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- 50岁腹水，是间皮还是癌？请老师会诊(已确诊：低分化腺癌)
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。
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
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本帖最后由 于 2009-09-20 19:26:00 编辑
Thank Drs. 青青子矜 and 海绵 for your excellent translation.
I hope all of you agree the concept that differential diagnosis is most important for pathological practice, especially in non-gyn cytopathology. We as pathologists should train the habit to consider all the possibilities for all our cases---called differential diagnoses. Then we can use our available sourses or methods to rule out or rule in the diagnosis. Now it is not like 20 or 30 years ago when pathologists made the dx only based on the cytomorphology and clinical information.
Read the case again. I would like to do three markers first , LCA, BerEP4, calretanin if it were my case.
Thank 千百合 for sharing the case. cz
abin译：谢谢青青子衿和海绵的翻译。
我希望大家都同意：在病理实际工作中鉴别诊断是最重要的，特别是非妇科细胞学。我们病理医生对自己的病例应该训练考虑所有可能性的习惯--称为鉴别诊断。然后利用我们现有的资源或方法以排除或锁定诊断。现在不像20或30年前那时病理医生仅根据细胞形态学和临床信息作出诊断。
再次阅读此例。如果是我的病例，我想先做三项标记物：LCA，BerEP4，calretinin。
谢谢千百合分享病例。
