海绵同志你千万别这么谦虚，我看此帖时感觉赵老师实在分析得好，也想趁机学习一下，所以就。。。

还有就是我们宫颈栏的几个小朋友太认真又热心，这种活我平时很难揽到，所以就。。。

不好意思！哈哈 

 今天这个患者取了病理，胃的，结果是低分化腺癌。

改日把病理片子传上来

 I would like to share a concept to young pathologists.

Example:

If adenocarcinoma cells are present in pleural fluid in a patient with lung adenocarcinoma history or had lung adenocarcinoma which was confirmed by pathology now, I will still order some stains, such as ck7/ck20/TTF-1 for the pleural cytology specimen. We know mostly the adenocarcinoma cells are from the lung. However, the chance of second primary is still present.

1. Without immunostains, I will diagnose the pleural cytology as  metastatic adenocarcinoma. In the comment, I will mention it may be lung primary.

2. With stains (ck7+/ck20-/TTF-1+), I will diagnose the pleural cytology as metastatic adenocarcinoma, lung primary.

The situation of lung ca to plerual fluid or the presence of second primary may change patient's prognosis and the strategy for the treatment.

Just for your reference. cz

 试译赵老师帖子，顺便学习一下赵老师的思路。

我愿意和年轻的病理工作者们分享一种观念。

实例：

如果在一个有肺腺癌病史或现阶段已被病理证实患有肺腺癌的病人胸水中发现腺癌细胞，我仍然会对胸水细胞样本选做一些免疫染色，如ck7/ck20/TTF-1。我们知道多数腺癌细胞来自肺脏，但仍然有第二原发灶存在的可能。

1、如果没有免疫染色，我会对胸水细胞给个“转移性腺癌”的诊断，在备注中，我会提及可能是肺原发；

2、如果有免疫染色（ck7/ck20/TTF-1），我会诊断为“转移性腺癌，肺原发”。

到底是肺癌至胸水还是有第二原发灶不仅可以改变患者的诊断，同时改变的还有治疗方案。

仅供参考。