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?

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

2. Check HPV infection and P16 protein expression.

1. endocervical or endometrial.

不好意思，这几天忙着准备去面试；没有来回帖子。我个人有以下这种感觉，不对请赵老师指点：

1、第一次的细胞片、细胞块和Ki67和后来的组织活检的组织象有差异；第一次象高柱状的分泌腺体；但是活检象矮柱状的腺体。

2、因为我最免疫组化结果不熟悉，这方面的知识需要恶补；但是我的老师告诉我HE切片是基础，当你基础没有过关，靠免疫组化来诊断是靠不住的，不知道对不对；我就是基础都没有过关的人；所以遇到腺上皮的就傻了。

3、一个大胆的假设是该病人有没有可能两中不同部位的腺癌同时发生（或者说宫颈和内膜），或着是一个地方侵犯到另一个地方。

4、如果象我们这些基层医院的医生确实难以分型的时候，我们该如何报告，对临床的治疗会有多大的不同及对病人造成多大的影响？请老师们指点，谢谢！

 1、难道是转移来的？卵巢有没有问题？肠道来源的？

2、P16是抑制细胞有丝分裂的，既细胞核增殖指标，和P53标记的目的相似，对吗？还是有其它作用？

3、Vimentin在鉴别子宫内膜和宫颈浆液性癌时，是指标记乳头的纤维轴心吧？

我迷糊了，请赵老师赐教！谢谢！

 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.

 呵呵，赵老师：我想您可能会有不同观点的，对此例，虽然我写了分析，心里没底，也有疑问，Case2细胞片、细胞块、HE切片上，细胞排列整齐，乳头腔缘平滑，倾向宫颈来源（与Case1的形态学不相同）。可不知道如何分析免疫组化（组化结构支持子宫内膜浆液性癌？！）？好在这里可以大胆发表意见。一直在关注您的详细讲解呢！

从Case1到Case2，回顾对比看，总觉得，Case2细胞片、细胞块、HE切片上，细胞排列整齐，乳头腔缘平滑，倾向宫颈来源，而IHC支持子宫内膜来源。因此，确定浆液性乳头状腺癌来源，要先了解诊刮的部位，再结合IHC。

不知赵老师有何看法？请赐教,谢谢！

子宫内膜浆液性乳头状腺癌。

终于柳暗花明了，呵呵。

 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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描述：图1

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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.

 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！