炎症Inflammation · 阴道 · 雌性生殖系统 · NTP ntp-0564

依据美国国家毒理学计划(NTP)Nonneoplastic Lesion Atlas 整理 · 中文译文与诊断建议 · 仅供科研使用,不用于临床诊断

一句话结论:在NTP研究中,炎症有五个标准类别:急性(急性(acute))、化脓性(化脓性(suppurative))、慢性(慢性(chronic))、慢性活动性(慢性 active)和肉芽肿性(肉芽肿性(granulomatous))。
诊断要点:阴道——只要炎症被认为是处理效应,就应进行诊断并分级。作为发情周期正常成分存在的炎症细胞不应诊断。

病变描述

在NTP研究中,炎症有五个标准类别:急性(急性(acute))、化脓性(化脓性(suppurative))、慢性(慢性(chronic))、慢性活动性(慢性 active)和肉芽肿性(肉芽肿性(granulomatous))。在急性炎症(Figure 1、Figure 2)中,主要的浸润细胞是中性粒细胞(neutrophil),但也可能存在较少的巨噬细胞和淋巴细胞。还可能有水肿或充血的表现。中性粒细胞也是化脓性炎症(Figure 3、Figure 4)中的主要浸润细胞类型,但它们聚集在一起,且其中许多已发生退变(化脓性渗出物)。渗出物中还可能存在来自常驻细胞群和浸润白细胞的细胞碎片,以及含纤维蛋白的蛋白性液体、较少的巨噬细胞、偶见的淋巴细胞或浆细胞,并可能存在感染因子。肉眼观察,这些病变以脓液存在为特征。在渗出物周围的组织中,可能存在成纤维细胞、纤维结缔组织和混合性炎症细胞,具体取决于病变的慢性程度。脓肿在组织学上应诊断为化脓性炎症。慢性炎症中以淋巴细胞为主。慢性活动性炎症(Figure 5、Figure 6)中也以淋巴细胞为主,但同时还存在大量中性粒细胞。两种病变均可能含有巨噬细胞。肉芽肿性炎症是慢性炎症的另一种形式,但该诊断要求存在大量聚集的、大的、活化的巨噬细胞、上皮样巨噬细胞或多核巨细胞。炎症与细胞浸润的鉴别在于是否存在其他改变,如水肿、出血、变性、坏死或其他组织损伤的证据。明显的化脓性炎症(子宫积脓,pyometra)偶尔见于阴道,且常与邻近器官(宫颈和子宫)的炎症相关。轻度炎症常见,但必须与发情周期特定阶段炎症细胞的正常存在相鉴别。在发情周期中,跨上皮移行的中性粒细胞往往较多,而管腔内积聚的中性粒细胞即使有也仅为少数。

诊断与分级建议(NTP 共识)

阴道——只要炎症被认为是处理效应,就应进行诊断并分级。作为发情周期正常成分存在的炎症细胞不应诊断。继发于炎症的病变,如坏死,除非严重程度足以支持,否则不应单独诊断。如果炎症继发于其他病变,如坏死或肿瘤,除非严重程度足以支持,否则不应单独诊断。诊断时,应通过使用修饰词在诊断中指明炎症的类型。

图谱

炎症(阴道)组织学图谱 1
图 1 · 炎症 · 来源:NTP NNL Atlas
炎症(阴道)组织学图谱 2
图 2 · 炎症 · 来源:NTP NNL Atlas

英文原文

展开 NTP 官方英文描述与建议

Comment:
In NTP studies, there are five standard categories of inflammation: acute, suppurative, chronic, chronic active, and granulomatous. In acute inflammation ( Figure 1 and Figure 2 ), the predominant infiltrating cell is the neutrophil, though fewer macrophages and lymphocytes may also be present. There may also be evidence of edema or hyperemia. The neutrophil is also the predominant infiltrating cell type in suppurative inflammation ( Figure 3 and Figure 4 ), but they are aggregated, and many of them are degenerate (suppurative exudate). Cell debris, from both the resident cell populations and infiltrating leukocytes, and proteinaceous fluid containing fibrin, fewer macrophages, occasional lymphocytes or plasma cells, and, possibly, an infectious agent may also be present within the exudate. Grossly, these lesions would be characterized by the presence of pus. In the tissue surrounding the exudate, there may be fibroblasts, fibrous connective tissue, and mixed inflammatory cells, depending on the chronicity of the lesion. Abscesses should be diagnosed histologically as suppurative inflammation. Lymphocytes predominate in chronic inflammation . Lymphocytes also predominate in chronic active inflammation ( Figure 5 and Figure 6 ), but there are also a significant number of neutrophils. Both lesions may contain macrophages. Granulomatous inflammation is another form of chronic inflammation, but this diagnosis requires the presence of a significant number of aggregated, large, activated macrophages, epithelioid macrophages, or multinucleated giant cells. Inflammation is differentiated from cellular infiltrates by the presence of other changes, such as edema, hemorrhage, degeneration, necrosis, or other evidence of tissue damage. Frank suppurative inflammation (pyometra) is occasionally encountered in the vagina and is often associated with inflammation in the contiguous organs, cervix, and uterus. Mild inflammation is commonly observed, but this must be differentiated from the normal presence of inflammatory cells at certain stages in the estrous cycle. In the estrus cycle there tend to be more transepithelial migratory neutrophils, with only a few, if any, luminal accumulations of neutrophils.

Recommendation:
Vagina - Inflammation should be diagnosed and graded whenever it is considered a treatment effect. Inflammatory cells present as a normal component of the estrous cycle should not be diagnosed. Lesions that are secondary to the inflammation, such as necrosis, should not be diagnosed separately unless warranted by severity. If the inflammation is secondary to another lesion, such as necrosis or neoplasia, it should not be diagnosed separately unless warranted by severity. When diagnosed, the type of inflammation should be indicated in the diagnosis through the use of a modifier.

来源与引用

原始条目:https://ntp.niehs.nih.gov/atlas/nnl/reproductive-system-female/vagina/Inflammation

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. Inflammation (vagina). LabSmart 中文版: https://www.labsmart.cn/ntp/vagina-inflammation.html

中文图谱总页(可展开对照全部 595 条):https://www.labsmart.cn/ntp-atlas.html#vagina-inflammation

上皮增生囊肿坏死基质肥大扩张溃疡