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- 50岁,绝经
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Direct sampling of endometrium. Don't have to report. Geographic irregular groups of small piled up cells with very scant cytoplasm. Spontaneously exfoliated endometrial groups are smaller size with round contour, have to report in postmaneupausal women. Don't mistake for HSIL. What is AIG? American International Group in Wall Street who handed out fat bonuses to high executives using tax payers' sweat money?
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jiangxiaoyu 离线
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本帖最后由 于 2009-04-05 01:28:00 编辑
Very interesting case. I showed the photos to Dr. Austin (he is our director of cytopathology and previous president of American Society of Cytopathology) and other cytopathologist. All of our three have similar oppinion.
1. We cannot report malignant,adenocarcinoma, or HSIL, based on the cytology above.
2. These cells look like endometrial cell orgin
3. Agree with Dr. Yu these cells mostly are endometrial cells from low uterin segment due to the sampling. There is mild cytologic atypia in high power. Few cells are large than others (two times)---pleomorphism.
The question is what we should call, endometrial cells in 绝经 (even though mostly the presence of the cells were due to the sampling) or atypical glandular cells.
The bottomline is that the women should have tissue sampling. Based on ASCCP guidline the women should have tissue sampling even we report normal endometrial cells in 绝经 women.
I may call normal endometrial cells if I take the test.
We all three agree to call atypical glandular cells for this true clinical practice. I hope to make sure the women get tissue sampling, even though the result turns out to be negative in histologic specimen. Remember that 70-80% of women with AGC Pap will have no any endometrial or endocervical lesions in histologic follow-up. Also the diagnosis of endometrioid adenocarcinoma in histology is often based on the architecture, but not cytology.
I did a lot AGC study and reviewed many AGC slides and have three publications in AGC. The more I study, the more I am confuded.
Just for your reference.
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本帖最后由 于 2009-04-06 10:03:00 编辑
其实这几天我一直在思考这个病例；并多次看这个帖子，都不知道如何回答和下手了；复习了一些书本上关于细胞群的一些特征性改变；现在一直思考的是如果这个病例是我自己手上的病例怎么发报告；如何给患者一个比较好的诊断呢？
就以上图片而言有如下特征：
1、高核浆比的细胞团比较丰富，即细胞量比较大；鳞状上皮细胞比较稀少。
2、细胞核大小有轻度的大小不等。
3、细胞团本身的细胞比较松散，细胞团不是那么致密。
4、细胞边缘不是那么平滑。
5、核仁不是很突出，有少量细胞有核仁。
6、又是绝经的妇女；出现这么大量的腺细胞也是一个可疑的因素。
现在我最需要的是临床资料：
1、病人有哪些有意义的临床症状和体征
2、影像学资料
3、用药史（绝经后服用一些激素类药或保健品之类也会导致这样的细胞学改变）
4、临床的一些其他方面的检测结果（生化或免疫学的结果）
如果真的这个病例是我自己来发：我至少会报AGC，建议临床进一步处理。
通过以上这几次回帖其实给我的教训很深刻，让我脑子不停的想起老师的话：“诊断恶性病变的时候一定要排除类似的良性病变；在诊断良性病变的时候一定要排除类似的恶性病变”。
- 掌心0164
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The correct interpretation of Pap test should not be decided by tissue diagnosis. We must know the priniciple that Pap is a screening test. If Pap interpretation is AGC or ascus and tissue bx is negative, it does not mean that you have a wrong diagnosis on Pap. Remember that most women with AGC or ASCUS Pap will be no cervical lesions in tissue biopsy.
Very heated discussion here. I would call the Pap "Atypical glandular cells, favor endometrial origin". Regarding the direct sampling question, if I don't see endometrial cells with stroma (the classic bi-phasic pattern", I will be very reluctant to let it go as direct sampled endometrium.
I completely agree with Dr. Zhao that Pap is a screening test, you call something "atypical" and the biopsy is nothing, does not mean your diagnosis is wrong. If you call "negative" and patient has HSIL or carcinoma and did not get proper management, then you have made mistake.
