坏死Necrosis · 口腔黏膜 · 消化系统 · NTP ntp-0221
诊断要点:如果坏死上皮仍然存在且至少部分附着于其下的固有层,或者坏死不仅累及上皮(即还累及或主要累及其下的结缔组织或骨),则诊断上皮坏死而非糜烂或溃疡。
病变描述
口腔黏膜坏死可能是与处理相关的影响,但更常见是由灌胃操作和/或异物(毛干、食物残渣)存在所致的创伤引起。受创伤区域可发生坏死和溃疡,导致化脓性或慢性活动性炎症及肉芽组织形成。如果坏死位于表面深部且不像是溃疡的一部分,或者没有上皮细胞丢失,则该病变被认为是坏死而非糜烂或溃疡。Actinomyces 属感染可导致深部感染和坏死。切牙周围也可能发生牙龈的炎症和坏死。
诊断与分级建议(NTP 共识)
如果坏死上皮仍然存在且至少部分附着于其下的固有层,或者坏死不仅累及上皮(即还累及或主要累及其下的结缔组织或骨),则诊断上皮坏死而非糜烂或溃疡。如果坏死符合继发于血栓形成的缺血(梗死),叙述中应如此说明,即使血栓不在切片平面内。严重程度分级将取决于病变的总体大小和受累区域的数量。虽然出血、水肿、纤维化或炎症可能与坏死相关,但只有当它们是坏死病变的显著组成部分时才单独记录,不过它们可以在叙述中描述。
图谱


英文原文
展开 NTP 官方英文描述与建议
Comment:
Mucosal necrosis in the oral cavity can be a treatment-related effect but is more commonly caused by trauma due to the gavage procedure and/or the presence of foreign bodies (hair shafts, food material). The traumatized area can undergo necrosis and ulceration, resulting in suppurative or chronic active inflammation and granulation tissue formation. If the necrosis is deep to the surface and does not appear to be part of an ulcer, or there is no loss of epithelial cells, then the lesion is considered necrosis rather than an erosion or an ulcer. Infection with Actinomyces species can result in deep infection and necrosis. Inflammation and necrosis of gingiva may also occur around the incisor teeth.
Recommendation:
Necrosis of epithelium is diagnosed instead of erosion or ulcer if the necrotic epithelium is still present and at least partially attached to the underlying lamina propria or if the necrosis involves more than just the epithelium (i.e., also or primarily involves the underlying connective tissue or bone). If the necrosis is consistent with ischemia secondary to thrombosis (infarction), the narrative should so state, even if the thrombus is not in the plane of the section. Severity grading would depend on the overall size of the lesion and number of areas affected. While hemorrhage, edema, fibrosis, or inflammation may be associated with necrosis, these are recorded separately only if they are a prominent component of a necrotic lesion, but they can be described in the narrative.
来源与引用
原始条目:https://ntp.niehs.nih.gov/atlas/nnl/alimentary-system/oral-mucosa/Necrosis
图谱总目录:NTP Nonneoplastic Lesion Atlas。 内容属美国联邦政府作品(公有领域),可引用;引用时请标注来源。
建议引用格式:NTP Nonneoplastic Lesion Atlas. Necrosis (oral-mucosa). LabSmart 中文版:
https://www.labsmart.cn/ntp/oral-mucosa-necrosis.html
中文图谱总页(可展开对照全部 595 条):https://www.labsmart.cn/ntp-atlas.html#oral-mucosa-necrosis