口腔组织病理学：口腔黏膜

1、口腔黏膜 Oral mucosa中山大学光华口腔医学院2学习要求：掌握口腔粘膜的基本组织结构、分层（上皮、 固有层、粘膜下层）熟悉口腔粘膜的组织结构特点与临床联系中山大学光华口腔医学院3粘膜:与体外相通的体腔表面衬覆的组织Mucous membrane the moist lining of the intestinal tract, nasal passage, other body cavities communicated with the exterior中山大学光华口腔医学院4口腔粘膜: 衬覆于口腔表面的组织，有涎腺开口于其表面oral mucosa or oral mucous l

2、ining in oral cavity continuous with skin, intestine中山大学光华口腔医学院5 HistologyEpithelium 上皮stratum basale 基底层 stratum spinosum 棘层 stratum granulosum 颗粒层 stratum corneum 角化层 中山大学光华口腔医学院6Basal membrane 基底膜Basal lamina Lamina reticularLamina proper 固有层Submucosa 粘膜下层中山大学光华口腔医学院7上皮（epithelium）: 角质形成细胞（kerati

3、n-producing cell ）90非角质形成细胞 10 stratified squqmous epithelium 典型的4层结构中山大学光华口腔医学院8 基底细胞层：stratum basale细胞分化程度最低：立方状 核深染 Cuboid or columna细胞间以桥粒相连接 Connect each other by desmosome借助半桥粒附着于基底膜 Connect with C.T. by semidesmosome细胞分裂繁殖的部位 Side of majority of cell devisions 中山大学光华口腔医学院9中山大学光华口腔医学院10 棘细胞层 s

4、tratum spinosum细胞体积大，卵圆形 Large ovoid胞浆:许多棘状突起:细胞间桥（桥粒） Intercellular bridges : desmosomes面间管：物质交换的通道 Intercellular space : interfacial canal中山大学光华口腔医学院11生发层 基底细胞 + 深部棘层细胞 proliferative or germinative layer Most active in protein synthesis中山大学光华口腔医学院12中山大学光华口腔医学院13 颗粒层 Stratum granulosum 细胞体积大，扁平 2 3

5、 列 large flatter cells胞浆内含嗜碱性颗粒：透明角质颗粒 Basophilic keratohyalin granules胞核变性，核浓缩 Nuclei:degeneration and pyknosis张力细丝更致密 Tonofilaments more dense中山大学光华口腔医学院14中山大学光华口腔医学院15 角化层 stratum corneum细胞大而扁平 Very large and flat cells (squames) 染色为淡红色均质状 eosinophilic and amorphous正角化：胞核及细胞器消失 orthokeratinizatio

6、n :no nuclei, no organelles不全角化：核固缩 parakeratinized :nuclei pyknotic, some lysed organelles中山大学光华口腔医学院16中山大学光华口腔医学院17角化上皮4层结构的超微结构特点基底层：除一般的细胞器外，有张力细丝 bundles of tonofibrils and other cell organelles 棘层：张力细丝增多，浅层出现膜被颗粒 membrane-coating granules 颗粒层：出现致密的透明角质颗粒 keratohyaline granules 角化层：细胞器消失，充满角蛋白纤

7、维 organelles lost 中山大学光华口腔医学院18细胞连接：桥粒、缝隙连接、紧密连接types of connection between cells of the oral epithelium: desmosomes gap junctions tight junctions 中山大学光华口腔医学院19 非角化的鳞状上皮 nonkeratinized epithelium 基底层 basal layer 棘层 prickle-cell layers, less conspicuous 中间层 intermediate cell layer 表层 superficial laye

8、r中山大学光华口腔医学院20非角化鳞状上皮的特点Characteristics of nonkeratinized epithelium ：表层细胞扁平，有细胞核，胞浆含糖元，染色浅 Flattened cells with glycogen，nuclei persist to surface胞浆中张力细丝分散不成束，细胞器少，膜被颗粒环状 containing dispersed tonofilments, fewer organells, circular type membrane-caoting granules细胞体积较大，细胞间桥不明显 Cells slightly larger,

9、 intercellular bridges less conspicuous 中山大学光华口腔医学院21The difference between keratinized epithelium and nonkeratinized epithelium中山大学光华口腔医学院22口腔上皮的特殊蛋白质：细胞角蛋白（cytokeratin）的合成口腔上皮的细胞增殖及更新 proliferation and maturation of the oral epitheliumimmunostaningfor proliferatingcell nuclear Antigen(PCNA)immunos

10、tainingfor cytokeratinAE1/AE3 中山大学光华口腔医学院23非角质形成细胞 nonkeratinocytes in oral epithelium透明细胞:占口腔上皮细胞总数10% Clear cells: may constitute up to 10% of the cell population不参与上皮的增生和分化 Not associated with the proliferation and differentiation of oral epithelium细胞内不含张力细丝，无桥粒 Without tonofilments and desmosoma

11、l connections中山大学光华口腔医学院24上皮内的非角化细胞 Nonkeratinocytes in oral epithelium 黑色素细胞 melanocyte 朗格汉斯细胞 Langerhans cell 梅克尔细胞 Merkel cell 中山大学光华口腔医学院25黑色素细胞（melanocyte）：来源：神经嵴细胞（胚胎第十一周） Originate from the neural crest (arriving at the oroepithelial connective tissue junction about 11th week of development)特

12、殊染色：有树枝状突起 With dentritic processes extending into the stratum basale and stratum spinosum, no desmosomes部位：基底层 Level in epithelium: basal功能：产生黑色素，可通过细胞突起传给角质细胞 Function: synthesis of melanin granules and transfer to surrounding keratinocyte中山大学光华口腔医学院26非角质细胞melanocytedopareaction中山大学光华口腔医学院27郎格罕斯细胞

13、（Langerhans cell）：形态：有多突起的细胞 With dentritic processes extending among the epithelial elements at all level光镜下透明，CD1、S-100免疫染色阳性； Specific staining reaction:电镜-在细胞质中有特殊的棒状颗粒 With langerhans granules (rod-shape granules)来源：造血组织 功能：与免疫反应有关With possible antigen properties 中山大学光华口腔医学院28Langerhans cell中山大

14、学光华口腔医学院29 梅克尔细胞（Merkel cell）：形态：在光镜下染色较角质细胞浅 Disk-shaped terminals 电镜：胞质中有致密膜被小泡，与神经轴突末梢相连 Electron-dense vesicles and associated with nerve axon来源：神经嵴或角质细胞 originate from neural crest or epithelium部位：基底层 Restrict to the deeper layers of the epithelium 功能：感受触觉 Tactile sensory cells中山大学光华口腔医学院30中山大学

15、光华口腔医学院31基底膜: 上皮与结缔组织交界basement membrane : junction between epithelium and CT光镜结构：非直线（结缔组织乳头与上皮嵴） 宽1 - 4 um PAS染色（+） A structureless band in HE preparation, stains brightly with PAS 超微结构：透明板、密板（合称基板，来自上皮） 网板（来自CT） Basal lamina = lamina lucida + lamina densa中山大学光华口腔医学院32基底膜的化学组成 Chemical composition

16、of the basement membraneLamina lucida : glycoproteinLamina densa : Laminin (层粘连蛋白) Type collagen Anchoring fibrils : Type Collagen ：中山大学光华口腔医学院33基底细胞与基板的结合方式： 半桥粒 hemidesmosomes结缔组织与基板结合的方式： 锚纤维 anchoring fibrils中山大学光华口腔医学院34固有层 lamina propria 由致密结缔组织构成：含细胞、纤维、基质、血管、 神经和淋巴管The lamina propria consist

17、s of cells, blood vessels, neural elements, and fibers embedded in an amorphous ground substance中山大学光华口腔医学院35分层：乳头层和网状层 Papillary layer & reticular layer 功能：调控上皮细胞的分化、支持和营养作用 adjustment and control of the cell differentiation support and nutrition中山大学光华口腔医学院36粘膜下层（submucosa）The deeper segment of the

18、 lamina propria containing the secretory portions of salivary glands or accumulations of fat cells communicates with bone and/or muscle疏松结缔组织，内含小涎腺、较大的血管、淋巴管、神经及脂肪组织分布：主要在被覆粘膜，牙龈、硬腭大部分区域及舌背无粘膜下层功能：为固有层提供营养及支持中山大学光华口腔医学院37分类 the types of oral mucoma咀嚼粘膜（masticatory mucosa）： 硬腭、牙龈 hard palate & gingiv

19、al 被覆粘膜 (lining mucosa): 颊、唇、舌腹、口底、牙槽、软腭特殊粘膜 (specialized Mucosa): 舌背 dorsal surface of the tongue 中山大学光华口腔医学院38中山大学光华口腔医学院39咀嚼粘膜 Masticatory Mucosa结构特点：上皮通常为角化，正角化时粒层明显棘层细胞间桥明显固有层厚，乳头多而长，与上皮嵴呈指状镶嵌，形成良好的机械附着胶原纤维束粗大并排列紧密，直接附着在骨膜上；或借粘膜下层与骨膜相连中山大学光华口腔医学院40Masticatory Mucosafrequently orthokeratinized W

20、ith thick lamina propria, containing a dense network of collagen fibers in the form of large closely packed bundles covers immobile structures and firmly bound to them directly or indirectly中山大学光华口腔医学院41咀嚼粘膜 Masticatory Mucosa功能：承受咀嚼压力和磨擦，但不能移动exposed to compressive and shear forces and to abrasion

21、during the mastication of foodinextensible 中山大学光华口腔医学院42咀嚼粘膜硬腭（hard palate）:解剖学：龈区、中央区、脂肪区和腺区 The palatine raphe, the fatty zone, the glandular zone and the gingival zone中山大学光华口腔医学院43咀嚼粘膜/硬腭正角化为主硬腭前方正中:切牙乳头，其中有退化的鼻腭管的口腔部分，为盲管，内衬假复层柱状上皮中间区即腭中缝的固有层内有时可见上皮珠 中山大学光华口腔医学院44hard palatemainly orthokeratiniz

22、edthe incisive papilla overlies the oral orifice of the incisive canalepithelial pearls appear in the lamina propria of the raphe (epithelial remnants involved in the formation of the premaxillary palate)中山大学光华口腔医学院45被覆粘膜 Lining Mucosa上皮无角化固有层胶原纤维不如咀嚼粘膜者粗大上皮与结缔组织交界比较平坦，结缔组织乳头较短粗有较疏松的粘膜下层被覆粘膜富有弹性，有一定

23、活动度中山大学光华口腔医学院46Lining MucosaCovering the underside of the tongue, inside of the lips, cheeks, floor of the mouth, and alveolar processesepithelium : thicker and non-keratinizedlamina propria: thick with numerous short papillaerelatively smooth interface with connective tissueflexible 中山大学光华口腔医学院47被

24、覆粘膜唇（lip）：皮肤、粘膜及唇红粘膜上皮为无角化复层鳞状上皮，中间层较厚固有层乳头短而不规则粘膜下层较厚，与固有层无明显界限中山大学光华口腔医学院48lipDivided into three regions: the skin of the external area the vermilion border the mucous membrane中山大学光华口腔医学院49唇红（vermilion border）上皮有角化，细胞中含较多的角母蛋白，透明度较高固有层乳头狭长，含许多毛细血管袢唇红部粘膜下层无小涎腺及皮脂腺，故易干裂中山大学光华口腔医学院50vermilion borderE

25、pithelium is throwm into deep folds which reflect the ridges of the epedermal layerThe papillae appear as numerous tall, slender evaginations of connective tissueHair follicles and sweat glands are conspicuously wantingLubricating effects of sebum not presentChapping is likely中山大学光华口腔医学院51颊粘膜（buccal

26、 mucosa/cheek）结构与唇粘膜相似,上皮无角化口角后方颊粘膜咬合线区: 粟粒状淡黄色小颗粒，为异位的皮脂腺（Fordyce spot)中山大学光华口腔医学院52buccal mucosa/cheekEpithelium: non-keratinizedLamina propria: dense connective tissue irregular, short papillaeSubmucosa: glands between muscle bundlesFordyces spots: isolated sebaceous glands opposite the molars中山大

27、学光华口腔医学院53口底 (mouth floor)：粘膜较薄，固有层乳头短。舌下皱壁处有舌下腺。口底粘膜与下颌舌侧牙龈相连舌腹 (ventral surface of the tongue)粘膜光滑而薄，结缔组织乳头多而短。粘膜下层不明显中山大学光华口腔医学院54Ventral surface of the tongue nonkeratinized smooth and relatively thin numerous short papillae submucosa cannot be identified as a separate layerFloor of oral cavity

28、thin and loosely attach to underlying structure non-keratinized, short papillae adipase tissue in submucosa sublingual glands close to mucosa 中山大学光华口腔医学院55软腭(soft palate)：粉红色 血管丰富上皮：非角化固有层：乳头数量少而短粘膜下层：疏松 含粘液腺及味蕾中山大学光华口腔医学院56soft palate Highly vascularized and reddish in colorEpithelium: nonkeratiniz

29、ed Lamina propria: papillae few and short layer of elastic fibersSubmucosa: loose mucous glands taste buds中山大学光华口腔医学院57特殊粘膜舌背(the dorsum of the tongue)：解剖学特点：舌体、舌根、盲孔、乳头组织学特点：分布大量乳头的特殊复层鳞状 上皮功能：参与咀嚼、味觉感受等中山大学光华口腔医学院58the dorsum of the tongue Vshaped line foramen cecum Lingual body: anterior two thir

30、d trigeminal nerve through its lingual branch Lingual base: posterior one third glossopharyngeal nerve Mucosa of dorsal surface (special mucosa) functionally masticatory and highly extensible different type of lingual papillae中山大学光华口腔医学院59lingual papillaefiliform papillae thread shaped, numerous ker

31、atinized epithelium core of CT: secondary papillae中山大学光华口腔医学院60舌背乳头丝状乳头(filiform papillae)：数量、分布，大小、方向表面有角化（如角化上皮剥落延迟，同时与食物残渣、唾液、细菌等混杂，附着于乳头表面即形成舌苔）中山大学光华口腔医学院61fungiform papillae Round, reddish, isolated Nonkeratinazed epithelium A few taste buds中山大学光华口腔医学院62 菌状乳头(fungiform papillae)：分散于舌尖和舌侧缘丝状乳头

32、之间，色泽较红，呈圆形头大 颈细的突起状，高0.71.5mm， 直径0.41.0mm上皮较薄，表层无角化，部分 菌状乳头上皮内可见少数味蕾中山大学光华口腔医学院63Vallate papillae 8-10, in front of terminal sulcus Not above the tongue surface Bounded by a deep circular furrow Thin, smooth epithelium Numerous taste buds on the lateral surgace Von Ebner s glands open into furrow中山

33、大学光华口腔医学院64特殊粘膜轮廓乳头(vallate papillae)：约812个(界沟前方)矮柱状，高约11.5mm， 直径约13mm，四周有轮廓沟表面上皮有角化，侧壁上皮无角化， 上皮内有圆形小体，称味蕾在轮廓沟底附近有味腺（Ebner gland）中山大学光华口腔医学院65Vallate papillae中山大学光华口腔医学院66foliate papillae Lateral border of posterior part Sharp, parallel cleft, varying length 中山大学光华口腔医学院67特殊粘膜 叶状乳头(foliate papillae)：位于舌侧缘后部，呈58条平行排列的皱壁在人类为退化器官炎症时往往肿大，且伴疼痛中山大学光华口腔医学院68