課件消化病理

PathologyPathologyofDigestive消化系統(tǒng)疾病病DiseasesoftheDigestiveDiseasesoftheGastro-intestinalInflammation炎Ulcer潰Tumors腫esophagealcarcinoma,gastriccarcinoma,colorectalDiseasesofthedigestiveHepatitis肝LivercirrhosisHepatocellularcarcinoma,Pancreatic

AcuteAcute急性胃TypesandPathologicalbingeovereating暴飲暴Acutehemorrhagicgastritis(急 性胃炎severestimulus（medicine、drinking）gastritiswithmucosalbleedingandnecrosis.粘 、輕度壞Corrosivegastritis(腐蝕性胃炎strongacid、strongbaseandothercausticitychemicalagents高濃堿、腐蝕性化學(xué)necrosis、dissolveofgastricmucosaevenperforation.粘膜壞死、軟溶Acuteinfectivegastritis( 染性胃炎staphylococcusaureus/pyogenicbacteria金葡菌等acutephlegmonousgastritis彌漫性蜂窩織ChronicChronic慢性ChronicChronicgastritisisdefinedasthepresenceofchronicmucosalinflammatorychangesleadingeventuallytomucosalatrophy（萎縮）andepithelialmetaplasia（化生）,usuallyintheabsenceoferosions.Theepithelialchangesmay dysplastic（異型增生）,andconstituteabackgroundforthedevelopmentofChronicinfectionbyH.pyloriToxic,aswithalcoholingestionandcigaretteImmunologicautoimmuneinassociationwithperniciousanemia惡性貧血Postsurgical,especiallyafterantrectomywithgastroenterostomywithrefluxofbiliousduodenalsecretionsHelicobacterH.pyloriisanoninvasive,non-spore-forming,S-shapedgram-negativerodmeasuring y3.5μm×0.5H.pylorisecretesaurease（尿素酶whichproducesammoniafromendogenousurea,therebybufferinggastricacidintheimmediatevicinityoftheorganismbacterialgenecytotoxin-associatedgeneA(CagA).（細胞毒素相 andvacuolatingtoxinvacA）（細胞空泡毒素areinvolvedincausingepithelialcellinjuryinductionofChronicChronicsuperficialgastritis(CSG慢性Chronicatrophicgastritis(CAG慢性萎SpecificformsofGastritisverrucosaHypertrophicgastritis肥厚性Chronicsuperficialchronicinflammationofthelaminapropria,limitedtotheouterthirdofthemucosainthefoveolararea.Theinvolvementoftheantrumisthemostcommon,socalledgastricantritislymphocytes,plasmaChronicatrophicchronicgastritiswithinfiltrationofthelaminapropria,involvingtheentiremucosalthickness,byinflammatorycells. TypeAgastritisprimarilyaffectsthebody/fundusofthestomach,andismorecommonwithperniciousanemia.TypeBgastritis(mostcommonoverall)primarilyaffectstheantrum,andismorecommonwithH.pyloriinfection.ChronicatrophicLoworHighorNormalorPlasmaAutoimmunedisease.IgGantibodiesbindtothegastrinreceptoronparietalcell.OtherAbreactwithintrinsicfactor.HighfrequencyH.Pylori

pale,thinandflattenmucosa,finegranularappearances.atrophyofthegastricinfiltrationofchronicinflammatory paniedbytheintestinalmetaplasiaofthegastricmucosa.(completetypeandpletetypesorpseudopyloricH.pyloriliesinthesuperficialmucouslayerandamongthemicrovilliofepithelialcellsIntestinalInresponsetogastricmucosalinjury,normalepitheliumisreplacedbyintestinal-typecells.Manymucin-containinggobletcellsandenterocyteslinecrypt-likeglands.Panethcells,whicharenotnormalinthestomach,arepresent.Intestine-likevillimayintestinalabsorptive╂—goblet╂sialicacid╂sialicacid╂sialicacidPaneth╂——columnar—╂Neutral╂sulphuricSpecificformsofGastritisverrucosa疣狀胃alsoknownaschronicerosivegastritis,smallpox-likeatthetopofasmallbutdeepumbilicus-likedepression,ornavel-likedepressiondisappearedtheupliftoftheinitialdepartmentofnecrosisofepithelium,hyperplasiaofSpecificformsofHypertrophicGastritis肥厚Menetrier'sExcessivesecretionoftransforminggrowthfactorαIrregularenlargementoftheHyperplasiaoffoveolarmucousPepticPepticUlcer消化性PepticUlcerUlcersofthealimentarytractaredefinedhistologicallyasabreachinthemucosathatextendsthroughthemuscularismucosaeintothesubmucosaordeeper.Pepticulcer(PU)referstoulcerationinarea,orthatmaybeacteduponbyacidgastricjuicethemostfrequentoccurrencesareattheantrumofthestomachalongthelesser胃小彎胃竇thefirstportionofatthejejunumafterinMeckel’diverticulumlinedbyheterotopicgastricEtiologyandMucosalMucosalexposuretogastricacidandpepsinpepticulcersarecreatedbyanimbalancebetweenthegastroduodenalmucosaldefensesandthedamagingforcesthat esuchdefensesH.pyloriH.pyloriAttractedneutrophilsreleasemyeloperoxidase髓過Thromboticocclusionofsurfacecapillariesispromotedbyabacterialpla EtiologyandGastricZollinger-Ellisonsyndrome---exhibitsmultiplepepticulcerationsinthestomach,duodenum,andjejunm,owingtoexcessgastrinsecretionbyatumorandhenceexcessgastricacidproduction.ChronicuseFunctionaldisturbanceofnerno-alityandpsychological

single,orafewmmto2cminanindurated,deep,ximalsizeissteep,distalsizetendstobe orterracedbaseofulceriscleanorcoveredbynecroticmaterialorexudate.andpatentvesselsinthebaseSurroundingmucosacreatesradiatemucosalfoldsThehistologicfromthelumenoutward:(fourasuperficialzoneoffibrinopurulentnecrotictissue;granulationtissue;肉芽組fibroustissueorcollagenousscar纖維疤Vesselwallsarethickenedandvariabledegreesofchroniceand結(jié)局和1, (10-GastricGastric胃HostfactorsChronicantralInfectionbyH.PartialGastricBarrettThelocationofgastricpolorusand bodyand lesser great afavoredlocationisthelessercurvatureoftheantropyloricregion.Thoughlessfrequent,anulcerativelesiononthegreatercurvatureismorelikelytobemalignantthanbenign.Depthof浸潤深MacroscopicgrowthHistologicsubtypeEarlygastricEarlygastriccarcinomaisdefinedasalesionconfinedtothemucosaandsubmucosa,regardlessofthepresenceorabsenceofperigastriclymphnodemetastases.1,Protrudedtype,Ⅰ型;隆起2,Superficialtype,Ⅱ型;表淺superficialflattypesuperficialdepressedtype3Excavatedtype,Ⅲ型;凹陷AdvancedGastric進展期Advancedgastriccarcinomaisaneoplasmthathasextendedbelowthesubmucosaintothemuscularwallandhasperhapsspreadmorewidely.Macroscopically(three1,Polypoidorfungating息肉型或蕈2Ulcerativetype潰瘍3,Infiltratingtype浸潤型Diffuselyinfiltrativetumorofgastriccarcinomaplastica革囊胃ThedifferencebetweenbenignandmalignantulcerBenignMalignantround,irregular,punched-outmargins,smooth,non-upliftirregular,flat,rugged,hemorrhagic,surroundingradiatinggastricBorrmann’s(4NodularorpolypoidLocalulcerativeDiffuseinfiltratingHistologicpapillaryadenocarcinoma glandularadenocarcinomamucoidcarcinoma粘液signet-ringcellcarcinoma印戒細胞Undifferentiatedcarcinoma未分化LaurenComposedofneoplasticintestinalglandsresemblingthoseofcolonicadnocarcinoma,whichpermeatethegastricwallbuttenttogrowalongbroadcohesivefrontsinanexpandinggrowthpattern.Composedofgastric-typemucouscells,whichgenerallydonotformglandsbutratherpermeatethemucosaandwallasscatteredindividualcellsorsmallclustersinaninfiltrativegrowthpattern.SpreadofgastricPathwaysofDirectliverandLymphaticregionaltomoredistantlymphnodes,finallysupraclavicularlymphnodes(Virchow’node).Hematogenousliver;lung,bones,brainImplantationalKrukenbergCarcinomaCarcinomaofCarcinomaofEsophageal makeup6%ofallcancersofGItract,butcauseadisproportiona yhighdeathrate.dietaryenviromentalgeneticDistribution(inupperthirdoftheesophagus20%middlethird50%lowerthirdEarly--superficialcarcinomadenotesinvasionnodeepthansubmucosa,nolymphaticbeginasinsitulesions:gray-white, thickeningsorelevationsofmucosawithprogression:extendandAdvancedGrossprotruded,ulcerated,infiltrative HistologicSquamousCellCarcinoma鱗 ytowell-differentiated(withorwithoutkeratinization)arisefromareasofdysplasiainBarrett’sBarrettesophagusisreplacementofesophagealsquamousepitheliumbycolumnarepithelium(intestinalmetaplasia)mucin-producingglandulartumorsordiffuselyinfiltrativesignetringcellsClinicalDysphagia(吞咽 esophagealobstructionweightlosssepsissecondarytofistulaformationintorespiratorytreewithColorectalColorectal結(jié)直ColorectalIntheearlycolorectalcarcinoma,thedepthofinvasionislimitedtomucosalor/andsubmucosa,generallywithoutlymphaticTheadvancedcancerimpliesthattheneoplasmhasextendedbelowthesubmucosa,infiltratedthemuscularis,perhapsspreadmorewidelyprotrudedtypeulcerativetypeinfiltratingtypecolloidtypepapillarytubularadenocarcinoma(subdividedintowell-differentiated,modera differentiated,andpoorlydifferentiated),mucinousadenocarcinoma,signet-ringcellcarcinoma,undifferentiatedcarc