| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- 与大家分享一个刚发的宫颈细胞病例
-
Pap smear is adenocarcinoma, invasive endocervical adenocarcinoma or
endometrial adeno. Not endocervical adenocarcinoma in situ.
AGC without any further specification or comment is a under diagnosis for this pap.
Biopsy shows adenocarcinoma, clear cell type? Patient needs endometrial biopsy too. If the adeno is from endocervix, not from endometrium, any DES exposure in uterus?
Nice case. Thanks.
图1
图2
Hi, Quanzi,
I am on Pap service this week, 50 Pap/day. I just released a case and like to share with you and others.
The patient (60-65Y) had routine test and no history. The pap smears show many clusters as above. I think it is like endometrial adenocarcinoma. I tell you how I handle the case today.
1. I showed the case to another pathologist, who concurred my diagnosis.
2. I called the gynecologist to know the pt had no more history or clinical symptom. I discussed the case with him and told him the patient may have endometrial carcinoma and need to have endometrial and endocervical sampling. He said he will call the patient and have the procedures done as soon as possible.
3. I released the case:
My report:
Diagnosis line:
Highly atypical glandular cell, suspicious for adenocarcinoma (it is not in the TBS, who care).
Comment in my report:
The Pap smear shows clusters of highly atypical glandular cells, suspicious for adenocarcinoma, endometrial origin. Endocervical and endometrial tissue sampling should be done to confirm the diagnosis. I discussed the case with Dr. xxxx at 11:00 Am, 11/4/2008 (important to document).
In this way I feel good about the case and am not worried about the final dx. Remember that Pap test is a screening test. We do not need to push ourselves too much to make the exact dx. We should leave some space for our dx.
I truly think your case may be an adenocarcinoma. If you feel comfortable you can report malignancy. I am not very against if some one call your case is adenocarcinoma. There is no difference in the clinical management of the patient if you call carcinoma (endocervical or endometrial) or if you call AGC, favor neoplastic or suspicious for malignancy. The bottom line is that the patient should get endocervical and endometrial tissue sampling. As pathologists we should always think what physicians should do if I make this diagnosis. You will fell bad if you call carcinoma and it turns out to be a benign or hyperplasia case. You always win if you call AGC .....
This is my philosophy about Pap tests. There are often some unexpected findings.
Thank for your case,
cz
-
xiaoyan0290 离线
- 帖子：1179
- 粉蓝豆：512
- 经验：2063
- 注册时间：2008-07-15
- 加关注 | 发消息
| 以下是引用cqzhao在2008-11-4 17:33:00的发言： So many clousters of atypical glandular cells. Consider adenocarcinoma. The atypical cells show papillary architectues. In addition to endometrial ca, metastatic carcinoma, such as ovarian seroud carcinoma, should be considered also. History and clincal information are important. |
-
So many clousters of atypical glandular cells. Consider adenocarcinoma. The atypical cells show papillary architectues. In addition to endometrial ca, metastatic carcinoma, such as ovarian seroud carcinoma, should be considered also. History and clincal information are important.
| 以下是引用cqzhao在2008-11-3 20:53:00的发言：
AGC. These cells may be endometrial origin. Endometrial and endocervical sampling suggested. Interested to know the follow-up result. Thnak Quanzi for the interesting case. See your name often in this website. |
感谢赵老师的回帖和对我的关注！
欢迎更多的老师发表意见，我会贴出最后跟踪结果
