???

Too easy? too hard? need more pictures or information?

What's your frozen section diagnosis or differential diagnoses?

 谢谢！细胞图是印片吗？

恶性。但不知类型，需学习后再来回答。

 谢谢Dr.stevenshen！请多指导！

印片细胞特点：肿瘤素质+散在异型细胞，多边形或不规则，浆中等或少，红染略显颗粒状，似有点灰褐色，核浆比增大，核圆形，略偏位，染色质细腻或泡状，核仁大而明显，多偏位，有核仁周晕，易见双核。

组织学特点：弥漫片状分布，细胞特点同上，胞界不清，夹杂少量梭形细胞（纤维细胞？还是血管？），瘤巨细胞，核内包涵体，凋亡细胞。

考虑：恶黑？鳞癌？淋巴瘤？

请进一步完善临床病史：阴囊有无病变？有无其它方面的病变？血常规怎样？

需先标记：CK/  HMB-45/   Malen-A/  s-100  / LCA 等。

因睾丸病变看的少，生殖细胞的肿瘤没有考虑，胚胎性癌发病年龄小，不考虑。

I have to admit this is a difficult diagnosis on frozen. The observation by byg is very insightful and accurate "切片像恶性，可涂片看起来又不像恶性".

• This case demonstrates the utility of touch prep imprint cytology - excellent cytologic details (round regular nuclei, small nucleoli, abundant eosinophilic cytoplasm etc.), features suggesting a more benign neoplasm.
• Frozen diagnosis: testicular neoplasm, favor leydig cell tumor (with consultation with colleagues)
• Final diagnosis: Leydig cell tumor (LCT) with focal marked cytologic atypia, with comment to have close follow-up. Selective immunostains support the diagnosis.
• Comment: LCT with marked cytologic atypia may have low malignant potential.  However, no reliable cytologic features can predict malignancy. Features that may suggest a malignant LCT include marked cytologic atypia, frequent or atypical mitoses, lymphovascular invasion and local invasive behavior.  The only reliable criteria for a malignant LCT diagnosis will be presence of distant metastasis.    

 谢谢Dr.stevenshen！

老师讲解非常详细，我又明白了一个病的诊断。

 嗜酸的胞浆，挖空的核

好典型的改变

期待指导