腺癌。

报告就是AGC，腺癌不除外。

学习

 腺上皮的问题AGC？

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

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

 感谢赵老师的谆谆教导，要是报告，我也觉得AGC，高度可疑够了，但是讨论的时候这是我的倾向

向您学习，感谢您的精彩病例和分享您的处理报告方式，谢谢！

 更多图片请看妇科板块的病例

http://www.ipathology.cn/forum/forum_display.asp?keyno=104593

 再看看细胞学，既有三维结构也有平铺细胞团，有单个有成团，有腺样、有乳头，细胞形态有扁平、立方、有钉突、有透明，如此丰富的形态！对照组织学，是不是很吻合？
还有一点此例细胞片首先在低倍镜下看到出血和癌性素质，考虑的时候就可以往恶性的靠一靠了

目前病人没有任何症状
大家有什么体会继续讨论:handshake