煤工尘肺病理学图谱(3)

图 谱 导 读 **部分 肺脏的基本结构与形态学特点 1 肺脏的解剖学/ 2 2 肺脏的组织形态学 /3 2.1 肺实质：导气部和呼吸部 /3 2.2 肺间质：肺的血管、淋巴管和神经组织/ 6 第二部分 煤工尘肺形态学特点 1 煤工尘肺大体形态学特点 /8 1.1 煤斑灶：包括胸膜煤斑灶和肺内煤斑灶/ 8 1.2 结节病变/9 1.3 块状纤维化 9 1.4 弥漫性间质纤维化/ 9 1.5 肺气肿病变/ 9 1.6 淋巴结的病变(多见肺门淋巴结的累及)/ 10 1.7 胸膜病变 /10 1.8 煤工尘肺伴发肺结核病/ 10 1.9 煤工尘肺伴发肺癌 /10 1.10 煤工尘肺伴发肺源性心脏病/ 10 2 煤工尘肺组织形态学特点/10 2.1 煤矽肺 /10 2.2 矽煤肺(矽肺) /12 2.3 煤肺 /13 2.4 伴发性病变/ 13 2.5 其他病变 /14 参考文献 /16 Atlas Guide Part I Anatomy and Histology of Lung 1 Anatomy of the lung/ 20 2 Histology of the lung/21 2.1 Parenchyma: It includes conduction portion and respiratory portion / 21 2.2 Mesenchyma: It contains blood vessels, lymphatic vessels and nerves / 25 Part II Pathology of Coal Workers' Pneumoconiosis 1 Gross appearance of coal workers' pneumoconiosis/ 27 1.1 Coal dust maculae/27 1.2 Coal dust nodules /28 1.3 Massive fi brosis /28 1.4 Diffuse interstitial fi brosis / 29 1.5 Emphysema /29 1.6 Lesions in the lymph nodes (usually in hilar lymph nodes)/ 29 1.7 Lesions in pleura /29 1.8 Coal works' pneumoconiosis with tuberculosis / 29 1.9 Coal works' pneumoconiosis with lung cancer /30 1.10 Coal works' pneumoconiosis with cor pulmonale /30 2 Histological changes of coal workers' pneumoconiosis/ 30 2.1 Anthracosilicosis/ 30 2.2 Silicosis/32 2.3 Anthracosis/33 2.4 Complicated lesions / 34 2.5 Others /35 References /37 图谱部分Atlas **部分 煤工尘肺大体形态学特点Part I Gross Appearance of CoalWorkers' Pneumoconiosis 图1 胸膜煤斑灶/43 Fig.1 Pleural coal dust maculae / 43 图2 至图4 肺内煤斑灶/43 Fig.2 to Fig.4 Pulmonary coal dust maculae / 43 图5 肺内煤斑灶伴大泡型肺气肿形成/ 45 Fig.5 Pulmonary coal dust maculae accompanied by bullous emphysema /45 图6 肺内煤斑灶伴囊泡型肺气肿形成/ 45 Fig.6 Pulmonary coal dust maculae with cystic emphysema / 45 图7 和图8 肺内煤斑灶(全肺大切片标本) / 46 Fig.7 and Fig.8 Pulmonary coal dust maculae(the large slice) / 46 图9 和图10 肺内煤斑灶(肺叶大切片标本) / 47 Fig.9 and Fig.10 Pulmonary coal dust maculae(the large slice)/ 47 图11 和图12 肺内煤斑灶、煤尘纤维灶(煤结节)形成/ 48 Fig.11 and Fig.12 Pulmonary coal dust maculae and fi brotic lesions( coal dust nodule) / 48 图13 和图14 肺内煤斑灶、煤矽结节/ 49 Fig.13 and Fig.14 Pulmonary coal dust maculae and coal silicotic nodules /49 图15 和图16 肺内煤斑灶、煤矽结节/ 50 Fig.15 and Fig.16 Pulmonary coal dust maculae and coal silicotic nodules/ 50 图17 和图18 肺内煤斑灶51 Fig.17 and Fig.18 Pulmonary coal dust maculae 51 图19 和图20 进行性块状纤维化/ 52 Fig.19 and Fig.20 Progressive massive fi brosis/ 52 图21 和图22 进行性块状纤维化(肺大切片标本) / 53 Fig.21 and Fig.22 Progressive massive fi brosis(the large slice) / 53 图23 和图24 结节融合型块状纤维化/ 54 Fig.23 and Fig.24 Nodular confl uent massive fi brosis / 54 图25 和图26 结节融合型块状纤维化(同图23 肺大切片标本) / 55 Fig.25 and Fig.26 Nodular confl uent massive fi brosis( this large slice shares the samplewith Fig.23)/55 图27 和图28 混合型块状纤维化/ 56 Fig.27 and Fig.28 Mixed massive fi brosis / 56 图29 至图38 煤工尘肺伴结核病/ 57 Fig.29 to Fig.38 Coal works' pneumoconiosis with tuberculosis / 57 图39 煤工尘肺伴肺癌(周围型) / 62 Fig.39 Coal works' pneumoconiosis with lung cancer( Peripheral type) / 62 图40 煤工尘肺伴肺癌(弥漫型) / 62 Fig.40 Coal works' pneumoconiosis with lung cancer( Diffuse type)/ 62 图41 和图42 煤工尘肺伴胸膜粘连与增厚/ 63 Fig.41 and Fig.42 Coal works' pneumoconiosis with pleural adhesion and thickening/ 63 图43 和图44 煤工尘肺合并肺源性心脏病/ 64 Fig.43 and Fig.44 Coal works' pneumoconiosis with cor pulmonale / 64 第二部分 煤工尘肺组织形态学特点 Part II Histological Appearance of Coal Workers' Pneumoconiosis 图45 至图48 胸膜煤斑/66 Fig.45 to Fig.48 Coal dust dots of pleura/ 66 图49 至图52 肺内煤斑/68 Fig.49 to Fig.52 Coal dust dots of lung /68 图53 和图54 煤尘细胞灶70 Fig.53 and Fig.54 Cellular coal dust foci / 70 图55 至图58 煤尘纤维灶/71 Fig.55 to Fig.58 Fibrous coal dust foci / 71 图59 至图74 大小不等、形状各异的煤尘灶/ 73 Fig.59 to Fig.74 Coal dust lesions varying in size and shape / 73 图75 至图78 巨噬细胞性肺泡炎/ 77 Fig.75 to Fig.78 Macrophage alveolitis / 77 图79 至图82 煤尘细胞性结节/ 79 Fig.79 to Fig.82 Cellular coal dust nodules / 79 图83 至图86 细胞纤维性结节/ 81 Fig.83 to Fig.86 Cellular fi brous nodules /81 图87 至图94 煤矽结节/83 Fig.87 to Fig.94 Coal silicotic nodules / 83 图95 不典型煤矽结节/88 Fig.95 Atypical coal silicotic nodule / 88 图96 至图103 融合型煤矽结节/ 89 Fig.96 to Fig.103 Confl uent coal silicotic nodules/ 89 图104 矽结节/93 Fig.104 Silicotic nodule /93 图105 融合型矽结节/93 Fig.105 Confl uent silicotic nodules / 93 图106 至图109 矽结节/94 Fig.106 to Fig.109 Silicotic nodule/ 94 图110 至图113 进行性块状纤维化/ 96 Fig.110 to Fig.113 Progressive massive fi brosis / 96 图114 和图115 融合型块状纤维化 / 98 Fig.114 and Fig.115 Confl uent massive fi brous lesion / 98 图116 和图117 弥漫性尘性间质纤维化 / 99 Fig.116 and Fig.117 Diffuse coal interstitial fi brosis/ 99 图118 和图119 间质纤维化伴平滑肌细胞局灶性增生 / 100 Fig.118 and Fig.119 Interstitial fi brosis with local proliferated smooth muscle cells / 100 图120 和图121 煤工尘肺伴结核病变/101 Fig.120 and Fig.121 Coal workers' pneumoconiosis with tuberculosis / 101 图122 肺内早期煤矽结核结节/ 102 Fig.122 Early stage of coal silicotic tuberculous nodule / 102 图123 肺内典型的煤矽结核结节/ 102 Fig.123 Classic coal silicotic tuberculous nodule / 102 图124 肺内煤矽结核结节/103 Fig.124 Coal silicotic tuberculous nodules/ 103 图125 至图127 肺内融合型煤矽结核结节/103 Fig.125 to Fig.127 Confl uent coal silicotic tuberculous nodules / 103 图128 和图129 煤工尘肺矽结核结节/105 Fig.128 and Fig.129 Silicotic tuberculous nodules of coal works' pneumoconiosis / 105 图130 结节融合型块状纤维化/ 106 Fig.130 Nodular confl uent massive fibrosis / 106 图131 至图134 煤工尘肺伴播散性粟粒性肺结核/ 106 Fig.131 to Fig.134 Disseminated miliary tuberculosis of coal workers' pneumoconiosis / 106 图135 尘性结核性结节/108 Fig.135 Coal dust tuberculous nodules / 108 图136 和图137 尘性结核性肉芽肿(结节)/ 109 Fig.136 and Fig.137 Coal dust tuberculous granuloma( nodule) / 109 图138 和图139 尘性结核性支气管炎/ 110 Fig.138 and Fig.139 Coal dust tuberculous bronchiolitis / 110 图140 煤工尘肺伴结核性胸膜炎/ 111 Fig.140 Tuberculous pleuritis of coal workers' pneumoconiosis / 111 图141 煤工尘肺结核性空洞/ 111 Fig. 141 Tuberculous cavity of coal workers' pneumoconiosis . 111 图142 和图143 煤工尘肺伴发肺腺癌/ 112 Fig.142 and Fig.143 Coal workers' pneumoconiosis with pulmonary adenocarcinoma / 112 图144 和图145 煤工尘肺伴淋巴结转移腺癌/ 113 Fig.144 and Fig.145 Coal workers' pneumoconiosis with lymph node adenocarcinoma metastasis / 113 图146 和图147 煤工尘肺伴发肺腺癌/ 114 Fig.146 and Fig.147 Coal workers' pneumoconiosis with pulmonary adenocarcinoma / 114 图148 至图151 煤工尘肺伴发腺鳞癌/ 115 Fig.148 to Fig151 Coal workers' pneumoconiosis with pulmonary adenosquamous carcinoma / 115 图152 和图153 煤工尘肺伴发恶性间皮瘤/117 Fig.152 and Fig.153 Coal workers' pneumoconiosis with malignant mesothelioma/ 117 图154 煤工尘肺伴发恶性间皮瘤淋巴结转移/ 118 Fig.154 Coal workers' pneumoconiosis with lymph node malignant mesothelioma metastasis 118 图155 血管内瘤栓形成118 Fig.155 Carcinoma cells emboli in small blood vessels / 118 图156 至图159 淋巴结煤尘沉积. 119 Fig.156 to Fig.159 Lymph nodes with coal dust deposition . 119 图160 至图163 淋巴结内煤矽结节. 121 Fig.160 to Fig.163 Coal silicotic nodules in lymph nodes / 121 图164 淋巴结病变/123 Fig.164 Silicotic lesions in lymph nodes/ 123 图165 至图167 淋巴结内矽结节/ 123 Fig.165 to Fig.167 Silicotic nodules in lymph node / 123 图168 至图171 淋巴结内融合型矽结节/ 125 Fig.168 to Fig.171 Confl uent silicotic nodules in lymph node / 125 图172 和图173 淋巴结内煤矽结核结节/ 127 Fig.172 and Fig.173 Coal silicotic tuberculous nodules in lymph nodes / 127 图174 和图175 淋巴结内矽结核结节. 128 Fig.174 and Fig.175 Silicotic tuberculous nodules in lymph nodes / 128 图176 至图180 煤尘侵及支气管/129 Fig.176 to Fig.180 Coal dust deposition in bronchi /129 图181 至图183 尘性慢性细支气管炎/ 131 Fig.181 to Fig.183 Coal chronic bronchiolitis /131 图184 至图189 胸膜病变/133 Fig. 814 to Fig.189 Pleural lesions / 133 图190 煤尘沉积在肺内小支气管/ 136 Fig.190 Coal dust deposition in small bronchia / 136 图191 煤尘沉积在肺内细支气管及终末细支气管/ 136 Fig.191 Coal dust deposition in small bronchia and terminal bronchia / 136 图192 和图193 煤尘沉积在呼吸性细支气管及其分支/ 137 Fig.192 and Fig.193 Coal dust deposition in respiratory bronchia and its branaches /137 图194 尘性小叶中心型肺气肿/138 Fig.194 Coal dust-induced centriacinar emphysema /138 图195 全小叶破坏型肺气肿/ 138 Fig.195 Destructive panacinar emphysema / 138 图196 和图197 累及肺动脉/ 139 Fig.196 and Fig.197 Lesions in pulmonary artery / 139 图198 肺内小动脉病变/140 Fig.198 Lesions in pulmonary small arteries / 140 图199 肺内小血管病变/140 Fig.199 Lesions in pulmonary small vessels / 140 图200 和图201 小动脉病变/141 Fig.200 and Fig.201 Lesions in small arteries / 141 图202 煤尘累及淋巴结及其脂肪组织/ 142 Fig.202 Coal dust deposits involve lymph nodes and adipose tissue / 142 图203 煤尘累及支气管及其周围脂肪组织/ 142 Fig.203 Involvement of bronchi and adjacent fat tissue by coal dusts / 142 图204 和图205 淋巴管病变/ 143 Fig.204 and Fig.205 Lesions in the lymphatic vessels / 143 图206 和图207 胸膜下神经纤维受累/144 Fig.206 and Fig.207 Coal dusts involve subpleural nerve fi bers / 144 图208 煤工尘肺伴浆液出血性炎/ 145 Fig.208 Coal workers' pneumoconiosis with serous hemorrhagic infl ammation / 145 图209 煤工尘肺伴肺水肿/145 Fig.209 Coal workers' pneumoconiosis with pulmonary edema / 145 图210 和图211 煤工尘肺伴肺淤血、肺水肿 /146 Fig.210 and Fig.211 Coal workers' pneumoconiosis with pulmonary congestion and edema/ 146 图212 煤工尘肺伴化脓性炎/ 147 Fig.212 Coal workers pneumoconiosis with purulent infl ammation / 147 图213 煤工尘肺伴脓肿/147 Fig.213 Coal workers' pneumoconiosis with abscess / 147 图214 煤工尘肺伴浆液、纤维素性炎/ 148 Fig.214 Coal workers' pneumoconiosis with serous fi brinous infl ammation / 148 图215 煤工尘肺伴浆液、化脓性炎/ 148 Fig.215 Coal workers' pneumoconiosis with serous purulent infl ammation / 148 图216 和图217 煤工尘肺“棒状小体”形成 /149 Fig.216 and Fig.217 “Rod-shaped” bodies of coal workers' pneumoconiosis / 149 图218 至图223 肌成纤维细胞分化/ 150 Fig.218 to Fig.223 Myofi broblasts differentiation / 150 图224 正常心肌组织(右心室)/ 154 Fig.224 Normal heart tissue( from right ventricle)/ 154 图225 肺源性心脏病心肌组织(右心室)/ 154 Fig.225 Right ventricle with cor pulmonale / 154 第三部分 煤工尘肺案例 Part III Cases of Coal Workers' Pneumoconiosis 案例一 煤矽肺Ⅰ期(结节+ 尘斑- 气肿) /156 Case 1 Anthracosilicosis(stage Ⅰ，Nodules and maculae surrounded by emphysema) / 157 案例二 煤肺Ⅰ期(煤尘斑灶+ 细胞性结节) / 161 Case 2 Anthracosis(stage Ⅰ，Coal dust maculae and cellular nodules) /162 案例三 煤矽肺Ⅱ期(尘斑- 气肿型) 166 Case 3 Anthracosilicosis( stage Ⅱ，Coal dust maculae and emphysema) / 167 案例四 煤矽肺Ⅲ期(大块纤维化) / 170 Case 4 Anthracosilicosis(stage Ⅲ，Massive fi brosis) / 171 案例五 煤矽肺Ⅲ期合并肺结核病/ 176 Case 5 Anthracosilicosis( stage Ⅲ) with pulmonary tuberculosis /177 案例六 煤矽肺Ⅲ期合并肺癌 /182 Case 6 Anthracosilicosis( stage Ⅲ) with lung cancer / 183 案例七 煤肺Ⅰ期(煤斑- 气肿)合并肺源性心脏 / 189 Case 7 Anthracosis( stage Ⅰ，Coal dust maculae and emphysema) with cor pulmonale /191 后记 /198 Acknowledgement/ 199