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1、医学资料,1,女性生殖系统和乳腺疾病 The Female Genital System and Breast,第十三章,医学资料,2,子宫颈疾病,慢性宫颈炎 Chronic cervicitis 宫颈上皮内瘤变Cervical intraepithelial Neoplasia (CIN)宫颈上皮不典型增生Cervical epithelial dysplasia 宫颈原位癌 Carcinoma in situ 宫颈癌 Cervical carcinoma,医学资料,4,医学资料,5,医学资料,6,医学资料,7,Normal cervix,医学资料,8,Normal cervix,医学资料,
2、9,宫颈炎,阴道（粘液）脓性分泌物 感染性 沙眼衣原体 (40% of cases) 真菌类 淋球菌 单纯疱疹II型 人类乳头瘤状病毒 HPV 非感染性,医学资料,10,医学资料,11,Nabothian cyst at 5 oclock,医学资料,12,宫颈肿瘤,癌前病变CIN （组织学）SIL （脱落细胞学） 浸润型癌,医学资料,13,CIN I ：Mild dysplasia CIN II：Moderate dysplasia CIN III: Severe dysplasia and CIS,Cytologic smearsSIL low-grade: CINI or flat con
3、dylomasSIL high-grade: CINII or CINIII，癌,医学资料,14,Cervical conization,医学资料,16,PAP smear,医学资料,17,医学资料,18,医学资料,19,A normal Pap smear picture,医学资料,20,LSIL,医学资料,21,HSIL,医学资料,22,Normal cervical squamous epithelium,医学资料,23,CIN I,医学资料,24,CIN I,医学资料,25,CIN II,医学资料,26,CIN III,医学资料,27,CIN III,医学资料,28,医学资料,29,医
4、学资料,30,Carcinoma in situ (glands involved),医学资料,31,It is important to emphasize that most (perhaps all) invasive cervical squamous cell carcinoma arise from precursor epithilial changes referred to as CIN. However, not all cases of CIN progress to invasive cancer, and indeed many persist without cha
5、nge or even regress.,医学资料,32,CINI Regression 50-60% Persistence 30% Progression to CIN III 20% Progression to invasive cancer 1-5%,CINIII Regression 33% Progression 6-74%,医学资料,33,流行病学,CIN高峰年龄 30y，癌高峰年龄50y Risk factors Early age at first intercourse Multiple sexual partners A male partner with multip
6、leprevious sexual partners Persistent infection by “High-risk” HPV Others,医学资料,34,The Death of Eva Peron Eva Peron (“Evita“), wife of Argentinas left-wing dictator Juan Peron, died in January 1952 of cervical cancer.,医学资料,35,宫颈癌,75-90%,鳞癌 腺癌和腺鳞癌 小细胞癌,30yo 1.9First live birth 35yo 2.0-3.0Nulliparous 3.0,
