| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- 宫颈活检
This is case of CIN 1. I know in China you guys still use four tier diagnosis of CIN: HPV infection, CIN1, CIN2 and CIN3. This is totally out of date classification. In international pathology community, the so-called diagnosis of "HPV infection" has been lumped into CIN 1 diagnosis. If you can recognize "HPV infection" with koilocytosis, then just make diagnosis of "CIN1". There is no need to separate CIN1 from so-called "HPV infection". Clinically both are treated the same with clinical follow up with PAP test annually.
NO MORE DIAGNOSIS OF "HPV INFECTION' PLEASE!!!
- 不坠青云之志，长怀赤子之心
杨斌老师意见：
该例就是CIN1。据我了解，在国内大伙儿对CIN还是用四级分类的诊断：HPV感染，CIN1-3.这种分类已经过时了。在international pathology community，通常我们所说的HPV感染已经合并到CIN1的诊断里面。如果能通过挖空细胞而识别出HPV感染，那么就诊断个CIN1就够了。没必要再将CIN1和HPV感染区分开来。临床嘱患者每年定期复查液基就可以了。
不要再诊断HPV感染了……
（international pathology community，不知道有没有专用名词，没敢翻）
- 赚点散碎银子养家，乐呵呵的穿衣吃饭
-
HPV感染只是个关于病因的推断性描述，而非诊断。所以不能和CIN1,CIN2,CIN3并列。但是尖锐湿疣或扁平湿疣有其独特的形态学特征，所以一直作为独立诊断应用。我的理解是：湿疣属于CIN1级病变，但是CIN1并不全是湿疣，即后者所涵盖的形态学改变更广。
- If you have great talents, industry will improve them; if you have but moderate abilities, industry will supply their deficiency. 如果你很有天赋，勤勉会使其更加完美；如果你能力一般，勤勉会补足其缺陷。
-
CIN 1 is not equivalent to condyloma. These are two entities with different pathogenesis. Condyloma is almost 100% caused by low-risk HPV types, such as 6 and 11. From molecular point of view, since integration of HPV 6 and 11 is vanishingly rare event and lack of production of viral oncoproteins, E6 and E7, therefore, pure condyloma has almost zero chance to undergo malignant transformation. However, when a person has co-infection by both low-risk and high risk HPV (HR-HPV, such as 16 and 18), you can see approximately 1-3% of condyloma with co-existing cervical dysplasia. In contrast, about 85% of CIN1 is caused by HR-HPV and only 15% of CIN1 is caused by LR-HPV. Among those CIN1 caused by HR-HPV, about 10% will progress to CIN2+ lesions. Therefore, when you make a diagnosis of CIN1, you warn clinicians that patient has at least 10% chance to progress to CIN2+ lesions and should be closely followed up. However, when you make a diagnosis of cervical condyloma, you basically tell clinicians and patients that she has almost zero chance to progress to higher grade lesion. Since cervical condyloma is far less common than CIN1 lesions ( maybe 1:100 or less), practically you should be very conservative to make diagnosis of so-called "condyloma" in cervical biopsy. This is totally different from vulvar lesions where condyloma is far more common than VIN1. That is one of the reasons that ISSVD (International Society of the Study of Vulvovaginal Diseases) recently propose to abandon the term of VIN1 for so-called low grade vulvar dysplasia.
- 不坠青云之志，长怀赤子之心
