regression
6%-74% progression
Smoking Lower social class Immunosuppression e.g. HIV, post-transplant Slight increase in risk with use of combined oral contraceptive Non-attendance at cervical screening programme.
Normal cervix
Schematic of the development of the cervical transformation zone
Normal cervix
Pathological classifications
糜烂型：最常见 复层鳞状上皮脱落为单 层上皮取代
颗粒型：真性糜烂 增生型：腺体腺瘤样增生 囊泡型：Nabothian囊肿 肥厚型：子宫脱垂 肥厚增大2-3倍
* only a fraction of cases progress to invasive carcinoma
CIN I
50%-60% regression
30%
persistence
20%
CIN III
1%-5% invasive carcinoma (20 years)
CIN III
33%
Squamous Ca. （75%） adenocarcinoma (20%) Neuroendocrine Ca. ( less than 5%)
Risk Factors:
Early age at first intercourse Multiple sexual partners A male partner with multiple previous sexual partners persistent infection by “high-risk” papillomaviruses
HPV infection
HPV 感染
85-90%病人有
高危组
HPV-16 HPV-18 HPV-31 HPV-33 HPV-35
低危组
HPV-6 HPV-11 HPV-42 HPV-44
CIN
Condyloma (尖锐湿疣)
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HPV
Growth inhibitors TP53
infections
The diseases of Genital Syital System
Male Genital System
The common diseases
➢Chronic Cervicitis
(慢性宫颈炎）
➢Carcinoma of the Cervix (宫颈癌）
鳞状上皮和纤维结缔组织增生
Chronic Cervicitis
Chronic Cervicitis
疱疹病毒
乳酸杆菌
Squamous metaplasia at the transition zone. Mature squamous epithelium is seen to the right of the arrow, and squamous metaplasia is seen to the left. In squamous metaplasia, the nuclei may be larger and more immature appearing and the cytoplasm more dense.
CINⅠ: Mild dysplasia CINⅡ: Moderate dysplasia CIN Ⅲ: Severe dysplasia and carcinoma in situ
* begin as lower grade CIN and progress to higher-grade or begin as high-grade CIN
Polypus
Tumors of The Cervical
the 2nd commonest female malignancy CIN ——cervical intraepithelial neoplasia Invasive carcinoma
Epidemiology Peak age CIN--30y Invasive carcinoma--45y Transformation zone
编码合成 E6 和E7 protein
RB hyperphosphorylated
RB hypophosphorylated
TP53 RB
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Pathogenesis：
Cervical intrepithelial neoplasia (CIN)
CIN is the precancerous lesion of cervical carcinoma.
一、Diseases of Cervix
Chronic cervicitis Tumors
Chronic Cervicitis
Etiology and Types of chronic cervicitis
1. Specific: tuberculosis, gonorrhea（淋病), HPV 2. Nonspecific: many types of germs and viruses 3. Some degree of cervical inflammation may be found in virtually all multiparous and in many nulliparous adult women with little clinical consequence.
➢Gestational Trophoblastic Tumors (绒毛膜滋养细胞肿瘤）
➢Carcinoma of the Breast (乳腺癌)
➢Nodular hyperplasia of the Prostate (前列腺结节状增生)
➢Carcinoma of the Prostate (前列腺癌）