NCCN子宫内膜癌治疗指南解读

This is the microscopic appearance of normal proliferative endometrium in the menstrual cycle.The proliferative phase is the variable part of the cycle.In this phase,tubular glands with columnar cells and surrounding dense stroma are proliferating to build up the endometrium following shedding with previous menstruation.Here is early secretory endometrium.The appearance with prominent subnuclear vacuoles in cells forming the glands is consistent with post-ovulatory day 2.The histologic changes following ovulation are quite constant over the 14 days to menstruation and can be utilized to date the endometrium.正常子宫内膜正常子宫内膜 增生期增生期 早期分泌期早期分泌期(proliferative endometrium)(early secretory endometrium)This is normal secretory phase endometrium.Note the larger tortuous glands with secretions.The secretory phase follows a set 14 day course leading to either implantation of a fertilized ovum or menstruation.晚期分泌期（月经前期）晚期分泌期（月经前期）(secretory phase endometrium)This is endometrial cystic hyperplasia in which the amount of endometrium is abnormally increased and not cycling as it should.The glands are enlarged and irregular with columnar cells that have some atypia.Simple endometrial hyperplasias can cause bleeding,but are not thought to be premalignant.However,adenomatous hyperplasia is premalignant.子宫内膜非典型增生子宫内膜非典型增生This adenocarcinoma of the endometrium is more obvious.Irregular masses of white tumor are seen over the surface of this uterus that has been opened anteriorly.The cervix is at the bottom of the picture.This enlarged uterus was no doubt palpable on physical examination.Such a neoplasm often present with abnormal bleeding.The endometrial adenocarcinoma is present on the lumenal surface of this cross section of uterus.Note that the neoplasm is superficially invasive.The cervix is at the right.子宫内膜癌子宫内膜癌 III 期期 侵肌全层、宫颈、附件侵肌全层、宫颈、附件 侵肌侵肌 This is endometrial adenocarcinoma which can be seen invading into the smooth muscle bundles of the myometrial wall of the uterus.This neoplasm has a higher stage than a neoplasm that is just confined to the endometrium or is superficially invasive.子宫内膜癌侵肌子宫内膜癌侵肌The endometrial adenocarcinoma in the polyp at the left is moderately differentiated,as a glandular structure can still be discerned.Note the hyperchromatism and pleomorphism of the cells,compared to the underlying endometrium with cystic atrophy at the right.子宫内膜增生子宫内膜增生子宫内膜子宫内膜 癌（息肉样）癌（息肉样）子宫内膜增生子宫内膜增生Normal cavityHysteroscopyPolyp 阴道流血、排液或宫腔积脓、积液者阴道流血、排液或宫腔积脓、积液者 妇科检查妇科检查 细胞学检查细胞学检查 腹部或阴道腹部或阴道B B超检查超检查 宫腔镜检查宫腔镜检查 分段刮宫分段刮宫 病理组织学检查确诊病理组织学检查确诊 图图 子宫内膜癌的诊断步骤子宫内膜癌的诊断步骤全子宫切除全子宫切除筋膜外子宫切除筋膜外子宫切除次广泛子宫切除次广泛子宫切除广泛子宫切除广泛子宫切除