我们的病理诊断：高级别宫颈上皮内瘤变累及腺体，局灶微小浸润性癌。

上海权威妇科病理学家会诊结果：高级别宫颈上皮内瘤变累及腺体。

 本例不知道是活检还是手术切除大标本上取到的宫颈组织。

图片3和4显示的裂隙可能制片引起的人工假象。

图片中有CIN累腺表现，但没见明确的宫颈表面上皮CIN。

两小灶细胞异型性较大并伴有核分裂，没有基底样细胞环绕，与周围背景中的鳞状上皮区分较大，但细胞太少不能定性。

诊断微小浸润的前提应有CIN III。如果是活检，需要深切，看看有没有CIN III的病变；如果深切还见不到，建议对宫颈分点活检和颈管搔刮，再送诊。

如果是手术大标本，建议对宫颈连续取材

 我觉得微小浸润是肯定的，脉管内癌栓是可疑的。没看到表面CIN病变及其程度，累腺部分已经够CIN3。但是如果是活检小组织，不宜直接报微小浸润（因为它限定了浸润范围），可以报小灶浸润。最保守也要报可疑浸润。

深切，多层面观察，也许会有更明确的病变。

个人观点仅供参考

 累腺的部分能达到CIN3

个人觉得有浸润

 学浅学习心得：异常分化成熟的鳞状上皮与间质直接接触，就可能是浸润。

学浅法则：间质中上皮巢越小，则浸润的可能性越大。如果上皮巢仅为一两个细胞组成，那一定是浸润。

需再切进一步证实。连续切片看看。

我觉得够浸润了

 I suspect invasive SCC (cannot tell microinvasive from outright invasive SCC before you measure the width and depth of the invasive focus) and also suspect lymphovascular invasion.

The suspicious cell nests are quite atypical with very prominent nucleoli and keratinization, both are signs of invasion.  Some nests are breaking from the basement membrane.  Not very sure, but my memory is: once you see lymphovascular invasion, you cannot call it microinvasive SCC anymore no matter how small the size is.  The size criterion for microinvasion is mildly different, i think it is no more then 7 mm in length and 3 mm in depth.

You can do immunostain for D2-40 and CD31, CD34 to confirm the lymphovascular invasion, and basemement membrane stain to determine the microinvasion or invasion size.

I would challenge the Shanghai authority's diagnosis by doing those special stains.  Maybe they are right, but i need evidence.  Anybody can see it has HSIL involving glands.  With biopsy and LEEP, HSIL is not a acceptable diagnosis here, we have to say CIN 2 or CIN 3.  HSIL is for cytology.