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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
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Very interesting case and even more interesting story. Thanks.
To be very honest with everybody, i would report this case like this in my daily practice:
Interpretation category (there is such a field in our standard pap report, we have options like: negative..., atypical... positive or other): other
Interpretation: Endometrial cells present in a woman older than 40 years old...
Comment: THe presence of endometrial cells in pap smear in women older thatn 40 years old could represent menstrual smear, hormonal changes or pathology... Clinical correlation is suggested.
These cells really look like endometrial groups and the bloody background could easily be due to menstruation. Some menstrual EM glands become degenerated and could have very coarse and dark chromatin.
Maybe with the real slide and microscope, i could appreaciate abnormal chromatin and other features suggestive of small cell carcinoma. I have seen a few cases of small cell ca in pap, very difficult to diagnose. Luckily, this woman is older than 40 years old, our standard practice demands for the lengthy comment, hopefully it will alleviate us a little from legal trouble. If this was a woman younger than 40 years old, i may have ignored the cell clusters and bloody background as menstral smear, then i would get screwed completely!
My God, that is why we have liability insurance.
谢谢喻老师的“救命稻草”，很有启发。
1、“报：其他（不知国内的标准宫颈涂片报告中有无此项）然后加以说明。"我们有这项，但我知道很多医院病理医生和临床医生对这个问题没有统一认识。我们医院几乎不报，我要报的话也要和临床医生交待很久，很麻烦（要知道我们工作量很大），所以干脆不报。希望其他医院做得比我们好。
2、“不要太相信LMP，有些病人将异常子宫出血误认为月经。”的确，经验之谈。谢谢！
3、“My God, that is why we have liability insurance.”你们是幸福的，我们没有保险。我们医院医疗赔偿医生个人要陪1/3，真正是高风险低收入。这样的大环境下我们不敢轻易发肯定报告，挺悲哀的。
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