，考虑的太多了，如果病人有钱，可以多做，否则，从前往后排查。
，谢谢！
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- Neck 副节瘤 (paraganglioma )FNA and its differential diagnosis (cqz 3)
| 以下是引用有福不在忙在2009-1-3 22:51:00的发言：
cqzhao老师做事很认真，上传病例很典型，一般都是不常见的，让我们开阔了眼界。诊断和鉴别诊断都很详细，学到不少知识。再次感谢cqzhao老师。 另外我有一个问题：是不是PAN CK-和TTF-1-才排除小细胞癌的？形态学上考虑不考虑小细胞癌？ |
| 以下是引用天山望月在2009-1-3 23:33:00的发言：
转移性肉瘤形态
高级别，梭形细胞 核染色深 奇形怪状（异型性明显） IHC：神经内分泌标志物为阴性， vimentin + |
Dr. Chen and I sent here some interesting and classical FNA cases here. It seems that people here are not very interested to these cases. I assume that most pathologists here do not do or sign out FNA cases in your clinical practice.
You have to attend the discussion if you want to learn sth from online. People are more likely to see one photo and give a guess diagnosis especially for Pap smears. I think it will not be very useful.
Anyway I conclude this case in the end of 2008. Happy New Year for every one.
cz
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本帖最后由 于 2008-12-30 11:31:00 编辑
Metastatic medullary thyroid carcinoma-Cytomorphology
n Numerous single cells or loose clusters
n Epitheloid/plasmacytoid/spindle
n Round nuclei
n Fine to coarse chromatin
n Inconspicuous nucleoli
n Nuclear pseudoinclusions
n Binucleation/multinucleation
n Amyloid
n IHC: Calcitonin, CEA,TTF-1, Thyroglobulin
名称：图1
描述：图1
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本帖最后由 于 2008-12-31 02:26:00 编辑
Metastatic papillary thyroid carcinoma
n Hypercellular, sheets, papillae, microfollicles
n Nuclear crowding, powdery chromatin
n Nuclei grooves, pseudoinclusions, nucleoli
n Cytoplasm-scant, squamoid, Hurthle-like or vacuolated
n Psammoma bodies, multinucleated giant cells,
n IHC: Thyroglobulin, TTF-1 +
名称：图1
描述：图1
名称：图2
描述：图2
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本帖最后由 于 2008-12-30 11:25:00 编辑
Metastatic Adenocarcinoma-Cytomorphology
n Hypercellular, clusters and isolated cells
n Gland formation
n Nuclear pleomorphism, overlapping nuclei
n Nuclear hyperchromasia
n Irregular nuclear membranes
n Vacuolated cytoplasm
n IHC: Keratin +
名称：图1
描述：图1
Paraganglioma-Cytomorphology
n Cellular/bloody
n Loosely cohesive, epitheloid and spindle cells
n Varies from uniform to pleomorphic
n Rosettes, Zellballen structures
n Reddish cytoplasmic granules on DQ
n Round/oval /spindle nuclei
n “Salt and pepper chromatin”
n Intranuclear cytoplasmic inclusions
n Cytology hardly recommended by surgeons because of risk of complications:
n Hemorrhage, damage to carotid body
n Distinction between benign and malignant CANNOT be made on cytology
n Require surgical excision with demonstration of metastases and NOT local invasion
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Some facts about paraganglioma:
n Mostly benign tumors, up to 12% malignant
n Composed of cells derived from the primitive neural crest
n Found in different locations;
n middle ear
n skull base
n pelvic floor
n Others
n Head and neck area, located near along the cranial nerves and the arterial vasculature
n Found commonly in association with the carotid body
n Rarely seen in :orbit, paranasal sinuses or thyroid
n Average age 50-60yrs
n M:F =(1:4)
n Presentation
n enlarging masses that are asymptomatic or associated with symptoms of mass effects
Some facts about paraganglioma:
n Mostly benign tumors, up to 12% malignant
n Composed of cells derived from the primitive neural crest
n Found in different locations;
n middle ear
n skull base
n pelvic floor
n Others
n Head and neck area, located near along the cranial nerves and the arterial vasculature
n Found commonly in association with the carotid body
n Rarely seen in :orbit, paranasal sinuses or thyroid
n Average age 50-60yrs
n M:F =(1:4)
n Presentation
n enlarging masses that are asymptomatic or associated with symptoms of mass effects
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本帖最后由 于 2008-12-19 23:15:00 编辑
This case is difficult and rare. Maybe I should put the case here.
IHC: Chromogranin+, synaptophysin+, GFAP-, EMA-, Pan CK-, calcitonin-
few spindle cells are positive for S-100. Sorry I do not have IHC photos to show you.
Also give you another photo from this case.
Now I hope every one know the dignosis
名称：图1
描述：图1
| 以下是引用天山望月在2008-12-14 13:45:00的发言：
中年，颈部肿块，要可虑原发或转移，不知在颈部何处（正中、侧部）？此例考虑标记： 1、神经内分泌源性:Syn , CgA, S-100 2、肺上皮源性：CK-Pan, CK7, CK8 /18, TTF1, CK20, CK5/6 3、甲状腺的：TTF1, TG, TM 4、涎腺多形性腺瘤：GFAP, PA 5、淋巴造血系统：LCA 6、还要考虑鼻咽部和胃肠道转移。 呵呵 不知当否，请专家点评 |
Above analysis is excellent. We have to think about differential dx first, then decide if IHC study is needed. What IHC will we order if needed. This is way for FNA cytology. We cannot give one dx after we see few photos. Althogh your guess may be right, it is not true interpretation.
