




版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
DiseasesoftheNervousSystem
KunMu(牟坤)MD,PhDDepartmentofPathologySchoolofMedicine,ShandongUniversityContentsStructureoftheNSandbasicpathologicchangesCommoncomplicationsofCNSInfectiousdiseasesofNSNeoplasmsofNSI.StructureoftheCNSandbasicpathologicchangesCerebellum(小脑)
Cerebellarpeduncles(小脑脚)Occipitallobe(枕叶)
Gyri(脑回)Sulci(脑沟)Parietallobe(顶叶)
Frontallobe(额叶)
Pons(桥脑)Fourthventricle(四脑室)
SpinalCord(脊髓)Microscopicstructureofthe
CNSNeuron(神经元)Cellbodies--greymatterCellprocesses–axons--WhitematterbundlesStainingofneuronesinthecerebralcortexMicroscopicstructureofthe
CNSNeuron(神经元)Cellbodies--greymatterCellprocesses–axons--WhitematterbundlesGlia(胶质细胞)AstrocytesOligodendrocytesEpendymalcellsStainingofastrocyteinthecerebralcortexGlia-oligodendrocytesEpendymalcellsMicroscopicstructureofthe
CNSNeuron(神经元)Cellbodies--greymatterCellprocesses–axons--WhitematterbundlesGlia(胶质细胞)AstrocytesOligodendrocytesEpendymalcellsMicroglia(小胶质细胞)Meningocyte(脑膜细胞)Vessel(血管)I.BasicpathologychangesofCNSNeuronAstrocytesOligodendrocytesEpendymalcellsMicroglia1.BasicpathologychangesoftheNeuronChromatolysis(尼氏体溶解)Redneuron(红色神经元)Simpleneuronalatrophy(单纯性神经元萎缩)Cellularinclusion(包含体形成)CellStructureproteinchange(细胞结构蛋白异常)Wallerdegeneration(Waller变性)中央型尼氏体溶解正常神经细胞1.BasicpathologychangesoftheNeuron
1.Chromatolysis(尼氏体溶解)
1.BasicpathologychangesoftheNeuron2.Redneuron(红色神经元)---Coagulationnecrosis1.BasicpathologychangesoftheNeuron1.Chromatolysis(尼氏体溶解)2.Redneuron(红色神经元)3.Simpleneuronalatrophy(单纯性神经元萎缩)Commoninsomechronicdegenerativediseases1.BasicpathologychangesoftheNeuron4.Cellularinclusion(包含体形成)Negribody-rabies(狂犬病)1.BasicpathologychangesoftheNeuron5.CellStructureproteinchange(细胞结构蛋白异常)NeurofibrillaryTangles-AZLewybodies-PD1.BasicpathologychangesoftheNeuron6.Waller
degeneration
(Waller变性)DegenerationDemyelination(脱髓鞘)RegenerationTrichrome染色:髓鞘染成红色,胶原纤维染成青色,可见髓鞘缺失、崩解。
2.Basicpathologychangesoftheastrocytes
1.Swelling(肿胀)2.Reactiveastrogliosis(反应性胶质化)
2.Basicpathologychangesoftheastrocytes2.Reactiveastrogliosis
2.Basicpathologychangesoftheastrocytes
1.Swelling(肿胀)2.Reactiveastrogliosis(反应性胶质化)3.Amyloidbody(淀粉样小体)
3.Basicpathologychangesoftheoligodendrocyte
Satellitosis(卫星现象)
4.Basicpathologychangesoftheependymalcell
Ependymalgranulation(颗粒状室管膜炎)颗粒状室管膜炎正常室管膜细胞
5.Basicpathologychangesofthemicroglia
1.Neuronophgia(噬神经细胞现象)2.Foamycell(gittercell)(格子细胞形成)3.Microglialnodules(胶质结节)
5.Basicpathologychangesofthemicroglia噬神经细胞现象neuronophagia格子细胞
gittercell5.Basicpathologychangesofthemicrogliamicroglialnodules(胶质结节)II.CommonComplicationsofCNS1.Brainedema(脑水肿)2.Hernia(脑疝)3.Hydrocephalus(脑积水)1.BrainedemaBrainedema(脑水肿):increasedwatercontentwithinthebrainparenchymaVasogenicedema:
Astateofincreasedextracellularfluidvolume;Braintumor,abscess,infarct,hemorrhageCytotoxicedema:
Theswellingofcellularelements;Hypoxia,toxication1.Brainedema1.Brainedema
脑水肿2.HerniationHerniation(脑疝形成):Abnormalprotrusionofbraintissuethroughanopening.Causes:RaisedICP(Intracranialpressure)Intracranialexpandinglesions–tumor,haematoma,abscess2.HerniationIntracranialpressure(ICP)Withintheintactskull,thereare3majorcomponentsofintracranialpressure:thebrain,theCSFandblood.Anyincreaseinvolumeofoneofthese3componentswillproduceanincreaseinICPNormalICPis0.6-1.8kPa2.Herniation-TypesSupracallosalhernia(扣带回疝,大脑镰下疝)Tentorialhernia(小脑天幕疝,海马沟回疝)Foramenmagnumhernia(枕骨大孔疝,小脑扁桃体疝)2.Herniation扣带回疝
海马沟回疝小脑扁桃体疝
3.HydrocephalusHydrocephalus(脑积水)referstotheaccumulationofexcessiveCSFwithintheventricularsystem
3.Hydrocephalus-Types1.noncommunicatinghydrocyphalus(非交通性脑积水)
Obstructivehydrocephalus
2.communicatinghydrocyphalus(交通性脑积水)
OverproductionofCSF
DefectiveabsorptionofCSF
3.Hydrocephalus-TypesCauses:IncreasedsecrationofCSF:脉络丛肿瘤ObstractiontotheflowofCSF:肿瘤、粘连性阻塞failureofabsorptionofCSF:蛛网膜粒的闭塞Dilatedlateralventriclesseeninacoronalsection
3.Hydrocephalus-TypesIII.InfectiousdiseasesofCNS
EpidemicmeningitisEpidemicEncephalitisBRoutesofinfectionHematogenousspread
DirectimplantationTrauma,NasalorparanasalsinusesinflammationInvasionviatheperipheralnervesStructureofmengingesMeningitisAcutesuppurativemeningitis:bacteriaAcutelymphocyticmeningitis:virusChronicmeningitis:TB1.EpidemicmeningitisGroupAmeningococcusaccountsforanestimated80–85%ofallcasesinthemeningitisbelt,withepidemicsoccurringatintervalsof7–14years.Suppurativeimmflamation1.Epidemicmeningitis-TransmissionThebacteriaaretransmittedfromperson-to-personthroughdropletsofrespiratoryorthroatsecretionsfromcarriersThebacteriaoverwhelmthebody'sdefensesallowinginfectiontospreadthroughthebloodstreamtothebrain.1.Epidemicmeningitis-GrossThereare
abundantcreamy,purulentexudate,mostprominentlyoverthesuperiorsurfaceofthecerebrum.Theexudationfullinsulci.Thegyriareswollen.Thevesselsarecongested.
1.Epidemicmeningitis-Gross1.Epidemicmeningitis-MicroNeutrophilicexudate,dilatedvessels,edemainthesubarachnoidspace
1.Epidemicmeningitis-ClinicalsignsSignsofinfection(fever,
malaise,skinrashes….)Signofhighintracranialpressure
a.headacheb.vomitingSignsofmeningealirritationa.neckstiffness,episthiotonus(角弓反张)b.Kernigpositive1.Epidemicmeningitis-ClinicalsignsSignsofinfection(fever,malaise,skinrashes….)Signofhighintracranialpressure
a.headacheb.vomitingSignsofmeningealirritationa.neckstiffness,episthiotonusb.KernigpositiveCSFchanges:a.cloudypurulentb.abundantneutrophilsc.highproteinlevelandreducedglucoselevel1.Epidemicmeningitis-CSFvaluesCellsProteinGlucosePressureAcutebacterialPMNsAcuteviralLymphsNormalChronic(TB)LymphsneutrophilBacteriamonocyte1.Epidemicmeningitis-CSFvalues1.EpidemicComplications
Hydrocephalus(脑积水)Cranialnerveparalysis(颅神经麻痹)Cerebralischemiaandinfarct(脑缺血和梗死)
Fulminantmeningococcalsepticemia
暴发性脑膜炎球菌败血症anextremeformofendotoxin-inducedsepsisandcoagulopathy.Theconditionisdiagnosedclinicallybytheappearanceofhemorrhagicskinlesionsandcompromisedcirculation
Fulminantmeningococcalsepticemia
暴发性脑膜炎球菌败血症2.EpidemicEncephalitisBEpidemicencephalitisBisacuteinfectiousdiseasecausedbyencephalitisBvirusUsuallyoccursinsummer&fallThevirusistransmittedbymosquitoVirusReplicationinMononuclear-phagocyteSystem(MPS)CNSBloodStreamBloodBrainBarrierBriefViremia2.EpidemicEncephalitisB-TransmissionBloodBrainBarrier-血脑屏障2.EpidemicEncephalitisB-GrossPathologiclocation:
cerebralparenchyma2.EpidemicEncephalitisB-MicroCongestionandinflammation:endothelialcellsswelling,perivascularcuffingDegenerationandnecrosisofneurons:softingfocus,neruonophagia,satellitosisProliferationofmicroglialcells:microglialnodule2.EpidemicEncephalitisB-MicroCongestionandinflammation:endothelialcellsswelling,perivascularcuffing2.EpidemicEncephalitisB-MicroDegenerationandnecrosisofneurons:softingfocus,neruonophagia,satellitosis2.EpidemicEncephalitisB-MicroProliferationofmicroglialcells:microglialnodule2.EpidemicEncephalitisB-
ClinicalfeatureHighfeverHeadacheVomitingSleepinessConvulsion抽搐
V.TumorsofNerousSystem
TumorsofCNSPeripheralNerveTumorsTumorsofCNSComprise:10%ofalltumorsPeakincidence20-50yrCommonchildhoodtumorSupratentorialtumorsinadultsInfratentorialtumorsinchildhoodLocationdeterminesprognosisRareextraneuralmetastasisWHOGradeGradeISlowgrowingNon-malignanttumorsPatientshavelong-termsurvivalGradeIIRelativelyslowgrowingSometimesrecurashighergradetumorsMaybenon-malignantormalignant.GradeIIIMalignanttumorsOftenrecurashighergradetumorsGradeIVHighlymalignantandaggressiveTumorsofCNSGliomasMedulloblastomaMeningiomasTumorsofCNSGliomas---derivedfromglialcells,include
AstrocytomaOligodendrogliomasEpendymomaHistologicClassificationofGlialTumorsAstrocyticTumorsPilocytic(grade1)Diffuse(grade2)Anaplastic(grade3)Glioblastoma(grade4)OligodendroglialtumorsandmixedvariantsOligodendroglioma,welldifferentiated(grade2)
Anaplasticoligodendroglioma(grade3)Mixedoligodendroglioma/astrocytoma(grade2)Mixedanaplasticoligodendroglioma/astrocytoma(grade3)EpendymalTumorsMyxopapillaryependymoma(grade1)Ependymoma(grade2)Anaplasticependymoma(grade3)Astrocytoma4thto6thdecade,Cerebrum.GradingsystembasedonAnaplasiaMitoticactivityNecrosisEndothelialproliferationDiffuse(WHO-II),anaplastic(WHO-III)&Glioblastoma(WHO-IV)Molecularmarkers:GFAP,Ki67,TP53,EGFR,IDH1,MGMT…DiffuseAstrocytoma(WHO-II)Histologictype:fibrillary(纤维型),protoplasmic(原浆型),gemistocytic(肥胖细胞型).Gross:apoorlydefined,gray,infiltrativetumorthatexpandsanddistortstheinvadedbrain.Thecutsurfaceofthetumoriseitherfirm,orsoftandgelatinous;cysticdegenerationmaybeseen.Micro:amildtomoderateincreaseinthenumberofglialcellnuclei,somewhatvariablenuclearpleomorphism,andtumorcellscanbeseeninfiltratingnormaltissue.GliomaCerebrumGliomaCerebrum
A.低密度细胞,核轻度异型;B.疏松瘤性间质背景中的肿瘤性纤维星形细胞;C.弥漫性微囊形成;D.不同程度的弥漫性GFAP表达。DiffuseAstrocytoma(WHO-II)
纤维型星形细胞瘤A.弥漫粘液变性;B.在微囊背景中肿瘤细胞有少许依稀可见的胞浆。DiffuseAstrocytoma(WHO-II)
原浆型星形细胞瘤肿瘤细胞浆丰富,轻度嗜酸性,核偏向周边并且GFAP强阳性。DiffuseAstrocytoma(WHO-II)
肥胖细胞型星形细胞瘤A.高密度细胞;B.大部分肿瘤细胞核内聚集TP53蛋白;C.部分区域明显的核异型和分裂活性;D.Ki67阳性率5-10%Anaplastic(WHO-III)Glioblastoma(WHO-IV)OlderadultsMediansurvival:12monthsHighlymalignantDiffuseinfiltrativetumors79岁原发性胶质母细胞瘤患者MRI。肿瘤发展迅速,初期为一个小的皮质病灶,68天后肿瘤体积明显增大,伴瘤体周围水肿和中央坏死。Glioblastoma(WHO-IV)A.具有高度间变的胶质母细胞瘤;B.腺样GBM形成腺样结构;C.GBM中少突胶质细胞成分。A.多个蜿蜒的假栅栏坏死;B.瘤细胞在坏死周围形成栅栏结构;C.TUNEL法示细胞凋亡。Glioblastoma(WHO-IV)PilocyticAstrocytoma(WHO-I)CommoninchildhoodMostslowgrowingofthegliomasSites:cerebellum,aroundIIIIVV.,opticnerveGrosslycysticwithmuralnoduleMicroscopicelongatedhair-like(pilo)cellsRosenthalfibersPilocyticAstrocytoma(WHO-I)毛细胞型星形细胞瘤年龄分布
A.毛细胞型星形细胞瘤生长侵及基底池;B.大的、多囊性小脑毛细胞型星形细胞瘤突入第四脑室,压迫脑干。C,D典型的双相成分,富有纤维,GFAP阳性区和少细胞区伴小囊形成,GFAP阴性A.术中印片示长的双极瘤细胞B.Rosenthal纤维PilocyticAstrocytoma(WHO-I)OligodendrogliomaCellsoforigin:OligodendrocytesCommonincerebralhemispheresCalcificationscommonGrades:
Lowgrade(WHO-II)
Anaplastic(WHO-III)Oligodendroglioma(WHOII)A.典型的致密分枝状血管网;B.瘤细胞胞浆透明,细胞膜明显TumorsofCNSGliomasMedulloblastomaMedulloblastoma(髓母细胞瘤)Origin:primitiveneuroectodermalcellsAge:1st-2nddecadeoflife.Mostcommonbraintumoratthisage.Medulloblastoma(髓母细胞瘤)Origin:primitiveneuroectodermalcellsAge:1st-2nddecadeoflife.Mostcommonbraintumoratthisage.Site:vermisofcerebellum,mayprojectintotheVventriculeCerebellumMedulloblastomaMedulloblastoma(髓母细胞瘤)Origin:primitiveneuroectodermalcellsAge:1st-2nddecadeoflife.Mostcommonbraintumoratthisage.Site:vermisofcerebellum,mayprojectintotheVventriculeSubarachnoiddisseminationMaycausehydrocephalusA.肿瘤转移至硬脑膜内表面;B.肿瘤转移至马尾。Medulloblastoma-SubarachnoiddisseminationA.典型的未分化肿瘤细胞片状排列;B.Homer-Wright菊形团;C.肿瘤细胞平行排列;D.产生假腺样结构的栅栏状肿瘤细胞。Medulloblastoma-HistologyMedulloblastoma-HistologyHomerWrightRosettesTumorsofCNSGliomasMedulloblastomaMeningiomasMeningiomaMeningiomasarepredominantlybenigntumorsofadultsUsuallyattachedtothedura,thatarisefromthemeningothelialcellofthearachnoidMorecommoninwomenMeningiomaGross:Meningiomasareusuallyroundedmasseswithawell-definedduralbasethatcompressunderlyingbrainbutareeasilyseparatedfromit.
Meningioma-gross矢状窦旁脑膜瘤压迫周围顶叶脑组织蝶骨中翼脑膜瘤包绕颈动脉前颅凹冠状切面显示位于嗅沟的脑膜瘤蝶骨翼的脑膜瘤斜坡脑膜瘤压迫脑干脊髓脑膜瘤压迫脊髓Meningioma-histology上皮型脑膜瘤伴核内包涵体纤维型脑膜瘤平行束状排列过渡型脑膜瘤同心圆洋葱球样结构砂粒体型脑膜瘤有大量钙化的砂粒体脊索瘤样脑膜瘤,丰富粘液背景里可见嗜伊红肿瘤细胞血管型脑膜瘤,大量血管之间为脑膜瘤细胞。V.TumorsofNerousSystem
TumorsofCNSPeripheralNerveTumorsPeripheralNerveTumorsNerveSheathTumorsNeurilemmoma(神经鞘瘤)Neurofibroma(神经纤维瘤)Perineurioma(神经束膜瘤)
MalignantPeriphe
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 造价工程师基础知识课件
- 糖尿病的健康指导资料
- 2026届湖北利川文斗重点中学中考三模语文试题含解析
- 非常规油藏提高采收率技术研究与应用
- 神经内科质子泵抑制剂
- 健康奇妙的心跳
- 通信工程一级建造师课件
- 女装店创业培训计划书
- 静脉血栓术前护理
- 个人卫生健康安全
- 《会展经济与管理论文报告12000字(论文)》
- GB/T 25155-2010平板硫化机
- 环境作用下结构受力性能的退化2
- 山东中烟雪茄烟产品推广
- 中国传统美食文化介绍课件
- 200题最新2022-2023医护急救知识培训考试题及答案
- 超声诊断质量控制规范及考评标准
- 不宜流通人民币纸币行业标准课件
- 公路工程工程质量管理制度
- 大型公立医院巡查应知应会
- 我国及发达国家圆珠笔发展现状Microsoft Word 97 - 2003 Document
评论
0/150
提交评论