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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
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本帖最后由 于 2010-03-13 16:07:00 编辑
Some features of cervical small cell carcinoma
-Rare (2-5% of invasive cervical carcinomas)
-Clinically aggressive with rapid metastases; frequently presents with parametrial invasion and pelvic lymph node metastases
-Similar age as squamous cell carcinoma (mean 43 years, range 23 to 63 years)
-Associated with HPV, usually HPV-18
-Occasionally presents with paraneoplastic syndromes (Cushing etc)
-Coexisting SIL is rare; endocrine cell hyperplasia may be a precursor lesion
-Can be a part of squamous cell carcinoma or adenocarcinoma
Immuno:
-Chromo+, Synapto+, CD56 (most senstitive) at least one neuroendocrine marker should be positive.
-p16+ almost all cases positive
CK (AE1/3)+, few case TTF-1 +,
Typical cytology of small cell ca
– Small cells (2xlymphs)
– Carrot-shaped nuclei
– Even powdery chromatin
– Nuclear molding
– Indistinct nucleoli
– Paranuclear blue bodies
– Mitoses
– Scant cytoplasm
– Background of nuclear debris and crush artifact (chromatin streaks)
How do we tell difference of the small cell ca from different location? Some IHC stains may be helpful.
Histopathology. 2007 Sep;51(3):305-12.
Biomarker-assisted diagnosis of ovarian, cervical and pulmonary small cell carcinomas: the role of TTF-1, WT-1 and HPV analysis.
Carlson JW, Nucci MR, Brodsky J, Crum CP, Hirsch MS.
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Comment in:
AIMS: Small cell carcinoma of the ovary, hypercalcaemic-type (SCCOH) is morphologically similar to small cell carcinomas from other sites. The aims of this study were to (i) determine if a biomarker panel would distinguish small cell carcinomas of the ovary, cervix (SCCCx) and lung (SCCLu) and (ii) potentially determine the histogenesis of SCCOH. METHODS AND RESULTS: Nine ovarian small cell carcinomas (seven hypercalcaemic type; two pulmonary type), eight SCCCx and 22 SCCLu were immunostained for thyroid transcription factor (TTF)-1, WT-1, p16, cKIT and OCT3/4; a subset of cases were tested for human papillomavirus (HPV). WT-1 was diffusely positive in 6/7 SSCOH versus two of 33 other small cell carcinomas (P <or= 0.001). TTF-1 was diffusely positive in 20/22 SCCLu and 1/8 SCCCx, and negative in all SCCOH. p16 and cKIT demonstrated variable patterns of immunoreactivity in all cases. HPV was identified in 5/6 SCCCx; SCCOH and SCCLu were negative for HPV. CONCLUSIONS: Combined staining with WT-1 and TTF-1 will distinguish SCCOH from SCCLu and SCCCx with a sensitivity of 86% and specificity of 97%. HPV is specific for tumours of cervical origin, but p16 immunohistochemistry is not useful for this purpose. The presence of diffuse WT-1 supports a Müllerian origin for SCCOH, whereas the absence of cKIT and OCT3/4 argues against a germ cell origin.
When we read Pap, we should consider the patients, clinical situation, clinical managment, histology et al.
These also can make the Pap more interesting.
Some one can make a list for the differential diagnosis of small cell carcinoma in Pap test. Thanks, cz
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本帖最后由 于 2010-03-08 21:01:00 编辑
I think these photos are good enough for you to have an interpretation. I love this case. Hope you love it too.（我人分为这些图片足以给出合理的解释，我喜欢这个病例‘希望你们也喜欢）
Always keep the principle in your mind that Pap test is a screening test not a diagnostic test (TBS 2001). This is why the words "interpretaion" or "report" replace the term "diagnosis"（你们脑子中始终有这个原则：巴氏检测是一个筛查不是诊断<2001版TBS>。这就是用“解释”或“报告”代替“诊断”的原因）
应太阳要求，翻译了赵老师的总结部分，供参考
宫颈小细胞癌的部分特征：
——少见(约占宫颈浸润性癌的2-5%)
——临床侵袭性强，易快速转移，常浸润子宫旁组织及盆腔淋巴结转移
——发病年龄和鳞癌类似（23-63岁，平均43岁）
——和HPV感染相关，尤其是HPV-18
——有时出现类肿瘤综合征（如Cushing综合症等）
——很少合并SIL，内分泌细胞增生可能是其癌前病变之一
——可以是鳞癌或腺癌的一部分
免疫标记：
神经内分泌标记至少有一个阳性：CgA+, Syn+, CD56+ (最敏感)
几乎所有病例p16+
CK (AE1/3)+，少数病例TTF-1 +
宫颈小细胞癌的典型细胞学特征：
——小细胞
——胞核可出现胡萝卜样外形，并易见胞核扭曲
——染色质粉尘状，分布均匀
——核仁不清楚
——核旁蓝染小体
——可见核分裂相
——胞质稀少
——背景核碎片和人为挤压
子宫内膜来源，疑问有：
1、数量有一点多；2、排列有一点散，有一点平铺。
但是：
1、细胞小；2、胞浆少、烂，3、成小团，又不得不考虑子宫内膜。
如果是子宫内膜：最常见的肿瘤，子宫内膜样腺癌、浆液性癌、透明细胞癌、子宫内膜间质肿瘤。
【细胞小、圆、柱状形态不突出】浆液性癌可能性最大，但浆液性癌还有两个特征——A、乳头，B、异型性大（总喜欢出现一些差异性大的怪异的东西）。
A、乳头：结构在哪里？B、大的异型性：相反，出现的是一致性、均一性。
而且所有子宫内膜的上皮源性癌，细胞的核膜还是喜欢增厚的，核仁还是多见的，结构也是要有的。
【1、胞浆非常少，烂，无定形；2、细胞小，且排列紧密密、形态一致、无结构】低级别子宫内膜间质细胞肿瘤有可能。但鉴别困难，太少见——关键是我没见过（细胞学病例）。我没见过，那的确是少见了。既然没见过，那就一定是信口雌黄了。呵呵。。。
不说了，越说越离谱。且说多了还有严重的误导作用。
