Exactly. I confused me also.

But if you know the clinical information, it will be so easy

第三例：

             年龄：24   月经周期：第六天         病史：无   

Remember to try to know all information including previous Pap tests before you sign out Pap.

 1,宫颈管内膜；

2，宫内膜腺癌；

3，疑似腺癌；

4，滴虫感染。

 Menstral phase (day 1-4)

Proliferative phase (day 5-14)

Secretory phase (day 15-28).

Endometrial biological chemical changes are due to effect of multple hormons.  I cannot remember it exactly now. But you will understand if you read the text books about menstrual cysle.

Exfoliation of normal-appearing endometrial cells during the first part of menstrual cycle (from day 1 tp day 10-14) is normal, called physiologic shedding.

Now it is easy for the dx with LMP and age. Just remind your guys that you do not need to report the endometrial cells if women is younger than 40. For this case if women is 40 or older your report should be 1). NILM, 2) endometrial cells correlate with the menstrual history provided.

In the US we have taken many times of tests during residency and  cytofellow training,for pathology board, cytopathology board. Tell you a secretory.  The first impression for the question photos in computer often is right. You are easy to make wrong dx if you think more and more.

I used only two minutes for the above 4 photos when I reviewed them first time during my working time. I got all correctly (floor 6). I saw the four photos more carefully and thought over at night, then made 2 questions wrongly (floor 9). Ha, ha. It is a good example.

Of cause you always need to consider all the conditions to make your diagosis in true clinical practice.

Thank 兰青风采 for the good study cases. cz

赞同，就这样定了，发报告。

 好病例！谢谢！

1，颈管内膜细胞

2，腺癌

3，子宫内膜细胞

4，滴虫

 这里人回答少的原因如下：

1、春节还没有过完；中国传统是过完元宵节才正式开工。

2、像我一样缺乏否定自我的勇气。

3、确实很忙，只有浏览的时间；没有回复的时间。

4、其他不明原因。

所以赵老师别介意，回复少没有关系；只要来这里的人都有所提高，有所进步；我们的目的就达到了！

最后祝福所有人：Happy Lantern Festival !

 现在来补充病史（我所知道，因为片子是别人送的，只给了一个简单病史和结果；没有组织片；不好意思了）：

第一例：

             年龄：18   月经周期：第四天       病史：无

第二例：

             年龄：78   月经周期：绝经           病史：阴道不规则流血

第三例：

             年龄：24   月经周期：第六天         病史：无          

第四例 ：

             年龄：50   月经周期：第23天         病史：无 

 谢谢赵老师：从赵老师身上我们需要学习以下几点：

1、学会思维：做为病理医生或细胞病理医生的思维很重要。

2、学会否定：人要有否定自己的勇气，人很容易肯定自己；但是否定自己是很难的事情。

3、学会总结：人在学习和总结中进步；总结自己和别人的长处；剔除自己的短处；提高自己。

4、学会坚持：坚持是一种习惯，也是一种毅力；成功来源于毅力。

       再次谢谢赵老师，其实每次看赵老师的回复是一次提高；对我思维的缜密性是一次检测。

 很好的学习方式。

意见：1.不典型宫颈柱状上皮，可能为炎性反应。2.宫内膜腺癌细胞。3，不典型腺上皮，考虑内膜来源。4 滴虫

1.宫颈管上皮。

2.腺癌。

3.非典型腺上皮。

4.滴虫。

 例一：柱状上皮，伴核异质，AGC

例二：腺癌；

例三：退变上皮，AGC，考虑宫内滴膜来源；

例四：滴虫。

 Thank for more photos. I change my dx again. Now I agree with all of my times of diagnoses.

1. Bengin reactive endocervical cells, tubal metaplasia

2. Adenocarcinoma

3. benign endometrial cells, exodus. Cohesive clusters, double contour, present in day 6-10 of the cycle.

4 Trich

This is my final and no more change.

More than 100 person reviewing the cases and only few gave the interpretation. I never understand why. Here just is a study place, not true clinical practice. No persons care your performance. No one has any responsibility for the diagnoses, right or wrong. For these cases I changed three times for my interpretation.I do not care if you think I am a changable or bad cytopathologist. I do not need you to get promotion or get monthly pay. Joking