病理学经典图片集.ppt

病理学经典图片集,Classical Photograph Of Pathology,Esophageal Varices,第一部分,Grossly, esophageal varices appear as tortuous, dilated, blue veins running along the long axis of the esophagus.,This is a photograph of the actual slide in your class set. Note the markedly dilated veins in the submucosa and in the muscularis propria of the esophagus.,These dilated varices often cause pressure atrophy and ulceration of the overlying mucosa, as has happened in this case. The subsequent inflammation of the submucosa causes erosion of the thin wall of the varices with subsequent rupture. The large varix noted by the arrow communicates directly with the lumen and has probably ruptured in the past. It is now thrombosed.,Shows thrombosis of a large submucosal varix. Note the ulceration of the overlying mucosa (arrow) and inflammation of the submucosal stroma.,Squamous Cell Carcinoma of the Esophagus,第二部分,Gross: This is an example of an ulcerated squamous cell carcinoma of the esophagus. It differs from a benign peptic ulcer of the esophagus in that it is a much larger lesion and rather than being sharply punched-out, it has irregular borders. Note the perforation in the center.,Is a low power view of the histologic section in your class set. (M = mucosa; Sm = submucosa; Mp = muscularis propria). The intact mucosa is to the left of the arrow; the ulcerated carcinoma (C) is to the right.,Is taken at the juncture (arrow head) of the normal mucosa (M) and the ulcerated carcinoma (C) and it shows another common feature of esophageal cancer. The gross margins of the cancer are often misleading because the tumor frequently spreads longitudinally in submucosal lymphatics (double arrows).,Is a section taken through the full thickness of the esophageal wall. Carcinomas of the esophagus are typically deeply infiltrating lesions and this one has extended through the muscularis propria (arrows).,Shows nests of malignant squamous cells within the submucosa. This is a moderately differentiated squamous cell carcinoma in that there is keratin production. The malignant cells show a common feature of malignancy, namely altered polarity. The differentiating squamous cells within the submucosal nests cannot slough keratin to the luminal surface. Instead the keratin accumulates in the center of the nests as spherical keratin “pearls“ (arrow).,Shows the moderately differentiated squamous cell carcinoma with keratin pearls at higher power.,Mitotic figures are usually common in malignant tumors and often they are abnormal. This is a tripolar mitosis and if you look carefully you can see 3 mitotic spindles.,Chronic Peptic Ulcer of the Stomach,第三部分,Gross: Chronic peptic ulcers are typically small (less than 4 cm in diameter), round, sharply punched-out lesions with perpendicular walls and a clean base. Fibrous contracture of the base of the ulcer may cause puckering of the surrounding mucosal folds such that they radiate away from the ulcer in spoke-like fashion.,Is a low power view of the gastric ulcer in your class set. The ulcer (U) lies between the arrows. The intact, but chronically inflamed, gastric mucosa (M) is on either side. Note that the base of the ulcer extends all the way to the serosa of the stomach. Large arteries (A) are present at the base of the ulcer. Erosion into one of these large arteries could result in massive hematemesis.,Is a low power view of the full thickness of the gastric wall in the region of the ulcer. This ulcer shows ongoing necrosis and inflammation as well as fibrous repair and the classic zones of Askenazy are readily apparent. “A“ represents the superficial layer of necrotic debris and acute inflammation. Just below this superficial layer is a zone of active granulation tissue (B) which in the deeper layers matures into a fibrous scar (C). The entire ulcer extends to the serosa of the stomach and the subserosal fat layer is noted by the letter “D“. Again, notice the large artery at the base of the ulcer.,The classic zones of Askenazy can be seen to better advantage at higher power. “A“ represents the superficial zone of necrosis and active inflammation, “B“ the z