我觉得1图应该是正常的颈管细胞

             2图来源于子宫内膜的腺癌

             3图   不好确定

            4图应该是滴虫吧

呵呵         

My following answers are based on that if I am taking a test, but not the true clinical practice. This is why I answered the four questions with 2 minutes

1. Reactive endocervical cells

2 Adenocarcinoma; orign may be endometrial.

3. Normal cluster of endometrial cells

4. Trichomonas

 Ok, I change my dx now after using the high power and thinking more in true practice

1. AGC, endocervical. Enlarged, variablely sized nuclei with some crowding and overlap of nuclei. The cili??? Should biopsy.

2. Adenocarcinoma. no way to tell the origin.

3. AGC, endometrial orgin. Three-dimensinal cluster of cells with irregular, hyperchromatic and overlapped nuclei. Should have endometrial and endocervical biopsy.

4. ThreeTrichomonas

AGC raises the old philosophical question " is the glass is half full or half empty?"

I read all AGC agreement study papers including the study I organized (5 cytopathologists, three cytofellows). All studies indicated that the agreement is very poor among the pathologists, cytopathologists, different hospitals, expert cytopathologists.

From my two times of answers you can know that I even do not agree with myself. Ha, ha.

Hope more people write your dx. It is not important your answers are right or wrong here. The importance is that we should learn how to handle these similar cases in our clinical practice based on patients' clinical information, previous Pap history, HPV result, age et al. Reading true slides and photos on cmputer are different.

Thank 兰青风采 for sharing these photos.

1  正常颈管细胞。

2   腺癌，倾向颈管。

3   AGC。

4   裸核，不象滴虫。

看了赵老师的回复，感动；这样的认真和反复实践的精神值得我们学习；现在多传些图片给大家看看吧；请大家接着讨论；谢谢！

第一例图：

第四例图：

 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

 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。