泌尿系统的比较形态学

掌握急性弥漫性增生性肾小球肾炎、慢性熟悉快速进行性肾小球肾炎的病变特点及临床病理联系。熟悉慢性肾盂肾炎的病理形态特点，了解了 移行细胞癌的病理形态特点实验内快速进行性肾小球肾炎*慢性肾小球肾炎慢性肾小球肾炎（53，示慢性肾盂肾炎慢性肾盂肾炎状移行上皮癌预习大体观察要肾体积、质包膜表面情切面皮髓肾其切片观察要Acute Acutediffuseproliferativeglomerulonephritis，slideThisglomerulusishypercellularandcapillaryloopsarepoorlydefined.Thisisatypeofproliferativeglomerulonephritisknownaspost-infectiousglomerulonephritis.ThiscasefollowedagroupAbetahemolyticstreptococcalinfectionofthepharynx3weeksearlier,andthusitcouldbetermed'post-streptococcalgomerulonephritis'.Thehypercellularityofpost-infectiousglomerulonephritisisduetoincreasednumbersofepithelial,endothelial,andmesangialcellsaswellasneutrophilsinandaroundtheglomerularcapillaryloops.ThisdiseasemayfollowseveralweeksafterinfectionwithcertainstrainsofgroupAbetahemolyticstreptococci.Patientswhohavehadastrepinfectiontypicallyhaveanelevatedanti-streptolysinO(ASO)titer.Post-infectiousglomerulonephritisisimmunologicallymediated,andtheimmunedepositsarewidelydistributedwithinthecapillaryloops.Thedepositsareseenherewithbrightbreenfluorescenceinagranular,bumpypatternbecauseofthefocalnatureoftheimmunecomplexdepositionprocess.IntypeIIIhypersensitivity,antigen-antibodycomplexestendtofilterout etrappedalongbasementmembranes,suchasthoseinglomerularcapillaries. rapidlyprogressiveglomerulonephritis(RPGN)Crescenticglomerulonephritis，slide52Seenherewithintheglomeruliarecrescentscomposedofproliferatingepithelialcells.Crescenticglomerulonephritisisknownasrapidlyprogressiveglomerulonephritis(RPGN)becausethisdiseaseisveryprogressive.RPGNisadescription,notaspecificdisease.TherearemultiplecausesforRPGN,andinthiscaseitisduetoSLE.Noteinthelowerleftglomerulusthatthecapillaryloopsaremarkedlythickened(theso-called"wireloop"lesionoflupusnephritis).Hereisanotherglomeruluswithepithelialcrescentssquashingtheglomerulartuftsfromallsides.RPGNmaybeidiopathicormayresultfromSLE,post-infectiousGN(asinsomecasesofpost-infectiousGN),fromvarioustypesofvasculitis,andfromGoodpasturesyndrome.Thisimmunofluorescencemicrographofaglomerulusdemonstratespositivitywithantibodytofibrinogen.WitharapidlyprogressiveGN,theglomerulardamageissoseverethatfibrinogenleaksintoBowman'sspace,leadingtoproliferationoftheepithelialcellsandformationofthebrightcrescentshownhere.chronic

chronicglomerulonephritis.Seenhereareatrophickidneyswithathincortexfromapatientatautopsywithchronicrenalfailure(CRF).AboutathirdtohalfofpatientswithCRFslowlyreachendstagewithoutsignificantsignsorsymptomsalongtheway,andattheendstagerenaldisease(ESRD)therearenodiagnosticfeaturesand,therefore,nopointinperformingarenalbiopsy.Asteadilyrisingserumcreatinineandureanitrogenareclues.Mostpatientswillalsobehypertensive.(Somesimplecystsarealsoseenhere.)慢性肾小球肾炎chronicglomerulonephritis，slide慢性肾小球肾炎（53，示教 （代偿部分肾单位chronic慢性肾盂肾炎chronicpyelonephritis（slide慢性肾盂肾炎（slide部分肾小管萎缩，另一部分肾小管扩张，其内有均质红肾间质纤维组织增生，慢性炎细胞浸润（淋巴细胞、浆肾盂粘膜增厚，肾盂肾盏粘膜及粘膜下组织出现多量淋Thelargecollectionofchronicinfl torycellshereisinapatientwithahistoryofmultiplerecurrenturinarytractinfections.Thisischronicpyelonephritis.Theseverityofdiseasedependsupontheamountofremainingfunctionalrenalparenchyma.Papillarytransitionalcarcinomaof大者约3.5×3cm，高出黏 Thisbladderwasremovedsurgicallyfromamalewhohadalonghistoryofsmoking.Hehadpresentedwithhematuria.Theopenedbladderrevealsmassesofaneo smthathistologicallyprovedtobeurothelialcarcinoma(previouslyknownasatransitionalcellcarcinoma).Urothelialcarcinomacanariseanywhereintheurotheliumliningtheurinarytractfromtheurethratothecalyces,butismostcommoninbladder.Aurothelialcarcinomaoftheurotheliumisshownhereatlowpower.Notethefrond-likepapillaryprojectionstotheleft.Itisdifferentiatedenoughtoresembleurothelium,butitisproducingamass