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- case1 宫颈小细胞癌； case2宫颈ADC; case 3 50 y/f月经增多
I showed a case here a few days ago. It was a very complicated law-suit case and I cannot find more photos now. So I deleted it because it is not good for education.Sorry for that.（几天前我贴了一个病例在这里。那是一个非常复杂的法律诉讼病例，由于我没有更多的图片，对于教学不是很好所以我删除了它。为此我深感抱歉。）
Our fellow showed an interesting case. I put here for your review.（我们的住院医有一个很有趣的病案，我贴在这里一起分享）
42 y women with LMP 5 days ago and no previous Pap history （女性，42岁，末次月经5天前，既往无巴氏检查）
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本帖最后由 于 2010-05-07 07:28:00 编辑
×参考诊断
For this 帖子， I showed three cases to demonstrate it is very challenge for pathologists to evaluate the glandular abnormality. It is easy to have overdiagnosis or underdiagnosis. We all should be cautious for this area.
I think I finish this 帖子。
谢谢所有阅读本帖的人，尤其是参与讨论的同行。
This case was called AGC, favor neoplasia. After the negative bx, patient or gyncologist still felt afraid of the term of neoplasia. The procedure of hysterectomy was done. Remeber that clinicians or patients may not understand the correct meaning of our diagnostic term.
I agree with most of you who put your interpretation that AGC should be a good call for this case.
It is not important how other people called the case. The importance is that how you will make your interpretation if you have the similar cases in your future practice.
Lession from this case:
We should be cautious when we see the cases with prominient and irregular 核仁 in endocervical cells.
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本帖最后由 于 2010-04-26 20:17:00 编辑
3 years late this women had vaginal bleeding, the photos showed bx results. This is a very challenge case. You can determine or guess if this cluster of cells was the cancer cells. It may be yes, may be not.
Anyway, just hope every one knows that it is difficult for all pathologists to interpretate cervical glandular lesions in Pap cytology. This is one of the reasons why the rate of cervical adenocarcinoma continue to increase even though the rate of cervical carcinoma has declined internationally.
名称：图1
描述：图1
名称：图2
描述：图2
| 以下是引用追逐太阳在2010-4-23 7:13:00的发言：
 再学习。
【浆】少，分化差，从这个角度来看，细胞是不成熟的。
【核】大、圆、拥挤；核仁有增大、显眼，异型性肯定是有的。
【结构】细胞拥挤，排列规则。细胞拥挤，有异型性，但细胞拥挤就不松散，细胞间粘附性尚好；排列规则，蜂窝状结构尚存，未出现特殊结构，如腺样结构、放射状结构、菊形团样结构，羽毛状结构，未出现极性紊乱，结构消失等。总之结构异型性不突出。
【组织学来源】假想图，鉴别问题：（1）修复；（2）腺癌
【整体印象】看到这样的视野，我们最好把它称为：AGC，非典型宫颈内膜细胞。 |
Above is excellent analysis. This is the way to learn from case study. Thnaks, cz
| 以下是引用掌心0164在2010-4-19 21:54:00的发言：
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If all or most pathologists think it is negative, correct answer is negative.
If all or most pathologists think it is positive, correct answer is positive.
It is called standard care.
I do not know the correct answer and will let you know when I have.
| 以下是引用青青子矜在2010-4-17 18:45:00的发言：
More history: patient had negative pap test one year ago. 难道赵老师是在提示我们：一年前是阴性而现在有病变？我怎么也看不出问题来啊，又没底啦 |
Just provide more information. Do not guess and make your judgment based on your knowledge and Pap information.
In fact I am not sure what the cell cluster represent.
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本帖最后由 于 2010-03-19 16:16:00 编辑
Finally I complete this Pap case presentation and discussion here.
I hope whoever reviewed this case think about what you learn from this case. You may say I have learned how to make interpretation of cervical samll cell carcinoma in Pap. I do not think so. You may never meet one case of small cell ca of cervix in Pap for all of your life practice even though you may be young. The purpose I present the case here is to let more young pathologists know to make interpretation of the Pap or even surgical pathology. We need to think all clinical information and have open mind for all possible differential diagnosis. You can be excellent to read Pap smear, but that do not mean you are a good pathologist or cytopathologist. Cytotechnologists may have better skill to screen Pap smears, but their knowledge and 思维方式limite them as pathologists, generally speaking. I have no any meaning here to 冒犯 our Chenise cytotechnicians if we have some technicians here.
Any way I feel deserved if some ones can learn to use logic and 严谨的思维方式来分析和解读你的病例。
Thank all people who read or attended discussion for this case.
Thank God I am done for this case.
最后我完成了本例巴氏涂片病例的介绍和讨论。
我希望看过此病例的同仁都能回想一下你从中学到了什么。也许你会说：我学会了在巴氏涂片中判读宫颈小细胞癌。我不这样认为。即使你们依然年轻，但也许你从业一生也遇不到一例宫颈小细胞癌。我展示此病例的目的是想让更多的病理医生了解如何去判读巴氏涂片或如何去做外科病理学。我们必须搜集所有临床信息、开动脑筋想到所有可能的鉴别诊断，也许你看巴氏涂片很厉害，但并不意味着你一定是位优秀的病理医生或细胞病理医生。通常来讲，细胞技术员筛查巴氏涂片技术可以不断提高，但他们的知识范围和思维方式限制了他们成为病理医生的可能。这里我并无意冒犯我们中国的细胞技术员，如果这里有技师的话。
我们应该学会以逻辑的、严谨的思维方式来分析和解读病例，这方面无论怎样做都不为过。
谢谢所有浏览或参与讨论的同仁。
感谢上帝，我终于完成了这一病例的所有讨论。（感谢上帝，我终于翻译完了。青青子衿）
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本帖最后由 于 2010-03-19 16:15:00 编辑
Small Cell Carcinoma of the Uterine Cervix
Cases containing RBCs and clusters of small hyperchromatic cells should not be screened at low power assuming they are exfoliated endometrial cells
Small cell carcinoma is HPV18+ so hrHPV co-testing can help (+in endocervical, -in endometrial)
宫颈小细胞癌
含有红细胞大小的深染小簇状的病例，低倍镜下不要认为是剥脱的子宫内膜而漏诊
小细胞癌HPV18+，所以hrHPV和细胞学共同筛查有帮助作用（+提示子宫颈来源问题，—子宫内膜）
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本帖最后由 于 2010-03-19 16:14:00 编辑
Small Cell Squamous Cell Ca
Well-defined nests of basaloid-type cells resembling small cell neuroendocrine carcinoma, but with more cytoplasm, coarser chromatin and prominent nucleoli; 60% also have SIL
Can show mixed pattern with small and non-small cell differentiation
p63 +; neuroendocrine markers -
f1 : non-keratinizing squamous cell carcinoma
f2: poorly differentiated squamous cell carcinoma
小细胞鳞癌
分化好的基底细胞样型鳞癌和小细胞神经内分泌癌很相像，但前者胞质较丰富、染色质粗糙、核仁明显，并且60%的病例可见SIL细胞
可表现为小细胞和非小细胞混合型，p63 +，神经内分泌标记-
1图：非角化性鳞癌
2图：低分化鳞癌
名称：图1
描述：图1
名称：图2
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本帖最后由 于 2010-03-19 16:14:00 编辑
HSIL
Sheets, syncytia, single cells of variable size
Variable nuclear size, hyperchromasia, irregular membranes
Nucleoli absent (except glandular involvement)
Immature lacy or dense cytoplasm
HSIL
大小多变的片状、合胞体样或单个散在排列的细胞
胞核大小也存在较大变数，胞核深染，核膜不规则
无核仁（除外累及腺体病例）
不成熟的花边状或稠密胞质
名称：图1
描述：图1
名称：图2
描述：图2
