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也读器官病理学原著：只看目录就收获不小
很多图文并茂讲解详尽的器官病理学专著，是干好病理的超好工具！也是我们这些年轻医生离不开的指导老师！因为工作中经常遇到很多问题，一般的外科病理学专著描述的太简单，或一些细节性的东西没有被提及，如果对某个问题搞明白些，还得去查某某某的文献论述。
也读器官病理学专著：只看目录就收获不小；详尽内容需在今后的实践中反复领会；目录提示了诊断思路的全面性，对一个器官疾病的总体性的把握！
从工作中最常见的标本，自己疑问最多的子宫内膜活检病理诊断开始： Diagnosis_of_Endometrial_Biopsies_and_Curettings 开始坚持读...
Chapter 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 2 Normal Endometrium and Infertility
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Chapter 3 Pregnancy, Abortion, and Ectopic Pregnancy . . . . 34
Chapter 4 Gestational Trophoblastic Disease . . . . . . . . . . . . . 67
Chapter 5 Dysfunctional Uterine Bleeding . . . . . . . . . . . . . . . 100
Chapter 6 Effects of Hormones . . . . . . . . . . . . . . . . . . . . . . . 121
Chapter 7 Endometritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Chapter 8 Polyps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Chapter 9 Endometrial Hyperplasia, Endometrial
Intraepithelial Carcinoma, and Epithelial
Cytoplasmic Change . . . . . . . . . . . . . . . . . . . . . . . . 178
Chapter 10 Endometrial Carcinoma . . . . . . . . . . . . . . . . . . . . . 208
Chapter 11 Other Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Chapter 12 Methods of Endometrial Evaluation . . . . . . . . . . . 275
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Chapter 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Indications for Biopsy . . . . . . . . . . . . . . . . 1
Clinical History and Biopsy
Interpretation . . . . . . . . . . . . . . . . . . . . . . 2
Abnormal Uterine Bleeding . . . . . . . . . 2
Infertility Biopsy . . . . . . . . . . . . . . . . . . 3
Products of Conception . . . . . . . . . . . . . 4
Hormone Therapy . . . . . . . . . . . . . . . . . 4
Other Considerations . . . . . . . . . . . . . . 4
Clinical Queries and Reporting . . . . . . . . 4
Chapter 2 Normal Endometrium and Infertility
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... 7
General Considerations in Histologic
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . 8
Histologic Dating of the Normal,
Cycling Endometrium . . . . . . . . . . . . . . . . 10
Proliferative Phase Endometrium . . . . . 11
Secretory Phase Endometrium . . . . . . . 12
Menstrual Endometrium . . . . . . . . . . . . 19
Pitfalls in Dating . . . . . . . . . . . . . . . . . . . . 21
Artifacts and Contaminants . . . . . . . . . . . 23
Luteal Phase Defect and Abnormal
Secretory Phase Patterns . . . . . . . . . . . . . . 26
Clinical Queries and Reporting . . . . . . . . 29
Chapter 3 Pregnancy, Abortion, and Ectopic Pregnancy . . . . ...34
Endometrial Glands and Stroma in
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 35
Early Gestational Endometrium (1 to 3
Weeks Postfertilization) . . . . . . . . . . . . . 35
Endometrium in Later Pregnancy (4 or
More Weeks Postfertilization) . . . . . . . . 37
Arias-Stella Reaction . . . . . . . . . . . . . . . 39
Other Glandular Changes in
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . 41
Trophoblast and Villi . . . . . . . . . . . . . . . . . 43
Trophoblastic Cells . . . . . . . . . . . . . . . . 44
Immunohistochemistry of Trophoblastic
Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Placental Implantation Site . . . . . . . . . . 48
Exaggerated Placental Implantation
Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Placental Site Nodules . . . . . . . . . . . . . . 54
Chorionic Villi and Villous Trophoblast
in the First Trimester . . . . . . . . . . . . . . . 57
Hydropic Change and Other
Pathologic Changes in Abortions . . . . . 58
Chorionic Villi and Villous Trophoblast
After the First Trimester . . . . . . . . . . . . 59
Placental Polyps . . . . . . . . . . . . . . . . . . . 61
Placenta Accreta . . . . . . . . . . . . . . . . . . 62
Endometrium Associated with Ectopic
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 62
Clinical Queries and Reporting . . . . . . . . 63
Chapter 4 Gestational Trophoblastic Disease . . . . . . . . . . . . ....67
Hydatidiform Mole . . . . . . . . . . . . . . . . . . 67
Persistent Postmolar Gestational
Trophoblastic Disease and Invasive
Hydatidiform Mole . . . . . . . . . . . . . . . . 79
Clinical Queries and Reporting of
Hydatidiform Mole . . . . . . . . . . . . . . . . 80
Trophoblastic Neoplasms . . . . . . . . . . . . . 81
Choriocarcinoma . . . . . . . . . . . . . . . . . . 81
Placental Site Trophoblastic
Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Epithelioid Trophoblastic Tumor . . . . . . 91
Clinical Queries and Reporting of
Trophoblastic Neoplasms . . . . . . . . . . . . 94
Chapter 5 Dysfunctional Uterine Bleeding . . . . . . . . . . . . . . ....100
Morphologic Features of Glandular and
Stromal Breakdown . . . . . . . . . . . . . . . . . 100
Dysfunctional Uterine Bleeding . . . . . . . . 108
Estrogen-Related Bleeding . . . . . . . . . . . . 109
Proliferative with Glandular and
Stromal Breakdown . . . . . . . . . . . . . . . . 109
Disordered Proliferative Phase and
Persistent Proliferative Phase . . . . . . . . 112
Atrophy . . . . . . . . . . . . . . . . . . . . . . . . . 113
Progesterone-Related Bleeding . . . . . . . . 115
Luteal Phase Defects . . . . . . . . . . . . . . . 117
Irregular Shedding . . . . . . . . . . . . . . . . . 117
Abnormal Secretory Endometrium with
Breakdown of Unknown Etiology . . . . . 117
Clinical Queries and Reporting . . . . . . . . 119
Chapter 6 Effects of Hormones . . . . . . . . . . . . . . . . . . . . . . . ...121
Estrogenic Hormones . . . . . . . . . . . . . . . . 122
Progestins and Oral Contraceptives . . . . . 122
Patterns of Response . . . . . . . . . . . . . . . 123
Combined Estrogen and Progestin as
Replacement Therapy for Menopausal
Women . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Progestin-Like Effects with No Hormone
Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Effects of Other Hormones . . . . . . . . . . . . 133
Tamoxifen . . . . . . . . . . . . . . . . . . . . . . . 133
Raloxifene . . . . . . . . . . . . . . . . . . . . . . . 136
Clomiphene Citrate . . . . . . . . . . . . . . . . 136
Danazol . . . . . . . . . . . . . . . . . . . . . . . . . 137
Human Menopausal Gonadotropins/
Human Chorionic Gonadotropin . . . . . 137
Gonadotropin-Releasing Hormone
Agonists . . . . . . . . . . . . . . . . . . . . . . . . . 138
Antiprogestin RU 486 . . . . . . . . . . . . . . 138
Clinical Queries and Reporting . . . . . . . . 139
Postmenopausal Hormone
Replacement . . . . . . . . . . . . . . . . . . . . . 139
Abnormal Uterine Bleeding . . . . . . . . . 139
Treatment of Hyperplasia . . . . . . . . . . . 140
Infertility Therapy . . . . . . . . . . . . . . . . . 140
Chapter 7 Endometritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....147
Nonspecific Endometritis . . . . . . . . . . . . . 147
Inflammatory Cells . . . . . . . . . . . . . . . . 148
Stromal Changes . . . . . . . . . . . . . . . . . . 151
Abnormal Glandular Development . . . 152
Glandular and Stromal Breakdown . . . . 154
Specific Infections . . . . . . . . . . . . . . . . . . . 154
Granulomatous Inflammation . . . . . . . . 154
Actinomycosis . . . . . . . . . . . . . . . . . . . . 155
Cytomegalovirus . . . . . . . . . . . . . . . . . . 155
Herpesvirus . . . . . . . . . . . . . . . . . . . . . . 156
Mycoplasma . . . . . . . . . . . . . . . . . . . . . . 156
Differential Diagnosis . . . . . . . . . . . . . . . . 158
Clinical Queries and Reporting . . . . . . . . 160
Chapter 8 Polyps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..163
Classification and Histologic Features . . . 164
Common Polyps . . . . . . . . . . . . . . . . . . . 167
Atypical Polypoid Adenomyoma . . . . . . 170
Differential Diagnosis . . . . . . . . . . . . . . . . 173
Adhesions . . . . . . . . . . . . . . . . . . . . . . . 174
Clinical Queries and Reporting . . . . . . . . 175
Chapter 9 Endometrial Hyperplasia, Endometrial
Intraepithelial Carcinoma, and Epithelial
Cytoplasmic Change . . . . . . . . . . . . . . . . . . . . . . . . 178
Terminology and Classification of
Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . . 179
Endometrial Hyperplasia . . . . . . . . . . . . . 179
Hyperplasia Without Atypia . . . . . . . . . 180
Atypical Hyperplasia . . . . . . . . . . . . . . . 182
Differential Diagnosis . . . . . . . . . . . . . . 188
Behavior . . . . . . . . . . . . . . . . . . . . . . . . 192
Endometrial Intraepithelial
Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . 193
Differential Diagnosis . . . . . . . . . . . . . . 193
Behavior . . . . . . . . . . . . . . . . . . . . . . . . 195
Epithelial Cytoplasmic Change
(Metaplasia) . . . . . . . . . . . . . . . . . . . . . . . 195
Differential Diagnosis . . . . . . . . . . . . . . 202
Clinical Queries and Reporting . . . . . . . . 204
Chapter 10 Endometrial Carcinoma . . . . . . . . . . . . . . . . . . . . .208
Important Issues in Interpretation of
Biopsies . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Criteria for the Diagnosis of
Well-Differentiated Endometrial
Adenocarcinoma . . . . . . . . . . . . . . . . . . 209
Benign Changes that Mimic
Carcinoma . . . . . . . . . . . . . . . . . . . . . . . 214
Malignant Neoplasms—Classification,
Grading, and Staging of the Tumor . . . . . . 216
Classification . . . . . . . . . . . . . . . . . . . . . 216
Grading . . . . . . . . . . . . . . . . . . . . . . . . . 216
Clinically Important Histologic
Subtypes . . . . . . . . . . . . . . . . . . . . . . . . 221
Staging . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Endometrial Versus Endocervical
Carcinoma . . . . . . . . . . . . . . . . . . . . . . . 237
Metastatic Carcinoma . . . . . . . . . . . . . . 238
Clinical Queries and Reporting . . . . . . . . 239
Chapter 11 Other Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Malignant Mixed Mesodermal Tumor
(Carcinosarcoma) . . . . . . . . . . . . . . . . . . . 249
Pathologic Features . . . . . . . . . . . . . . . . 250
Differential Diagnosis . . . . . . . . . . . . . . 253
Clinical Queries and Reporting . . . . . . . 255
Mullerian Adenofibroma and
Adenosarcoma . . . . . . . . . . . . . . . . . . . . . 256
Pathologic Features . . . . . . . . . . . . . . . . 256
Differential Diagnosis . . . . . . . . . . . . . . 259
Clinical Queries and Reporting . . . . . . . 259
Stromal Tumors . . . . . . . . . . . . . . . . . . . . . 260
Stromal Nodule and Low-Grade
Stromal Sarcoma . . . . . . . . . . . . . . . . . . 260
High-Grade Stromal Sarcoma . . . . . . . . 262
Differential Diagnosis . . . . . . . . . . . . . . 263
Clinical Queries and Reporting . . . . . . . 264
Smooth Muscle Tumors . . . . . . . . . . . . . . . 264
Leiomyomas . . . . . . . . . . . . . . . . . . . . . 264
Variants of Leiomyoma . . . . . . . . . . . . . 264
Tumorlets . . . . . . . . . . . . . . . . . . . . . . . . 265
Leiomyosarcoma . . . . . . . . . . . . . . . . . . 267
Clinical Queries and Reporting . . . . . . . 267
Rare Neoplasms . . . . . . . . . . . . . . . . . . . . 267
Lymphoma and Leukemia . . . . . . . . . . . 267
Miscellaneous Tumors . . . . . . . . . . . . . . 268
Other Lesions and Tumor-Like
Conditions . . . . . . . . . . . . . . . . . . . . . . . . . 269
Chapter 12 Methods of Endometrial Evaluation . . . . . . . . . . . 275
Endometrial Sampling Techniques . . . . . . 275
Noninvasive Methods of Endometrial
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . 276
Hysteroscopy . . . . . . . . . . . . . . . . . . . . . 276
Ultrasound . . . . . . . . . . . . . . . . . . . . . . . 277
Magnetic Resonance Imaging . . . . . . . . 277
Histologic Techniques . . . . . . . . . . . . . . . . 277
Frozen Section . . . . . . . . . . . . . . . . . . . . . . 278
Immunohistochemistry . . . . . . . . . . . . . . . 279
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289
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