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- 宫颈活检
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liguoxia71 离线
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listli1999 离线
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Do I miss something here? This is a terrible looking CIN-3 to me. I am worry about if there is focal microinvasion or not, which I do not appreciate it in the photos provided. Among proposed differential diagnoses, this is way beyond reparative changes response to inflammation. It is neither CIN-1 or condyloma acuminatum. I bet she is HPV positive. I would like to pick up phone and talk to GYN clinician to find out what is clinical history and presentation.
- 不坠青云之志，长怀赤子之心
包埋面换９０度更好，但这种小活检包埋时是随机的．炎症意味着本例无须切除治疗，或仅作药物、烧灼等即可，对本例明显是不恰当的。不敢用不留余地的炎症来诊断本例切片．原因如下：
１．上皮脚膨胀性生长，相互挤压，间质极少．这完全不同于炎症情况下的上皮脚增生．而更倾向肿瘤性增生。鳞状上皮团密集的情况容易见于腺体鳞化，但这些上皮团中少有腺腔样结构．且相互挤压过于明显．所以不好用单纯的腺体鳞化和炎性增生解释．
２．图５显示细胞团内似有大量的核分裂（病理性核分裂）．图片如果有高倍就更能说明问题．且深部细胞团的形态已经不太规则，这是要引起注意的．
所以，个人意见，高级别ＣＩＮ不能除外，建议复查．另外楼上有老师提出不能除外微小浸润，我也有同感．
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本帖最后由 于 2007-08-31 20:10:00 编辑
| 以下是引用杨斌在2007-8-31 6:19:00的发言：
Do I miss something here? This is a terrible looking CIN-3 to me. I am worry about if there is focal microinvasion or not, which I do not appreciate it in the photos provided. Among proposed differential diagnoses, this is way beyond reparative changes response to inflammation. It is neither CIN-1 or condyloma acuminatum. I bet she is HPV positive. I would like to pick up phone and talk to GYN clinician to find out what is clinical history and presentation. |
这例我会忽视一些重要东西吗？我觉得这是看上去很可怕的CIN-3。我担心是否存在微浸润，但提供的这些图片不能评价。在以上鉴别诊断中，这已经超出了炎症所致的修复性改变。它不是CIN-1或尖锐湿疣。我敢肯定患者HPV阳性。我会打电话给临床医生询问病史和临床表现。
华夏病理/粉蓝医疗
为基层医院病理科提供全面解决方案，
努力让人人享有便捷准确可靠的病理诊断服务。
This is one of the puzzles we are facing in daily practice everyday, since our dx will dictate the way clinicians managing the patient, such as a big LEEP versus a radical histerectomy in this case. In this case, I will communicate with clinician and tell your concerns. As long as you and clinician are on the same page, you can sign it out as " extensive carcinoma in situ, cannot rule out invasive carcinoma else where".
One of the differences I observed between China and US pathologists is that pathologists in US are close friends with clinicians and we are always the team with patient care as our central task. If I have any questions regarding the case, I will call clinicians immediately and nicely chat with him/her about the case and my concern. In most situations, it promotes the bonding between two sides and resolves puzzle on both sides. It also saved me many many times for making stupid mistakes. I hope we pathologists try to make clinicians as your friends, not your professional enemies.
- 不坠青云之志，长怀赤子之心
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本帖最后由 于 2007-09-18 23:09:00 编辑
| 以下是引用杨斌在2007-9-1 1:18:00的发言：
This is one of the puzzles we are facing in daily practice everyday, since our dx will dictate the way clinicians managing the patient, such as a big LEEP versus a radical histerectomy in this case. In this case, I will communicate with clinician and tell your concerns. As long as you and clinician are on the same page, you can sign it out as " extensive carcinoma in situ, cannot rule out invasive carcinoma else where". One of the differences I observed between China and US pathologists is that pathologists in US are close friends with clinicians and we are always the team with patient care as our central task. If I have any questions regarding the case, I will call clinicians immediately and nicely chat with him/her about the case and my concern. In most situations, it promotes the bonding between two sides and resolves puzzle on both sides. It also saved me many many times for making stupid mistakes. I hope we pathologists try to make clinicians as your friends, not your professional enemies. |
翻译：
这是我们日常工作中每天都会遇到的疑惑之一，因为我们的诊断会指导临床医生对患者的处理方式，如此例可选择大范围的LEEP手术或根治性子宫切除术。像此例情形，我会联系临床医生并告知你们的担心。只要你和临床on the same page(惭愧，不会翻译，猜：达成共识），你可以签发“广泛原位癌，不能排除其它部位浸润癌”。
我发现中国和美国病理医生之间的一个差别，就是美国病理医生与临床医生是亲密朋友关系，我们总是一个团队，以治疗患者为中心。如果我对病例有任何疑问，我会立即打电话给临床医生，和他/她恰当交谈讨论病例，提出我的担心。大多数情况下，这会促进双方的联系，解决双方的疑惑。这也避免我多次犯低级错误。我希望我们病理医生努力与临床医生交朋友，而不是职业敌人。
华夏病理/粉蓝医疗
为基层医院病理科提供全面解决方案，
努力让人人享有便捷准确可靠的病理诊断服务。
