervix, that cancer screening can be done by sampling some of the cells and sending them to the laboratory. Here is a cervical Pap smear in which dysplastic cells are present that have much larger and darker nuclei than the normal squamous cells with small nuclei and large amounts of cytoplasm.

一些部位象子宮頸上皮很容易發生惡變,腫瘤篩選常常選宮頸上皮細胞進行實驗室檢查。圖示是巴氏涂片后非典型增生的宮頸細胞的表現,細胞體積增大,胞核濃染,核體積縮小,細胞漿增多。

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 "carcinoma in situ" because the carcinoma is still confined to the epithelium.

當上皮全層發生非典型增生時,就已經形成腫瘤了。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。

This is a neoplasm. Neoplasia is uncontrolled new growth. Note the mass of abnormal tissue on the surface of the cervix. The term "tumor" is often used synonymously with neoplasm, but a "tumor" can mean any mass effect, whether it is inflammatory, hemodynamic, or neoplastic in origin. Once a neoplasm has started, it is not reversible.

圖示:腫瘤,腫瘤是生長失去正常調控形成的新生物。子宮頸表面可見異常腫塊。在實際工作中,Tumor和Neoplasia通常認為是同義的,Tumor泛指臨床上表現為腫塊的病變,包括炎癥性的、血管性的、腫瘤性的等。腫瘤一旦形成,表現為不可逆的。

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