多几副低倍图象？

考虑：低级别腺上皮内瘤变。

 谢谢大家参与！

答案是：endocervical adenocarcinoma in-situ.

椎切样本中有多处典型AIS。右图腺体右大半边是AIS，左小半是正常腺体。有比较很容易看到差别：AIS核大而深染，核质粗，核拥挤，stratified, 太多分裂相。典型AIS。 You don't need more photo  for the diagnosis.

病史也很有意思。宫颈涂片high risk HPV 阳性，细胞学阴性（I reviewed the pap smear and confirmed).  是samplig error, nobody's fault, but the limitation of the technology.  很高兴临床医生注意到HPV+，做了活检。There is no clear guideline regarding the management of patients with positive high risk HPV but negative cytology.  I notice many of our clinicans will do colposcopy if high risk HPV is positive for 2 times.

不是微偏腺癌，因为我给你的图太少了，而且核异性太突出。微偏腺癌必须看到其本正常的腺体infiltrate deep into the cervical stroma.

在美国我们不诊断腺体低级别上皮内瘤变，甚至不诊断高度上皮内瘤变.  It is either benign or AIS. Occasionally when the atypia is more than reactive changes but less than AIS, I mention atypia and recommend clinical follow-up.  But this is the exception, not routine.  The picture here is diagnositic for AIS.

掌心太厉害了，能从细胞学倒推组织学。我们这儿是相反的：必须先学组织学再学细胞学。During my residency, first year residents learn tissue pathology only, but attend cytology teaching lectures.  We started dealing with cytology cases at second year.  We have to finish general pathology training (4-5 years) before we do cytopathology fellowship.

 这样的病例如果诊断宫颈原位腺癌的话,就担心会诊时结果不一致.

我总觉得在实际工作中此例诊断为原位腺癌,科内也难达成共识.不知国内同道有无这样的感觉?

或许我的主观认识有偏差,本身就是个错觉.继续学习吧.

 细胞要更拥挤,类似胃肠道的高级别上皮内瘤变.

呵呵,我的错误认识让老师见笑了.我正更正自己.谢谢mingfuyu老师!

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