EndometralCaEndometralCa11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左宏玲河北医大二院左宏玲EndometralCaEndometralCa22子宫内膜增生子宫内膜增生（（endometrialendometrialhyperplasiahyperplasia，，EHEH））正常子宫内膜周期性再生、分化、剥脱，依赖女性正常子宫内膜周期性再生、分化、剥脱，依赖女性激素作用。激素作用。无排卵、排卵不规则妇女因雌激素刺激，子宫内膜无排卵、排卵不规则妇女因雌激素刺激，子宫内膜持续增生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::单用雌激单用雌激素一年，素一年，20%20%子宫内膜增生；子宫内膜增生；以腺体病变为主、伴有少量间质病变，少数内膜增以腺体病变为主、伴有少量间质病变，少数内膜增生可以发展成癌生可以发展成癌EndometralCaEndometralCa33国际妇科病理协会分期国际妇科病理协会分期(ISGP,1987)(ISGP,1987)（（InternationalSocietyofGynecologyPathologyInternationalSocietyofGynecologyPathology））单纯增生（单纯增生（simplehyperplasiasimplehyperplasia）良性病变）良性病变,,原腺囊性增生（原腺囊性增生（cysitichyperplasiacysitichyperplasia））复合增生（复合增生（complexhyperplasiacomplexhyperplasia）良性病变）良性病变原腺瘤性增生（原腺瘤性增生（adenomatoushyperplasia)adenomatoushyperplasia)非典型增生（非典型增生（atypicalhyperplasiaatypicalhyperplasia））癌前病变癌前病变EndometralCaEndometralCa44Thisisthemicroscopicappearanceofnormalproliferativeendometriuminthemenstrualcycle.Theproliferativephaseisthevariablepartofthecycle.Inthisphase,tubularglandswithcolumnarcellsandsurroundingdensestromaareproliferatingtobuilduptheendometriumfollowingsheddingwithpreviousmenstruation.Hereisearlysecretoryendometrium.Theappearancewithprominentsubnuclearvacuolesincellsformingtheglandsisconsistentwithpost-ovulatoryday2.Thehistologicchangesfollowingovulationarequiteconstantoverthe14daystomenstruationandcanbeutilizedtodatetheendometrium.正常子宫内膜增生期早期分泌期(proliferativeendometrium)(earlysecretoryendometrium)EndometralCaEndometralCa55Thisisnormalsecretoryphaseendometrium.Notethelargertortuousglandswithsecretions.Thesecretoryphasefollowsaset14daycourseleadingtoeitherimplantationofafertilizedovumormenstruation.晚期分泌期（月经前期）(secretoryphaseendometrium)EndometralCaEndometralCa66单纯增生单纯增生（（simplehyperplasiasimplehyperplasia））子宫内膜腺体和间质增子宫内膜腺体和间质增生生,,腺体不规则，腺体不规则，可扩张呈囊性并有群集可扩张呈囊性并有群集间质致密间质致密无细胞异型性无细胞异型性EndometralCaEndometralCa77复合增生复合增生（（complexhyperplasiacomplexhyperplasia））腺体高度增生，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，呈现结腺体不规则，呈现结构复杂和背靠背的群集，构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EndometralCaEndometralCa88非典型增生（非典型增生（atypicalhyperplasiatypicalhyperplasiaa））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。EndometralCaEndometralCa99Thisisendometrialcystichyperplasiainwhichtheamountofendometriumisabnormallyincreasedandnotcyclingasitshould.Theglandsareenlargedandirregularwithcolumnarcellsthathavesomeatypia.Simpleendometrialhyperplasiascancausebleeding,butarenotthoughttobepremalignant.However,adenomatoushyperplasiaispremalignant.子宫内膜非典型增生EndometralCaEndometralCa1010非典型增生（...
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