Non-small carcinoma.

IHC: CK7, CK20, TTF1, CK5/6, P63

 谢谢赵老师！

我考虑低分化腺癌，将上传细胞块，请您多指导！

 上传细胞块切片，请各位老师指导，谢谢！（抱歉，切片质量有点差）

 The quality of the slides are not very good. What stain is this? Is it quick H&E? If that is the case, I strongly discourage this type of stain. I basically agree with Dr. Zhao, this is non-small cell carcinoma. If this tumor is surgeically removable, I usually do not bother to do immunostains to further classify. If it is not resectable, because there is treatment differences between squamous cell ca and adenocarcinoma, I will do immunostains to help me further classify. This case I favor an adenocarcinoma on the cell block. One more comment, I have looked at some pictures people posted on this websites, the quality of the slides is not good, that is one of the main reasons to hinder the diagnosis.

 恶性肿瘤，考虑为鳞癌，因为胞浆红，核大深染，异型明显。期待组织学对照。

 腺癌

 谢谢陈博士的指导！

赞成！合格的细胞、组织切片是病理诊断的基础，大家都喜欢看清晰漂亮的图片，可是在国内的一些医院，病理科收入低，医院投入少，设备简单，切片质量受影响。

另外请教陈博士：细胞块用什么染色好？HE，巴氏 or  瑞士染色？

 此例细胞块是HE染色。细胞涂片是巴氏染色。

 In our hospital, we use H&E stain for cell block too. The Pap (巴氏染色) stain you showed in your pictures does not look like Pap stain. The hallmark of Pap stain is crisp and detailed nuclear morphology, which are missing in your stains. Maybe, you should work on the stains a little bit to improve.

 谢谢陈博士！

此例穿刺液含血较多，涂片稍厚，染色后就出现这样的效果，我也觉得有点不理想，薄处染色较好，但细胞有些退化，所以采集较厚处。(注:技术员制的片子）

另外请教陈博士：怎样处理穿刺液中的血液，制成合格的片子？

 上传痰液涂片，巴氏染色。

 13楼图片第4张为了与前面对照，此为同片，肿瘤细胞染色不像巴氏，不知原因，请专家赐教！谢谢！

 考虑腺癌

 13楼: If you did Pap stain on the FNA slides, even if you get a lot of blood, the stain still should be quite sharp. I suspect that people let the slides air-dryed, in another word, the slides did not get fixed by alcohol quickly. If the sample truly is very bloody, we also using liquid based cytology and process the specimen as a ThinPrep Pap slide, with the ThinPrep filter, we can get rid a lot of blood and junks. It is expensive though. Hope the above information help.

 考虑腺癌

 谢谢陈博士的指导！你的讨论非常有用！

此例可能是固定不及时，因为薄处有细胞退化。

如果穿刺含血较多可以用液基，不过我觉得用液基，有时细胞的排列方式会被分散，价格较贵，病人也多不接受。也用液基做过，好像细胞较少。不过，以后可以多做一些，找到最合适的方法。

 上传免疫组化结果：

CK7(+),  CK20(--),  CK5/6(--),   TTF1(--),   P63(--),  Ki67散在（+）。

 最后诊断：低分化腺癌。

 腺癌