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乳腺癌术后两年,做过化疗,不典型腺细胞?补传图片

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楼主 发表于 2009-09-08 23:17|举报|关注(0)
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35岁,乳腺癌术后的病人,有化疗史,片子的背景有念珠菌和放线菌,并且上传的图片中有两张像是带环引起的腺上皮的改变,但是有成团的细胞,具有立体结构,细胞核大,深染,考虑是不典型的腺细胞(子宫内膜)
  • 乳腺癌术后两年,做过化疗,不典型腺细胞?补传图片图1
    图1
  • 乳腺癌术后两年,做过化疗,不典型腺细胞?补传图片图2
    图2
  • 乳腺癌术后两年,做过化疗,不典型腺细胞?补传图片图3
    图3
  • 乳腺癌术后两年,做过化疗,不典型腺细胞?补传图片图4
    图4
  • 乳腺癌术后两年,做过化疗,不典型腺细胞?补传图片图5
    图5
  • 乳腺癌术后两年,做过化疗,不典型腺细胞?补传图片图6
    图6
  • 乳腺癌术后两年,做过化疗,不典型腺细胞?补传图片图7
    图7
  • 乳腺癌术后两年,做过化疗,不典型腺细胞?补传图片图8
    图8
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1 楼    发表于2009-09-10 15:18:00举报|引用
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 应掌心老师的要求补传三张较低倍数的图片,我还是觉得是子宫内膜来源的,因为有立体结构,但是不敢直接报癌
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2 楼    发表于2009-09-10 15:34:00举报|引用
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 有高倍和低倍感觉好多了;这样一来确实像宫内膜来源的;但是对乳腺癌转移到宫颈确实没有经验;不敢随便肯定和排除。但是这个可以通过一些临床情况和病史来鉴别。这个我同意您叫的AEM;建议查颈管和内膜。
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3 楼    发表于2009-09-10 15:59:00举报|引用
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 可能是脱落的病变的子宫内膜细胞,不一定是宫颈的转移癌
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4 楼    发表于2009-09-10 19:07:00举报|引用
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本帖最后由 于 2009-09-10 19:13:00 编辑

1. We should know the women's LMP, breast cancer type and diagnosed time, detailed treatment history (radiation?).

2. If this patient is not in LMP or within 12 days, At most I may consider to call AGC based on the first photo. The AGC may represent neoplastic lesions or reactive change, especially for this women with history of chemotherapy, 带环 (the patient has or not???).

3. Remember that most women (70-80%) with AGC Pap would have no neoplastic lesions. Again Pap test is a screening test. You must be 100% sure, otherwise please do not call malignant for your pap test, especially for this 35 young lady.

4. if the women is in LMP or within 12 days, we need to think over the meaning of these cells.

5. Breast cancer cells can occour in the Pap smear, but it is very rare.

6. Also we should consider the patient's age. If the young women has both breast and gynecologic tumor, the patient may have BRCA gene mutation.

just for your reference.

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5 楼    发表于2009-09-10 19:12:00举报|引用
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  I have a AGC-follow up paper published recently. This is the largest study in this area till now.

Gynecol Oncol. 2009 Sep;114(3):383-9. Epub 2009 Jun 7.

Comment in:
Gynecol Oncol. 2009 Sep;114(3):381-2.

Histologic follow-up results in 662 patients with Pap test findings of atypical glandular cells: results from a large academic womens hospital laboratory employing sensitive screening methods.

Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-3180, USA. zhaoc@upmc.edu

OBJECTIVE: Atypical glandular cell (AGC) Pap interpretations and screening for glandular neoplasias remain major challenges. We document the largest reported AGC histopathologic follow-up experience and include verification bias-adjusted data on laboratory screening sensitivity. METHODS: AGC Pap tests of endocervical origin (AGC-EC), endometrial origin (AGC-EM), and not otherwise specified (AGC-NOS) were documented at a center serving an older low risk population. 98% of Pap tests were liquid-based cytology (LBC) specimens screened using computer-assisted screening. Follow-up diagnoses were correlated with cytology and stratified into age groups. Screening sensitivity was assessed by examining Pap results during 1 year preceding neoplastic diagnoses. Verification bias was adjusted with findings in over 2000 patients with hysterectomies. RESULTS: Of 247,131 Pap tests, 1021 (0.41%) reported AGC results and 662 cases had tissue follow-up. Precancerous or malignant neoplastic histologic outcomes were documented in 101 patients (15.3%), including 8.3% cervical, 6.3% endometrial, and 0.6% ovarian. AGC results were most often associated with neoplastic cervical outcomes in women younger than 40 and with neoplastic endometrial outcomes in women 50 or older. AGC-NOS with a squamous cell abnormality and AGC-EC results suggested cervical neoplasia, while AGC-EM results suggested endometrial neoplasia. CONCLUSIONS: AGC Pap results detected significant numbers of cervical and non-cervical neoplasias. Since 38 of 44 (86%) of AGC-detected carcinomas were endometrial or ovarian, HPV co-testing would not have aided screening in detecting the majority of malignancies diagnosed after AGC Pap results. Verification bias-adjusted Pap screening sensitivity in the laboratory for detection of significant neoplastic cervical disease was 93%.

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6 楼    发表于2009-09-11 19:57:00举报|引用
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 很喜欢曹老师的讲解,该病人末次月经是2009.8.21,抹片日期是2009.9.7,2007.4.4诊断的是乳腺浸润性导管癌,是否带环,是否有放疗史不是太清楚,因为病人没有电话,和临床大夫也没有联系上,所以这一部分不是很清楚。
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7 楼    发表于2009-09-08 23:25:00举报|引用
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AGC,倾向于肿瘤性。

来源怎么定呢?学习学习。

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8 楼    发表于2009-09-08 23:47:00举报|引用
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 腺癌.
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body>h1>span>...................This signature is very handsome.

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9 楼    发表于2009-09-09 08:31:00举报|引用
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   腺癌

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10 楼    发表于2009-09-11 21:16:00举报|引用
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难得的好涂片!需要好好学习。

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11 楼    发表于2009-09-11 22:52:00举报|引用
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 Dr.Zhao的讲解很有教学意义,还专门研究过,值得学习借鉴。从医疗安全的角度,诊断AGS是合适的(尽管看上去就是腺癌细胞),同时注明疑癌或提示需分段诊刮或宫腔与宫颈活检进一步诊断比较好。国内有的开刀医生,只要听说一个癌字,就只管按癌开刀,那是挺吓人的。
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12 楼    发表于2009-09-09 13:59:00举报|引用
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 赞同不典型腺细胞--宫内膜。
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13 楼    发表于2009-09-11 23:08:00举报|引用
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 乳腺癌术后经Tamoxifen治疗后,极有可能发生子宫癌。请见文献报道。

1: Br J Cancer. 2008 Mar 11;98(5):870-4. Epub 2008 Feb 12.

Click here to read
Second malignancies after breast cancer: the impact of different treatment modalities.

Kirova YM, De Rycke Y, Gambotti L, Pierga JY, Asselain B, Fourquet A; Institut Curie Breast Cancer Study Group.

Department of Radiation Oncology, Institut Curie, Paris, France. youlia.kirova@curie.net

Treatment for non-metastatic breast cancer (BC) may be the cause of second malignancies in long-term survivors. Our aim was to investigate whether survivors present a higher risk of malignancy than the general population according to treatment received. We analysed data for 16 705 BC survivors treated at the Curie Institute (1981-1997) by either chemotherapy (various regimens), radiotherapy (high-energy photons from a 60Co unit or linear accelerator) and/or hormone therapy (2-5 years of tamoxifen). We calculated age-standardized incidence ratios (SIRs) for each malignancy, using data for the general French population from five regional registries. At a median follow-up 10.5 years, 709 patients had developed a second malignancy. The greatest increases in risk were for leukaemia (SIR: 2.07 (1.52-2.75)), ovarian cancer (SIR: 1.6 (1.27-2.04)) and gynaecological (cervical/endometrial) cancer (SIR: 1.6 (1.34-1.89); P<0.0001). The SIR for gastrointestinal cancer, the most common malignancy, was 0.82 (0.70-0.95; P<0.007). The increase in leukaemia was most strongly related to chemotherapy and that in gynaecological cancers to hormone therapy. Radiotherapy alone also had a significant, although lesser, effect on leukaemia and gynaecological cancer incidence. The increased risk of sarcomas and lung cancer was attributed to radiotherapy. No increased risk was observed for malignant melanoma, lymphoma, genitourinary, thyroid or head and neck cancer. There is a significantly increased risk of several kinds of second malignancy in women treated for BC, compared with the general population. This increase may be related to adjuvant treatment in some cases. However, the absolute risk is small.

PMID: 18268495 [PubMed - indexed for MEDLINE]


Uterine malignancy following tamoxifen use in breast cancer patients in Iran: case series and literature review.

Behtash N, Hashemi R, Karimi Zarchi M.

Gynecology Oncology Department, Vali-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran. nadbehtash@yahoo.com.

BACKGROUND: This study evaluated tumor characteristics and survival in women with breast cancer who subsequently developed uterine cancer. METHODS: Information about endometrial cancer in tamoxifen users following breast cancer refered to the gynecologic oncology clinic of Vali-Asr hospital between 1997-2007 was evaluated. RESULTS: Among 330 patients with endometrial cancer, 5 were in women previously diagnosed with breast cancer. Two cancers were malignant mixed Mullerian tumors of the uterus (MMMT), 2 were endometrioid adenocarcinomas, and one was a papillary clear cell carcinoma. Patients received tamoxifen for 4-8 years. The endometrial cancers occurred 2-11 years after initial treatment for the breast cancers. Four of the endometrial cancers featured abnormal uterine bleeding and one of them had increased vaginal discharge and all were diagnosed on endometrial curetting. All patients received standard surgical staging for endometrial cancer and all except one were stage I. At laparotomy of one patient, an advanced stage MMMT was found with diffused peritoneal spread and ascites. In spite of the surgery, she died of disease, 3 months later. The other patients remain recurrence-free for breast cancer and uterine cancer after 6-120 months. CONCLUSION: Breast cancer patients who use tamoxifen and have early stage endometrial cancers demonstrate a good prognosis. Abnormal uterine bleeding or vaginal discharge are the most important symptoms.

PMID: 19469647 [PubMed - indexed for MEDLINE]

Click here to read
Prognosis of uterine corpus cancer after tamoxifen treatment for breast cancer.

Hoogendoorn WE, Hollema H, van Boven HH, Bergman E, de Leeuw-Mantel G, Platteel I, Fles R, Nederlof PM, Mourits MJ, van Leeuwen FE; Comprehensive Cancer Centers TAMARISK-group. Department of Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.

Tamoxifen increases the risk of uterine corpus cancer. Since only few, mostly small, studies have examined prognosis of uterine corpus cancer following tamoxifen, we conducted a large retrospective cohort study to further investigate this. We examined histopathologic and immunohistochemical characteristics of 332 patients with uterine corpus cancer following breast cancer, according to tamoxifen use. Survival was examined in the same patients combined with 309 patients from a previous study with updated follow-up. Histological review of all cancers was performed. Long-term tamoxifen users showed a higher proportion of non-endometrioid tumors than non-users (32.7% vs. 17.4%, P=0.004), especially serous adenocarcinomas and carcinosarcomas. An increased proportion of FIGO stage III and IV tumors was also observed (20.0% vs. 11.3%, P=0.049). Within FIGO stage I, both short-term and long-term tamoxifen users showed a higher proportion of tumors limited to the endometrium than non-users (35.7% vs. 22.9%, P=0.049 and 0.004 respectively). Uterine corpus cancers in long-term tamoxifen users were more often steroid receptor-negative (ERalpha, PRA and PRB, P<0.05) and P53-positive (P=0.015). Three-year uterine corpus cancer-specific survival was worse for long-term tamoxifen users than for non-users (82% vs. 93% P=0.0001). The survival difference remained after adjustment for histopathologic and immunohistochemical characteristics (hazard ratio (HR) for >or=2 years tamoxifen=2.4; 95% CI=1.2-4.6). In conclusion, this large study clearly shows that tamoxifen-associated tumors have less favorable histological features and a worse survival. Our results can be applied when weighing risks and benefits of tamoxifen versus other hormonal agents used in the prevention and treatment of breast cancer.
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14 楼    发表于2009-09-12 07:58:00举报|引用
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 Thank Dr. 海上明月 for sharing above abstracts. This is a good way to know some knowledge in details.
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15 楼    发表于2009-09-12 08:02:00举报|引用
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以下是引用海上明月在2009-9-11 22:52:00的发言:

 Dr.Zhao的讲解很有教学意义,还专门研究过,值得学习借鉴。从医疗安全的角度,诊断AGS是合适的(尽管看上去就是腺癌细胞),同时注明疑癌或提示需分段诊刮或宫腔与宫颈活检进一步诊断比较好。国内有的开刀医生,只要听说一个癌字,就只管按癌开刀,那是挺吓人的。

They should do biopsy to confirm the diagnosis first even though our Pap dx is carcinoma.
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16 楼    发表于2009-09-09 16:29:00举报|引用
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 YYYY老师,您发的病例每次都很有难度;我在您的病例栽得最多;不过没有关系;我也可以学得更多。

这个病例腺的病变是肯定的;很可能是腺癌。但是来源确实是一个问题:

能提供一些低倍的图象吗?

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17 楼    发表于2009-09-12 09:10:00举报|引用
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 谁译一下,我看不懂英文
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18 楼    发表于2009-09-12 10:38:00举报|引用
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 16楼列举国外参考文献,说明乳腺癌术后他莫昔芬(Tamoxifen)等辅助治疗后,发生子宫癌(新发肿瘤)的风险性。按示本例图片所见的很可能是术后化疗诱发了子宫癌。

17楼说:感谢海上明月医生提供上述摘要供大家参阅,读参考文献是了解某些知识细节的佳径。

18楼说:即便是宫颈细胞学检查报了癌,那他们(指开刀医生)也应该先做活检来证实是不是癌(再开刀)。

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19 楼    发表于2009-09-12 11:35:00举报|引用
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以下是引用海上明月在2009-9-11 22:52:00的发言:

 Dr.Zhao的讲解很有教学意义,还专门研究过,值得学习借鉴。从医疗安全的角度,诊断AGS是合适的(尽管看上去就是腺癌细胞),同时注明疑癌或提示需分段诊刮或宫腔与宫颈活检进一步诊断比较好。国内有的开刀医生,只要听说一个癌字,就只管按癌开刀,那是挺吓人的。

赞同
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20 楼    发表于2009-09-17 15:58:00举报|引用
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AGC,建议查宫颈管与宫内膜。
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