Pap smears are too difficult, especially for photos in computer. Give you an easy one for fun.

A women aged over 50

How will you sign out the case?

Abin's summary is very good.

I showed you two cases of glandular lesions on Pap test in this topic. I want to close this topic today. Hope you can get some sense about AGC diagnosis. I have a online talk about AGC here. You can review it if you are interested in AGC. I think it is a very well prepared summary of AGC.

http://www.ipathology.cn/news_display.asp?id=2648

Thank all of you who read the cases and joined in the discussion.

I am waiting in my office for a middle night surgery for frozen. I finished this case before the frozen.

Happy Chinese New Year. But I have to work in the New Year day and week.

 Patient had hysterectomy. The tumor was located in endocervix, and endometrim was no tumor. So final dx is well-differentiated villoglandular adenocarcinoma.

See Photos of hysterectomy.

First three Fgs: 100x

Last one: 20x

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 Thank Abin's good analysis.

For the second case, it is a villoglandular carcinoma, a variant of well differentiated endometrioid carcinoma based on the H&E biopsy. Villoglandular carcinoma can occur in both endometrium or endocervix. The same as other adencarcinomas it is often difficult to tell the diffience by morphology. IHC can be helpful sometimes, but many times it can not help you.

I general use 4 markers, CEA, Vimentin, p16, ER.

Most endocervical adenocarcinomas: positive for cea, p16, negative for er and vimentin

Most endometrial carcinomas: positive for vimentin, ER, negative for CEA, p16.

Most endocervical carcinomas are relative to HPV infection, so p16 often diffuse and strong  positive.

Ki67 and p16 stains are very useful if you are not sure for some possible high grade squamous lesions. In the same way, the two makers are very useful for confirming cervical AIS lesions. please remember p16 and ki67.

Going back to our case the IHC pattern favors an endocervical origin, even CEA is negative.

Diagnosis of cervical biopsy: Adenocarcinoma, favor endocervical origin. In the comment you can mention the IHC favors endocervical orgin. Please clinial correlation wtih imaging is suggested. Remember even though IHC 100% match with endometrial or endocervical orgins you still do not need to say it must be...... Anyway give yourself some space. Of cause for Pap diagnosis you should give you more space, especially for the origin issue. For the type of tumor in biopsy if you are confident you can call villoglandular carcinoma. Otherwise it is good enough if you call well-differentiated adenocarcinoma. However it is not a good call if you call papillary serous carcinoma. They are different if you compare my first case with the second case. This is why I put the two cases in the same topic.

3. No. should see the stain in epithelial cells.

2. Check HPV infection and P16 protein expression.

1. endocervical or endometrial.

 1. what type of adecarcinoma baded on cytomorphology?

2. what possible origin based on the IHC?

Seem that we are the only two persons who are interested in this case. Ha, ha.

 IHC result of above biopsy

f1 CEA

f2 ER

F3 P16

F4 Vimentin

We have to sign out the case and no more investigation.

How will you sign out the case of cervical biopsy?

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The women had cervical biopsy.

both 100x

Now we agree that it is an adenocarcinoma case. Let us discuss the origins of the tumor, endocervical or endometrial. As gynecologic pathologists we oftern meet this situation. Gynecologists hope to know the origin of the adenocarcinoma when we report adenocarcinoma in cervical biopsy report. They wish to know it is endocervical origin or endometrial carcinoma metastatic to endocervix or other tumors from location to endocervix. Often we cannot answer the question even thpugh we perform many IHC studies.

Anyway, what IHC would you ordered if it is your case? What is your guess (I said guess, not diagnosis. So every one can give a guess) of the origin based on the H&E?

Now we transfer the Pap cytology to gynecologic surgical pathology.

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 The Pap smear demonstrates clusters of hyperchromatic crowded groups of cells. Based on the Pap only we should call AGC at least. It is ok If you call AGC because women should get biopsy. It is not a good call if we call negative or reactive. The causes of AGC are lesions. They range from completely normal, to hyperplastic, to neoplastic conditions.  If you call reacitve it means that you definitely think it cannot be hyperplastic or neoplastic conditions. Agree with all of your interpretation. The Pap was singed out adenocarcinoma based on Pap, cell block, and IHC.

  To 兰青风采:

Glad to see you here.  I like to read your discussion. Every one is the same on line. No one has any responsbility for patient care here. It is a good place for discussion, especialy for people who really want to learn sth.

Welcome you here and wish you can join in the discussion activily if you have additional time.

 Fig:  cell block, Ki67 stain.

Happy to see some of you had suggestion about IHC for the origins. Now forget the origins, just think how you will sign the report based the Pap, cell block, and ki67.

AGC

AGC, favor neoplastic

Adenocarcinoma.

choose one from above three

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 Summary above interpretation

AGC

No big problem

HSIL involving glands

small cell squamous carcinoma

What is your oppinion?