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- 51y宫颈液基
| 以下是引用掌心0164在2009-9-9 16:20:00的发言：
老师是高手，请您多来我们这里指点！ 高手拉低手，大家一起走！ |
| 以下是引用xymady在2009-9-11 8:42:00的发言： 青青子矜，您太敬业啦，真正的学者风范和求真精神，细胞学园地有您们这些奉献者和支持者能不火乎？呵呵。另外提一点建议给您和掌心0164，请不要称呼我为“师傅”行吗，我那一点点皮毛功夫在网络上各位老师面前实在是班门弄斧，我实在是觉得愧不敢当/无地自容，请谅解，说得不妥之处望海涵，呵呵！ |
马老师：您不要太谦虚，我们都认为您是看细胞的实干家，那是没的说，您的学生也是遍布大江南北。我那两手都是从您那里学来的呢。当然还要不断学习才行，否则出去还真不敢自称是您的学生，呵呵！
您要不认我和掌心啊，我就 
刚刚才得意没几天呢。。。
以后您就领着我们一道进步吧
刚看到一篇文献，楼主的这个病例也许可以归为“腺样基底细胞癌”。全子：你对照看看是否符合呢？我来不及翻译。或者你个人想法？？？
Adenoid basal lesions of the uterine cervix: evolving terminology
and clinicopathological concepts
Michael J Russell1,2 and Oluwole Fadare*1,3
The epithelial proliferations that are designated adenoid basal carcinoma (ABC) in the current
classification from the World Health Organization represent <1% of all cervical malignancies. These
lesions may be associated, and occasionally show morphologic transitions with, conventional
cervical malignancies. The determination of the precise frequency with which these so-called ABCs
show this association is hampered by the inherent selection bias in the reported cases. However,
this frequency appears to be substantial (>15%). The biologic course of ABCs that are associated
with separate malignancies is largely dependent on the clinicopathologic parameters of the
associated malignancies. Morphologically pure lesions, in contrast, have largely been associated with
favorable patient outcomes, as none of the 66 reported patients have experienced tumor
recurrence, metastases or tumor-associated death, irrespective of the modality of treatment.
Although the finding of genome integrated high-risk human papillomavirus (HPV) types and p53
alterations in adenoid basal lesions (ABL) argue in support of their neoplastic nature, we identified
no lines evidence that suggest an inherent malignancy for morphologically pure lesions. The finding
of morphologic transitions between ABLs and conventional malignancies and shared HPV types in
these areas, suggest that ABLs have some malignant potential. However, the precise magnitude of
this potential is not readily quantifiable and should not dictate the management of morphologically
pure lesions that are entirely evaluable. ABLs continue to occupy a unique position in human
oncology in which the term carcinoma (without an in-situ suffix) is applied to a tumor that has not
been shown to recur, metastasize or cause death. We concur with a previous proposal that the
term ABC should be discarded and replaced with Adenoid Basal Epithelioma (ABE). In our opinion,
there is insufficient evidence at present time to expose patients with morphologically pure lesions
to the ominous implications – social, psychological, medical, financial – of a "carcinoma" diagnosis.
Morphologically impure lesions should not be designated ABC or ABE. Furthermore, given the
uncertainties regarding the frequency with which ABE are associated with separate malignancies,
we suggest that the ABE designation only be applied when the tumor in question is entirely
evaluable e.g in a hysterectomy specimen or in an excisional biopsy with negative margins.
Otherwise, the generic designation Adenoid Basal Tumor is preferable. This approach strikes an
appropriate balance between the need to prevent over-treatment of pure lesions on one hand, and the need to ensure that the lesions are indeed pure on the other.
| 以下是引用掌心0164在2009-9-9 19:15:00的发言：
这可是一个复杂的而少见的病例；走弯路纯属于正常。在宫颈出现腺鳞的病变难以鉴别的时候。如果年龄年轻；绝经前；细胞学大多考虑鳞状上皮的病变为主。但是绝经之后；就刚好相反；考虑腺病变为主。这类正好是一个刚绝经的病类；正好有同时具备了腺鳞病变；所以走弯路纯属于正常。我们只有在这种病案中不停总结中进步。有好病例请全子姐姐多发上来给我们好好学习学习！谢谢！ |
感谢大家对我的病例所给予的热情，本例主要是本人在腺和鳞的问题上的判断上走了一些弯路，从中也学到了一些东西，拿出来希望可以跟大家分享一些收获以及汲取大家的一些思路，果然楼上各位的热烈讨论使我受益匪浅。其实这个病例的组织学结果我已经贴在本网站妇科专栏，大家可以再对照一下继续发表意见
http://www.ipathology.cn/forum/forum_display.asp?keyno=183842
是原位还是浸润，这里先不作讨论，主要是腺和鳞的问题，究竟是什么？细胞学为什么会出现这样的结果？看了组织学以后我想各位自己会有论断
再次感谢明月老师，尤其欣赏和学习了你的分析，就听您的，是啥我说了算呵呵
| 以下是引用海上明月在2009-9-8 18:25:00的发言：
鳞状上皮的基底细胞在正常时，无论是组织形态\细胞形态和免疫表型实在是与腺细胞哟许多共同之处; 而基底样鳞癌和非角化性细胞较小的鳞癌，是分化很差的鳞癌,在某种意义上，呈逆向分化。就细胞来说，甚至免疫表型，与腺发生的有相似之处。所以，莫说是细胞，就是看切片做诊断，有时都很难。 鳞状上皮的基底细胞也可以说是鳞状上皮分化发育的基础，具有干细胞的特性。这样，是不是可以说，前述的那种分化差的鳞癌在细胞学上会显示出与腺特征的异型细胞难以区分的特征。然而，或多或少总能见到鳞特征的异型细胞。 实际上，我看组织学切片要比看细胞片顺当得多，也是在学习看液基细胞片子。不妥之处，请指正。 |
| 以下是引用追逐太阳在2009-9-8 13:27:00的发言：
看来细胞学该有两个诊断了：1、发高级别不除外癌；2、AGC，倾向于肿瘤性。 我觉得这个病例有三个特点：（1）细胞异型性明显。从单个细胞的形态特点来看鳞状上皮来源可能性大。（2）具有一定的结构异型性，主要是腺样结构，从这方面来看，腺上皮来源可能性大。（3）数量、比例、整体印象。宫颈管腺上皮一旦出了问题，即使异型性不大，也非常容易出现量大的特点，结构异型性会非常明显。整体上觉得鳞状上皮来源可能性要大一些。需要活检以后再做一个宫颈管搔刮排除一下。 |
