那些小空泡，提示衣原体感染

个人认为，形态学不能确诊衣原体感染，正如不能确诊结核、HPV等病原，这是其他专科检测的范围。本例显示子宫内膜急慢性炎症伴腺上皮内空泡形成，提示衣原体感染可能，建议进一步作病原学检测。

The Cervic-Inflammatins-Specific Infections-Chlamydia Trachomatis Infection

C. trachomatis infection does not elicit specific epithelial changes, but is closely associated with severe acute and chronic inflammatory infiltrates, repair, and follicular cervicitis. The latter is not a very sensitive marker for chlamydia infection, but has been shown to be more commonly associated with positive cultures than not. Thus, if follicular cervicitis is identified in a biopsy, a comment should be made in the report that this finding may be associated with chlamydia, but is not diagnostic. Chlamydia is typically identified in small inclusion vacuoles in the endocervical or reparative epithelial cells. It is uncommonly identified in more mature squamous cells. Whether these inclusion vacuoles can be identified and distinguished from noninfectious vacuoles, by histology or cytology, is controversial. Raising the suspicion of chlamydia based on these changes alone is not recommended.
在宫颈，典型表现为宫颈上皮细胞内或修复细胞内的小包含空泡。组织学或细胞学上，这些包含空泡能否与非感染性空泡区分？存在争议。

1.  Adv Anat Pathol. 2001 Nov;8(6):327-9.
Chlamydia trachomatis in the endometrium: can surgical pathologists identify plasma cells?
Mount S, Mead P, Cooper K.
Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease. The authors examined the relation between chronic endometritis, which they term plasma cell endometritis (PCE), and chlamydial infection using plasmid-based polymerase chain reaction (PCR) and immunohistochemical staining (IHC) of paraffin-embedded endometrial sections. C. trachomatis infection was detected in 5 (24%) of 21 cases of PCE and in 1 (4%) of histologically normal endometrium. The diagnosis of chronic endometritis (with plasma cells confirmed by methyl green pyronin staining) was correctly made in 74% of the cases originally diagnosed as PCE and in 23% of control cases originally diagnosed as normal. The authors conclude that the histopathologic finding of plasma cells in endometrial samples should encourage further examination for chlamydial infection.
PMID: 11707623 [PubMed - indexed for MEDLINE]

子宫内膜标本中，组织学检查发现浆细胞，应当进一步检测是否存在衣原体感染。

2.  Contracept Fertil Sex. 1998 Jul-Aug;26(7-8):593-7.
[Chlamydia trachomatis endometritis][Article in French]
Judlin P.
Clinique Universitaire de Gynécologie-Obstétrique de la Maternité Régionale de Nancy.
Endometritis are upper genital tract infections. They are part of the Pelvic Inflammatory Diseases and are often difficult to differentiate from salpingitis. C. trachomatis, a sexually transmitted micro-organism, is a major pathogen of the genital tract. Most of the time, the upper genital tract infections are polymicrobial and C. trachomatis can be combined with other aerobes (E. coli, streptococci...) and anaerobes. Diagnosis of chlamydial endometritis is difficult since the clinical symptoms--lower abdominal pain, cervical discharge--often lack specificity or can be completely absent. Bacteriological studies from intra-uterine or intra-cervical samples are necessary. A laparoscopy can be useful to ascertain the integrity of Fallopian tubes. The treatment requires broad spectrum antibiotics effective against C. trachomatis and other probable pathogens, for 2 to 3 weeks.
PMID: 9810139 [PubMed - indexed for MEDLINE]

绝大多数上段生殖道感染由多种微生物引起，沙眼衣原体可以合并其它需氧菌（如大肠杆菌、链球菌……）和厌氧菌。治疗使用用对沙眼衣原体和其它可能的病原菌敏感的广谱抗生素2-3周。

如果做免疫学检查会更好.

仅从HE怎样和其他微生物包涵体鉴别呢?请楼主可否详细讲解一下?