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?

 回复104楼：

如果有活检标本，可以观察子宫内膜癌或宫颈腺癌各自的癌前病变，看过度形态，有利于鉴别，

IHC有帮助：宫内膜癌：CEA±(50%)，VIM＋，CAM5.2＋，宫颈腺癌CEA＋（100%），VIM－，CAM5.2－.

期待最后结果。。。

不简单的病例，锻炼思维，磨练意志！

 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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 IHC:Ki67很高的（  >80%），结合HE乳头状形态，我选Adenocarcinoma.

赵老师：此例分段诊刮了吗？期待欣赏哦！

 谢谢赵老师，在细胞网里这个贴子没有坚持下去；因为我也没有时间经常上网；但是只要有赵老师的回帖我都得认真学习，今天把整个看完之后；感觉我只是一个连井底的青蛙都不是。刚开始看宫颈细胞学以为很简单；越看感觉越看不懂，也越来越小心；最后以至于不敢报，对自己产生怀疑；一直想找一位名师指点，终于见到赵老师的执着和渊博，真诚的说一声谢谢；也祝福我们这里的所有同仁们在我们传统节日来之前开开心心，健康过大年。

     这个病例在如果只有前面细胞图片，我会选择报AGC，如果要我签发。如果不签发我当时在细胞网“忽悠”的是AIS；最后结合细胞块和Ki-67结果，我只能选择Adenocarcinoma了，谢谢！

  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.

 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.

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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 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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