病理学诊断基础图片

病理学诊断基础图片病理基本病变是病理诊断的基础，这里收集了一部分但愿对初学者有一定帮助。

1、核沟2、HP感染3、腱鞘巨细胞瘤中的“多核巨细胞”及“含铁血黄素”4、泡状核细胞（最醒目的核呈空泡状、核仁嗜酸的大细胞）5、菊形团（五星指示）6、泡沫细胞7、肝细胞小泡型脂肪变8、血栓9、肝细胞核空泡变性(糖原核)10、梭形细胞的栅栏状排列11、正常鳞状上皮细胞之间的细胞间桥12、玻璃样变性13、子宫内膜腺癌图示子宫内膜腺癌。

棕褐色不规则的肿块充满子宫腔并向肌层浸润。

大多数病人发病年龄在55－60岁之间，极少发生于40岁以下。

主要危险因素是长期过多雌激素的刺激。

雌激素升高导致内膜增生，并促使癌发生。

无排卵性月经周期、肥胖、分泌雌激素的卵巢肿瘤、未育、外源性雌激素治疗，都能增加子宫内膜腺癌发生的危险。

高血压、糖尿病也是其危险因素。

绝经期后不规则的阴道流血可能是其仅有的征象。

子宫无明显增大。

大多数子宫内膜腺癌局限于子宫（即Ⅰ期），其五年存活率为90%。

The irregular tan mass filling the endometrial cavity and infiltrating into the myometrium of the uterus is an endometrial adenocarcinoma, seen to be moderately differentiated microscopically. Most patients with this neoplasm are 55 to 65 years of age, and rarely younger than 40 years. The major risk factor for this carcinoma stems from prolonged estrogen stimulation. Conditions that lead to increased estogenic exposure can produce endometrial hyperplasia, from which a cancer can arise. Anovulatory cycles, obesity, estrogen-producing ovarian tumors, low parity or nulliparity, and exogenous estrogen therapy can all increase the risk for endometrial adenocarcinoma in this manner. Hypertension and diabetes mellitus are also risk factors. Irregular postmenopausal bleeding may be the only sign, and the uterus may not be significantly enlarged. Most endometrial adenocarcinomas are confined to the uterus (Stage I) with a 5-year survival around 90%.14胆石症伴有胆固醇结石的胆石症患者。

图示：剖开的胆囊内可见大量混合石（胆石分为色素性胆石、胆固醇性胆石和混合石三种）。

大多数结石由钙、胆红素和胆固醇组成。

明显的浅黄色与主要成分胆固醇有关。

老龄化、女性、肥胖均为胆石症的危险因素。

伴结石形成的慢性胆囊炎往往有胆囊粘膜及胆囊壁的慢性炎症。

虽然大多数胆石症病人无临床表现，然而胆囊炎急性发作可致右上腹痛。

色素石主要由胆红素钙形成，主要见于溶血和胆道梗阻。

A gallbladder is opened to reveal numerous composite gallstones. Most stones are mixtures of calcium, bilirubin, and cholesterol. This is cholelithiasis with "cholesterol stones." The prominent yellowish color to these stones is consistent with their predominant cholesterol component. Aging, female sex, and obesity increase the risk for gallstone formation. There can be chronic inflammation in the mucosa and wall of the gallbladder accompanying the stones--chronic cholecystitis. Though most persons with gallstones are asymptomatic, there may be episodes of acute cholecystitis marked by intense right upper quadrant pain. The so-called "pigment stones" composed mainly of dark calcium bilirubinate are seen in populations with chronic hemolysis (hemoglobinopathies) and biliary tract infections.15硬下疳梅毒螺旋体性传播疾病梅毒患者病损硬下疳中可见梅毒螺旋体。

病原体为苍白密螺旋体。

晚期妊娠患者可传播给胎儿，从而使新生儿患先天性梅毒。

病变组织学特征为动脉内膜炎和浆细胞浸润性炎。

早期梅毒的重要特征是感染梅毒螺旋体两周后在原始部位形成硬下疳。

自愈后发生二期梅毒，持续两个月，其特征性病变是梅毒疹，随后进入静止期。

但经十几年的发展可出现三期梅毒的典型病损如神经系统梅毒、心血管梅毒或梅毒瘤。

此期很难查见病原体。

Seen here are spirochetes from a lesion of primary syphilis known a chancre. The causative organism is Treponema pallidum. This is a sexually transmitted disease (STD). Mothers who are infected may pass the spirochetes to fetuses in the third trimester, resulting in congenital syphilis. The characteristic histopathologic findings include endarteritis and inflammatory infiltrates with numerous plasma cells. The primary stage of syphilis is evident a couple of weeks after initial infection as a chancre at the site of inoculation. This spontaneously heals, and secondary syphilis ensues, lasting for a couple of months, characterized by a rash. The disease then becomes quiescent, but manifestations of tertiary syphilis may develop decades later as neurosyphilis, cardiovascular syphilis, or gummatous necrosis in visceral organs or soft tissues. In this tertiary stage, the spirochetes are difficult to demonstrate in tissues.16腺癌淋巴道转移腺癌淋巴道转移。

淋巴结切面可见腺样结构，细胞多形、胞核深染。

多种原发癌都可以发生此种转移，肿瘤细胞侵入淋巴管随淋巴液运行转移至淋巴结。

体格检查受累淋巴结质硬、无痛、肿大。

This section of lymph node reveals metastases. The metastases are composed of glandular configurations with pleomorphic cells and hyperchromatic nuclei, consistent with adenocarcinoma.A wide variety of primary sites are possible. The most likely primary site is the organ from which the lymph drainage occurs--indicative of local or regional spread. A physical examination may reveal firm, non-tender, enlarged lymph nodes.17致密斑星号标记的是肾脏致密斑。

致密斑是由位于入球动脉和出球动脉之间的肾小体血管极处的远端小管上皮细胞组成。

致密斑细胞紧邻入球动脉处的近球细胞，致密斑细胞能感受远端小管内Na+浓度的变化。

浓度降低时，促使入球动脉扩张同时近球细胞分泌肾素增加。

肾素使血管肾张素Ⅰ生成增多，进而形成血管肾张素Ⅱ，不但使出球动脉收缩，还可以促使肾上腺皮质球状带分泌醛固酮，从而增加血容量和动脉血压。

这种反馈有助于肾小球滤过率的调控。

The asterisk marks the macula densa in the kidney. The macula densa is a specialized region of epithelial cells lining a portion of a distal convoluted tubule that lies between the afferent and efferent arterioles at the vascular pole of a glomerulus. The macula densa cells are in close approximation to the juxtaglomerular cells (modified smooth muscle cells) in the media of the afferent arteriole. The macula densa cells monitor sodium concentration, and when that concentration falls, they signal the afferent arteriole to dilate and the juxtaglomerular cells to secrete renin. Renin increases formation of angiotensin I, which is converted to angiotensin II, which constricts the efferent arterioles. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex, which increases blood volume and arterial pressure. This feedback loop helps to control the glomerular filtration rate.18多形性腺瘤肉眼观察：圆或卵圆形。