珍屯医学

标题: 阴道腺病 [打印本页]

作者: 大江 时间: 2020-6-20 00:01
标题: 阴道腺病
阴道腺病是阴道的良性异常，通常被认为是由子宫内和己烯雌酚和其他孕激素和非甾体雌激素的新生儿暴露引起的，但是在其他健康女性中也观察到这种现象，有时被认为是特发性或先天性的。还观察到青春期后病变从头生长。它的发病率相当普遍，约占成年女性的10％。

内容
1 原因
2 诊断
3 参考

原因
阴道腺瘤的特征是在阴道壁内存在化生性宫颈或子宫内膜上皮，这被认为是源自缪勒氏上皮胰岛。在暴露于某些化学物质的女性中，高达90％的女性可能发生阴道腺病。由于停止使用这些避孕药具，发病率急剧下降。然而，由于最近的接触，后代仍然存在风险。

据认为，类固醇激素在腺病形成中起刺激作用。在腺癌患者中也经常观察到阴道腺病。

诊断
在阴道镜下，其表现类似于子宫颈上的柱状上皮，并借助lugol溶液进行诊断。可以发现其为阴道管上的结节或囊肿，需要进行活检以进一步诊断。从细胞学上看，阴道腺瘤中的上皮和基质细胞显示出通过基底层或与基质成纤维细胞融合的特征。腺细胞可分为粘液性，肾小管内膜性和胚胎性。其粘液细胞类似于正常的宫颈内膜，而其肾小管内膜细胞类似于正常的输卵管或子宫内膜。

鉴于透明细胞腺癌患者在非典型肾小管子宫内膜腺体附近存在这些病变，并且这些病变会引起微腺增生，因此有时将其视为癌前病变。

参考
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Sandberg, E. C. (June 1968). "The incidence and distribution of occult vaginal adenosis". American Journal of Obstetrics and Gynecology. 101 (3): 322–334. doi:10.1016/0002-9378(68)90058-6. PMID 4172394.
Sherman, A. I.; Goldrath, M.; Berlin, A.; Vakhariya, V.; Banooni, F.; Michaels, W.; Goodman, P.; Brown, S. (October 1974). "Cervical-vaginal adenosis after in utero exposure to synthetic estrogens". Obstetrics & Gynecology. 44 (4): 531–545. PMID 4412373.
Kranl, C.; Zelger, B.; Kofler, H.; Heim, K.; Sepp, N.; Fritsch, P. (July 1998). "Vulval and vaginal adenosis". The British Journal of Dermatology. 139 (1): 128–131. doi:10.1046/j.1365-2133.1998.02329.x. PMID 9764164.
Sharp, Gerald B.; Cole, Philip (1990). "Vaginal bleeding and diethylstilbestrol exposure during pregnancy: Relationship to genital tract clear cell adenocarcinoma and vaginal adenosis in daughters". American Journal of Obstetrics and Gynecology. 162 (4): 994–1001. doi:10.1016/0002-9378(90)91303-T. ISSN 0002-9378. PMID 2327468.
Kurman, Robert J.; Scully, Robert E. (1974). "The incidence and histogenesis of vaginal adenosis". Human Pathology. 5 (3): 265–276. doi:10.1016/S0046-8177(74)80111-5. ISSN 0046-8177. PMID 4829509.
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Stafl, A.; Mattingly, R. F.; Foley, D. V.; Fetherston, W. C. (January 1974). "Clinical diagnosis of vaginal adenosis". Obstetrics & Gynecology. 43 (1): 118–128. PMID 4808952.
Roberts, Daniel K.; Walker, Nola J.; Parmley, Tim H.; Horbelt, Douglas V. (1988). "Interaction of epithelial and stromal cells in vaginal adenosis". Human Pathology. 19 (7): 855–861. doi:10.1016/S0046-8177(88)80270-3. ISSN 0046-8177. PMID 3402975.
Robboy, Stanley J.; Hill, Edward C.; Sandberg, Eugene C.; Czernobilsky, Bernard (1986). "Vaginal adenosis in women born prior to the diethylstilbestrol era". Human Pathology. 17 (5): 488–492. doi:10.1016/S0046-8177(86)80039-9. ISSN 0046-8177. PMID 3699812.
Robboy, Stanley J.; Young, Robert H.; Welch, William R.; Truslow, Geri Y.; Prat, Jaime; Herbst, Arthur L.; Scully, Robert E. (1984). "Atypical vaginal adenosis and cervical ectropion. Association with clear cell adenocarcinoma in diethylstilbestrol-exposed offspring". Cancer. 54 (5): 869–875. doi:10.1002/1097-0142(19840901)54:5<869::AID-CNCR2820540519>3.0.CO;2-I. ISSN 0008-543X. PMID 6537153.
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