注意：患者23岁！

 病理诊断面前人人平等，就象法律面前一样。

此例综合HE和标记，本人坚持高级别宫颈上皮内瘤变的诊断。

我们这里leep做得很滥，很多宫颈假性糜烂都没幸免一刀。象楼主提供的病例，又有何惧呢？

我会的，谢谢金老师！

最好还能跟踪一下Leep 标本的病理学检查结果，谢谢！

 最新消息！

刚接到患者的电话，在当地医生和亲友的关怀劝说下，患者在当地医院已经做了LEEP刀手术。

我有心等1-2个月观察一下患者的病情转归情况，这样什么都结束了！

但患者答应2个月后再做一次复查。

再次感谢各位老师的讨论！

只要您“客观观察病变、抓住诊断要点、充分认识病谱、不受“经典和权威”束缚、循证（形态、IHC、分子、随访）病理诊断。兼听则明，偏听则暗。”压力和风险就能逐渐地释放！

认真学习王老师提供的关于P16与宫颈病变的文献！

 这里有一篇关于P16与宫颈病变的文献。

 感谢Dr.xclbljys。有随访复检真是一件好事情。

谢谢赵老师！

感谢赵老师的关注和指导！刚学习了孟刚老师的《病理诊断风险防范》，对误诊导致的器官损害赔偿心有余悸，特别对低龄患者的恶性诊断，慎之又慎！当然，孤陋寡闻，水平欠缺是主要原因！

经各位老师指点，获益匪浅，相信以后碰到相似病例，处理方法一定好于现状！

此例病人目前没有做宫颈锥切手术，我正密切随访，希望1-2个月后能见到患者的新的病情图片！

 I feel difficult to give my impression for this case.

Stain results for P16 and Ki67 is consistent with dx of high grade dysplasia, but the cytomorphologic features on H&E are not like classic high grade dysplasia. I favor a dx of CIN2 based on IHC and H&E. However I need to review the true glass for diagnosis.

If luo zhu is not sure, can send out for consultation.

Other suggestions:

1. Dx of CIN1-2 is a bad call. Pathologists should avoid to use the diagnostic term.  If patients have both cin1 and cin2, it is fine that you call:

-CIN2.

-CIN1. (of cause it is fine you do not report cin1 if you report cin2 or cin3 already.

Or focal cin2 in the background of CIN1 if cin2 is focal.

If is ok you report CIN2-3 together.

2. For CIN lesion, HPV testing is not used for diagnosis

This is my study result

Histological Follow-up Findings in Adolescents with HSIL Cytology Results
  Arch Path Lab Med in print. 

Chengquan Zhao, MD,  Pal Kalposi-Novak, MD, R. Mashall Austin, MD, Dr.
Magee Womens Hospital, UPMC, Pittsburgh, PA, USA.

Abstract:
Introduction:
The incidence of cervical intraepithelial lesions is increased in adolescents and reflects the high prevalence of hrHPV infection in this special population. Recent follow-up guidelines emphasize conservative follow-up options. Furthermore, data from cohort studies suggest that regression of both low grade and high grade CIN are quite frequent in very young women. In this study we analyzed histological follow-up data for adolescent women who had HSIL cytology reports. We also assessed the effect of presence or absence of an adequate TZ/ECS in liquid-based Pap tests on the follow-up biopsy diagnoses.
Materials and methods:
The computerized records of a large academic women’s hospital were searched for cases reported as HSIL on TPPT in women age 20 or younger over a 6 year span between January 2002 and December, 2007. Histologic and Pap follow-up results, variations among age groups of adolescent women, and impact of presence or absence of TZ/ECS in Pap test were analyzed. Chi-Square test analysis was performed using SAS 9.1 System.
Results:
During the study period a total of 474 women age 20 or younger had HSIL Pap test results. 335 adolescent women with at least one cervical biopsy with or without endocervical curettage were included in the analysis. The average age was 18.6 years (13-20 years). The average follow-up period was 24 months (0 to 75 months) with a median of 22 months. The overall histologic CIN2/3 and detection rate was 44.2% and 47.8% for CIN1. The average period between the HSIL Pap test and an initial diagnosis of CIN2/3 was 5 months (0-62 months) with a median 2 months. The rates for histologic documentation of CIN in women age 19-20 compared to younger women were not statistically different. Detailed histologic findings are shown in Table 1. No invasive carcinomas or adenocarcinoma in situ cases were identified in this series of adolescents. The percentage of CIN 2/3 diagnosed on histologic follow up was not statistically significantly different when comparing women with and without a TZ/ECS in their preceding HSIL Pap tests (44.5% vs. 38.9%, p=0.642).
Conclusion:
Less than half of adolescent patients with HSIL cytology results had documented histologic CIN2/3 over an average follow-up period of 24 months, and no cases of invasive carcinoma were identified. CIN1 histologic follow-up findings were as common as CIN2/3 findings, likely reflecting both the increased likelihood of HSIL regression in younger women as well as the challenges of precise cytologic and histologic classification. High rates of hrHPV infection, only moderate rates of histologic CIN2/3 following HSIL cytology, and absence of invasive carcinoma all mark the adolescent group as a unique subset of patients deserving further study. Identification of additional biomarkers for HSIL progression would be useful.