病理診断アトラス(14) : 女性生殖器系1:子宮内膜・胎盤

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  • ビョウリ シンダン アトラス 14 ジョセイ セイショクキケイ 1 シキュウ ナイマク タイバン
  • Atlas of Diagnostic Pathology (14) : Female Reproductive System 1: Endometrium and Placenta

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The endometrium is greatly affected by sex-steroid hormones. It is immature in childhood, shows histological alteration depending on menstrual cycle, and becomes atrophic after menopause. Inflammation, dysfunctional bleeding and endometrial polyps are representative non-neoplastic lesions. The latter two lesions should be differentiated from endometrial hyperplasia or carcinoma, considering various metaplastic lesions and artifacts, especially in biopsy specimens. Endometrial hyperplasia has a pre-cancerous nature, and is classified into simple, complex, simple atypical and complex atypical hyperplasia. Complex atypical hyperplasia develops into carcinoma at a high frequency. Differentiation of atypical hyperplasia from well-differentiated adenocarcinoma is often difficult in small biopsy specimens. Endometrial carcinoma includes endometrioid adenocarcinoma, serous adenocarcinoma, clear cell adenocarcinoma, mucinous adenocarcinoma, squamous cell carcinoma and undifferentiated carcinoma. Endometrioid adenocarcinoma is most common and sub-classified into Grade 1 to 3, depending on atypia. There are tumors consisting of epithelial and mesenchymal components: adenofibroma, adenosarcoma, carcinofibroma and carcinosarcoma. Immunohistochemistry is sometimes required to confirm characteristics of the components. During pregnancy, the placenta changes histologically with the development of a fetus. Cytotrophoblasts and syncytiotrophoblasts are observed in chorionic villi, and intermediate trophoblasts in the area of implantation. Trophoblastic diseases include hydatidiform moles, choriocarcinoma, placental-site trophoblastic tumors and persistent trophoblastic disease. Chorionic villi swell more than 2 mm in diameter with cistern formation in hydatidiform moles, which are sub-classified into complete and partial moles. Choriocarcinoma is pregnancy-related or non-pregnancy-related. Atypical trophoblasts proliferate with severe hemorrhage and necrosis.

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