癌，考虑转移

 考虑卵巢低分化腺癌。

 谢谢各位老师指点！！

当时报告发低分化腺癌后，临床大夫坚持是转移的，要求会诊。会诊结果：双卵巢低分化浆液性腺癌。

以下是引用卜算子 在2007-4-14 17:12:00的发言： 当时报告发低分化腺癌后，临床大夫坚持是转移的，要求会诊。会诊结果：双卵巢低分化浆液性腺癌。

I have to caution everyone on this case. This is a high grade or poorly differentiated adenocarcinoma (not germ cell tumor) involving bilateral ovaries. Although this may be a high grade adenocarcinoma of mullerian origin, such as endometrioid, papillary serous, or clear cell type However, I do not see very classic papillary serous or clear cell features. Perhaps they are present in some areas and the uploaded photos do not include them. If no such areas could be found, a metastatic origin of bilateral ovarian malignancy has to be carefully ruled out. The most common metastatic origins include colon, rectum, stomach, small intestine, esophagus, breast, and pancreas. I would do immunohistochemical stains to further investigate this case - including CDX2, CK20, TTF-1, NSE, synaptophysin and chromogranin A - before calling this high grade bilateral papillary serous adenocarcinoma of ovaries.

The fact that the clinician (I would assume that was the surgeon) raised the possibility is a serious warning. She or he might have some information not known to us as pathologists. This may be as simple as a recently diagnosed rectal poorly differentiated adenocarcinoma in the history, or as obvious as an intraoperative finding of a large pancreatic mass that was unresectable. This brings out the importance of communication - adequate interaction with clinicians (surgeons or not) is essential in our practice. Often a simple question and answer saves us much headache and avoid many unnecessary tests. This kind of interctions with clinicians also improves our relationship with them, which helps them appreciate our work and respect us more. Some surgeons or other types of clinicians consider themselves the most important and regard pathologists as lab technicians. They may not wish to spend time with pathologists in discussing cases, and may even withhold pertinent clinical information from pathologists. These, however, are rare and we need to try our best to interact with them. With patient care as our mutual goal, I am sure a relationship can be established eventually.

(谦谦君子翻译)我必须提醒大家注意这个病例。这是一个高级别或低分化的腺癌（不是生殖细胞肿瘤）累及双侧卵巢。尽管这可能是苗勒氏管来源的高级别的腺癌，如内膜样、浆液乳头样、或透明细胞型的。但是我没有看到非常典型的浆液乳头样或透明细胞的特征。或许它们在一些区域出现而上传的图片中没有包括它们。如果不能发现这些区域，要注意排除双侧卵巢转移性的恶性肿瘤。最常见的转移性肿瘤可能来自结肠、直肠、胃，小肠、食管、乳腺和胰腺。在称这个病例双侧卵巢高级别浆液乳头状腺癌之前，我将做免疫组化染色去进一步证实这个病例－包括CDX2, CK20, TTF-1, NSE, SYN, CgA。
事实上临床医生（我猜想是外科医生）出现这种情况可能是一个严重的警示。她或他可能有一些信息没让我们病理医生知道。这可能简单的是近来有诊断为直肠低分化腺癌的病史，或者明显的是在术中发现无法切除的胰腺巨大肿块。这说明了沟通的重要性，和临床医生（外科医生或其他）足够的交流对我们的工作是很有必要的。经常一个简单的问题和答案可以省去我们太多的头痛和避免许多不必要的检测。这种交流也可改善我们同他们的关系，使他们承认我们的工作并且更加尊重我们。一些外科医生或其它科的临床医生认为他们自己是最重要的，而把病理医生看作是实验室技术员。他们不愿花时间和病理医生讨论病例，甚至对病理医生保留相关的临床资料。然而这些人毕竟是少数，我们需要努力同他们交流。为了病人是我们共同的目的，我相信我们之间最终能建立起稳定的关系。

 低分化癌。

双侧性的卵巢癌总是需要除外转移性。

但此例细胞异型性过大，某些区域细胞的透亮胞浆内似乎不是粘液成分，因此倾向低分化的浆液性癌。要确认诊断：（1）大网膜或盆腔腹膜部位情况；（2）如是浆液性癌总是能够找到相对明确的区域帮助诊断；（3）标记CK7，CK20，CA125，CEA多数情况下能够明确诊断。

 谢谢mjma老师！谢谢周老师的讲解！谢谢忍者神龟老师的提醒！

此例是收住妇产科和外科联合手术的，术中没有发现网膜、腹腔的转移，系膜淋巴结无明显肿大，因经济原因患者已经出院。基层医院免疫组化没开展。

 我想请教一下卵巢肿瘤中有"卵巢移行细胞癌"这一说法吗?希望各位老师赐教!谢谢!

以下是引用寿小燕 在2007-4-24 18:11:00的发言：  我想请教一下卵巢肿瘤中有"卵巢移行细胞癌"这一说法吗?希望各位老师赐教!谢谢!

有

 楼上的，11楼想问的并不是有没有“卵巢移行细胞癌”这个诊断名词，她不知道，书也不知道啊？你把上面的图不放大再看看，她问的有没有道理？如果把它放在肾脏和膀胱象什么？

 在出外转移性病变的前提下首先考虑（双卵巢）浆液性腺癌III级。

 谢谢！值得学习和推敲！