子宫颈糜烂

慢性宫颈炎，鳞状上皮乳头状增生伴轻度不典型增生。

包埋面不对，看上去很可怕。

 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.

 　　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．

 Abin,  Your translation is so perfect! I am impressed. Thanks again,

 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.