形态学 9、消化管的比较形态学

胃溃疡
Gastric ulc状、大小、深度； ③ 溃疡的底部、边缘情况； ④ 周围粘膜皱襞表现
慢 性 胃 溃 疡 （
45号 切 片 ）
描述要点:四层结构：1炎性渗出层 2坏死组织层 3肉芽组织层 4瘢痕组织层 5溃疡底部血管改变
十二指肠溃疡
蜂窝织性阑尾炎（化脓性阑尾炎）
Phlegmonous appendicitis(purulent appendicitis) （123）
临床病历摘要： 男性，45岁。入院前10小时开始脐周痛，4小时后 局限于右下腹，阵发性加剧，伴发热、恶心、呕 吐。体检：右下腹肌紧张，麦氏点附近有明显压 痛及反跳痛。化验：白细胞总数：18,000，中性：
90%。
观察要点： ① 阑尾大小、形状、颜色； ② 表面血管、渗出物；
坏疽性阑尾炎
Gangrenous appendicitis （16）
观察要点：
① 阑尾肿胀变粗，呈暗黑色； ② 阑尾浆膜面覆盖一层灰黄色炎性渗出物； ③ 切面见管壁显著增厚、层次不清，见粪石； ④ 有一处已穿孔。
急性蜂窝织性阑尾炎 （44号切片）
Microscopically, the ulcer here is sharply demarcated, with normal gastric mucosa on the left falling away into a deep ulcer whose base contains infamed, necrotic debris. An arterial branch at the ulcer base is eroded and bleeding.
Duodenal ulcer （122）
十二指肠球部黏膜面有一椭圆形溃疡，约1.5×0.6cm大小，深达肌层，边缘 整齐。周围黏膜皱襞略显放射状。
Here is a gastric ulcer in the center of the picture. It is shallow and is about 2 to 4 cm in size. This ulcer on biopsy proved to be malignant, so the stomach was resected as shown here.
镜检切片
慢性胃溃疡（45）*
蜂窝织性阑尾炎（44）* 胃印戒细胞癌（85，示教） 大肠腺癌（28）
A 1cm acute gastric ulcer is shown here in the upper fundus. The ulcer is shallow and sharply demarcated, with surrounding hyperemia. It is probably benign. However, all gastric ulcers should be biopsied to rule out a malignancy.
A history of smoking and/or alcoholism is often present in patients with esophageal squamous carcinoma, while a history of Barrett's esophagus precedes development of esophageal adenocarcinoma in many cases. Here, an ill-defined mass at the gastroesophageal junction produces mucosal ulceration and irregularity, which led to the clinical symptoms of pain and difficulty swallowing.
This is the tip of the appendix from a patient with acute appendicitis. The appendix has been sectioned in half. The serosal surface at the left shows a tan-yellow exudate. The cut surface at the right demonstrates yellowish-tan mucosal exudation with a hyperemic border.
急性单纯性阑尾炎
Acute simple appendicitis （28）
临床病历摘要： 男性，25岁。一天前开始有轻微上 腹部疼痛，逐渐加重，入院前3小 时疼痛局限于下腹部，检查发现麦 氏点轻度压痛。化验白细胞总数为 8.5×109/L，中性78%。
观察要点： ① 阑尾轻度肿胀，增粗 ② 浆膜面小血管扩张（黑色）
Complications of gastric ulcers (either benign or malignant) include pain, bleeding, perforation, and obstruction.
An acute duodenal ulcer is seen in two views on upper endoscopy in the panels below.
胃腺癌
gastric adenocarcinoma （68）
胃窦部黏膜面有一直径约10cm肿物，呈灰白色，凸起于黏膜面，肿物表面已坏死 脱落形成溃疡(癌性溃疡)。肿物与周围组织分界不清，浸润性生长。
胃腺癌
gastric adenocarcinoma （68）
① 胃窦部可见一个灰白色肿物， 绕胃壁生长，直径约6cm；
蜂窝织性阑尾炎（44号切片）
描述要点
1. 阑尾粘膜面、管腔 2. 阑尾壁各层及系膜充血水肿表现 3. 炎细胞浸润情况 4. 浆膜面表现
Gastric neoplasia is not uncommon. Here is a gastric adenocarcinoma. In the U.S., most gastric cancers are discovered at a late stage when the neoplasm has invaded and/or metastasized. ALL gastric ulcers and ALL gastric masses must be biopsied, because it is not possible to tell from gross appearance alone which are benign and which are malignant. In contrast, virtually all duodenal peptic ulcers are benign.
实验目的与要求
掌握病理情况（炎症、溃疡、肿瘤）下食 管、胃、小肠及大肠大体观及显微结构的 改变。
实验内容
大体标本
胃溃疡 （120）* 十二指肠溃疡（121） 胃溃疡伴穿孔（122） 单纯性阑尾炎（28） 化脓性阑尾炎（123）* 坏疽性阑尾炎（16） 胃癌（68） 食管癌（67） 肠癌（69
预习CPC6
Microscopically, acute appendicitis is marked by mucosal inflammation and necrosis.
Here, the mucosa shows ulceration and undermining by an extensive neutrophilic exudate
This irregular reddish, ulcerated exophytic mid-esophageal mass as seen on the mucosal surface is a squamous cell carcinoma. Endoscopic views of an ulcerated mid-esophageal squamous cell carcinoma causing lumenal stenosis are seen below. Risk factors for esophageal squamous carcinoma include mainly smoking and alcoholism in the U.S. In other parts of the world dietary factors may play a role.
This appendix was removed surgically. The patient presented with abdominal pain that initially was generalized, but then localized to the right lower quadrant, and physical examination disclosed 4+ rebound tenderness in the right lower quadrant. The WBC count was elevated at 11,500. Seen here is acute appendicitis with yellow to tan exudate and hyperemia, including the periappendiceal fat superiorly, rather than a smooth, glistening pale tan serosal surface.
结肠腺癌 adenocarcinoma of colon
（69）
观察要点：
① 结肠一段，局部黏膜面呈不规 则乳头状突起，可见小囊形成， 囊内有粘液；
② 局部肠壁增厚，肠腔狭窄； ③ 切面肠壁正常结构被破坏，灰