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- 如何领会：未成熟畸胎瘤的Norris分级系统？
如何领会：未成熟畸胎瘤的Norris分级系统？
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如何领会：未成熟畸胎瘤的Norris分级系统？
一、回允中主译《阿克曼外科病理学》第八版 下卷：高子芬、潘增刚、裴斐译 第19章 女性生殖系统 第1499页：Norris等提出的分级系统如下：
Ⅰ级 成熟组织丰富，其间混有疏松的间叶组织，偶见核分裂象；未成熟的软骨；牙齿原基。
Ⅱ级 成熟组织较少；神经上皮灶少见，核分裂象常见，任何一张切片中未成熟神经组织不超过3个低倍（x 40）视野。
Ⅲ级 几乎没有成熟组织；大量的神经上皮成份，同时有富于细胞的间质，占4个或4个以上的低倍视野。
二、回允中主译Stephen S.Sternberg主编《诊断外科病理学》第3版 下卷：沈丹华译，回允中校：卵巢 第2365页：
不成熟畸胎瘤根据不成熟组织的含量，这其中几乎总是神经组织，分成1~3级。1级肿瘤有稀少的胚胎性神经组织灶，在任何一张切片中占据一个低倍视野（x 40）以下，2级肿瘤含有中等量的胚胎性神经组织，在任何一张切片中占据1个以上但4个以下的低倍视野，3级肿瘤含有大量的胚胎性神经组织，在任何一张切片中占据4个或更多的低倍视野。
三、张建民著《卵巢病理学》第441页：由2003年卵巢肿瘤分类推荐Norris（1976）3级分类：
1级 肿瘤罕见灶状不成熟神经外胚层组织，每张切片＜1(40x )。
2级 肿瘤内不成熟神经外胚层组织或类似成份每张切片1~3（40x ）。
3级 肿瘤内大量不成熟神经外胚层组织每张切片＞3（40x ）。
上述叙述中，前二者的“任何一张切片”与后者之“每张切片”字面上理解似乎不同。“任何一张”，意味着只要有一张达到标准即可；而后者“每张”则标准陡然上升，意味着一张都不能少。
那么，大家觉得标准应该是如何界定？？？
那么，大家觉得标准应该是如何界定？？？
标签：卵巢 畸胎瘤 成熟性 非成熟性
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×参考诊断
Both the primary tumor and the metastases were graded by a method very similar to that used by Robboy and Scully.The histologic grade of the tumor was based on three factors: degree of immaturity, presence of a neuroepithelial component, and the quantity of the latter. Grade 1 was given to neoplasms with some immaturity but with neuroepithelium absent or limited to a rare low-magnification ( *4 0 )field within the tumor, and not more than one such focus in any slide. A grade of 2 was given when immaturity and neuroepithelium were present to a greater degree than grade 1. Neuroepithelium was common but did not exceed three low-power microscopic fields in any one slide. Grade 3 was given when immaturity and neuroectoderm were prominent, the latter occupying four or more law-magnification microscopic fields within individual sections. Grade 0, in which all tissues are mature and mitotic activity is rare or absent, was present only in metastatic deposits, as all well-studied grade 0 primary teratomas are regarded as benign’z and therefore are excluded from the study.
Norris HJ, Zirkin HJ, Benson WL. Immature (malignant) teratoma of the ovary: a clinical and pathologic study of 58 cases. Cancer 1976;37:2359-72.
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首先，谢谢九等生网友!
他说的方法非常好!!
Immature teratomas have been traditionally graded from 1 to 3 based on the amount of immature, almost always neural tissue (112). Grade 1 tumors have rare foci of embryonal neural tissue occupying less than 1 low-power (×40) field (lpf) in any slide, grade 2 tumors contain moderate quantities of embryonal neural tissue, occupying more than 1 but fewer than 4 lpfs in any slide, grade 3 tumors contain large quantities of embryonal neural tissue occupying 4 or more lpfs in any slide.
Sternberg Diagnostic Surgical Pathology, 4th Edition
他说的方法非常好!!Immature teratomas have been traditionally graded from 1 to 3 based on the amount of immature, almost always neural tissue (112). Grade 1 tumors have rare foci of embryonal neural tissue occupying less than 1 low-power (×40) field (lpf) in any slide, grade 2 tumors contain moderate quantities of embryonal neural tissue, occupying more than 1 but fewer than 4 lpfs in any slide, grade 3 tumors contain large quantities of embryonal neural tissue occupying 4 or more lpfs in any slide.
Sternberg Diagnostic Surgical Pathology, 4th Edition
但是，“fewer than 4 lpfs in any slide”与“occupying 4 or more lpfs in any slide. ”似乎是矛盾的。前者是全否定，后者是全肯定，那么部分肯定与部分否定的情况如何呢？对了，那一定是归为Grade 2~3了。
- “人生没有彩排，每一天都是现场直播”
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本帖最后由 于 2006-10-13 23:22:00 编辑
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