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- 39岁，宫颈微偏腺癌？(更新会诊的免疫组化结果，请继续讨论)
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宫颈肥大，3度糜烂，宫颈横径4.2cm。
免疫组化结果：CEA阴性（两次均阴性），ER少数腺体阴性，ki67极少数腺体阳性率30-40%。浸润深度8-10mm，患者无显著的阴道大量排液。
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本帖最后由 quyibl 于 2011-08-05 18:39:52 编辑
- 我思故我在！ know something about everything,know everything about something.
×参考诊断
腺体分布散乱，而且位置深在。腺上皮分化良好。应该就是微偏腺癌。
- If you have great talents, industry will improve them; if you have but moderate abilities, industry will supply their deficiency. 如果你很有天赋，勤勉会使其更加完美；如果你能力一般，勤勉会补足其缺陷。
引用 12 楼 quyibl 在 2011-08-05 18:38:20 的发言:
这个病例齐鲁医院会诊没能确诊，发的高度可疑。因为两次免疫组化CEA均阴性，Ki67极少数腺体阳性率30-40%。请继续讨论。
Most cases are positive for CEA. But negative CEA is not the reason to exclude the diagnosis. The dx is mainly based on the morphology
根据图片似微小偏离型腺癌。最好能确认下深度和患者有无阴道大量排液。微小偏离型腺癌PAX2不表达，或呈弱而局灶的表达(PMID:20061933);微小偏离型腺癌分化较差区域常表现为胞浆IMP3和CEA(21497449)阳性有助于鉴别诊断和确诊.
Minimal deviation adenocarcinoma of cervix
Gross: barrel-shaped cervix (diffusely enlarged)
Micro:
l very well differentiated glands (usually endocervical-type) with cystic dilation;
l glands are variable in shape or size with irregular or claw-shaped outlines;
l malignant due to distorted glands with irregular outlines deep in cervix, focal stromal response;
l 50% have small foci with a moderate/poorly differentiated focus;
l often has cilia or apical snouts;
l often has mitotic figures;
Positive stains:
periglandular smooth muscle actin+ stroma (Histopathology 2005;46:130), CEA (variable)
DD:
l diffuse laminar endocervical glandular hyperplasia endocervical type adenomyoma,
l florid deep glands (bland inactive appearing cells),
l lobular endocervical glandular hyperplasia (noninvasive proliferation of endocervical glandular cells in lobular arrangement without any irregular stromal infiltration, desmoplasia or focal malignant features, Pathol Int 2005;55:412, AJSP 1999;23:886),
l microglandular hyperplasia (different morphology; CEA negative),
l pseudoinfiltrative tubal metaplasia of the endocervix associated with in utero DES exposure (Int J Gynecol Pathol 2005;24:391),
引用 11 楼 zqfeng 在 2011-08-03 22:37:43 的发言:
好病例，学习了！！！
文献资料有报道微偏腺癌病例在宫颈刮片中找到癌细胞，但在印象中，微偏腺癌细胞一般分化都比较好，请教下各位老师，其脱落细胞学有没有特征性的改变，怎样在宫颈刮片中更好地认识它
宫颈细胞学没法确诊。
- If you have great talents, industry will improve them; if you have but moderate abilities, industry will supply their deficiency. 如果你很有天赋，勤勉会使其更加完美；如果你能力一般，勤勉会补足其缺陷。
引用 17 楼 全子 在 2011-08-07 12:20:58 的发言:
引用 11 楼 zqfeng 在 2011-08-03 22:37:43 的发言:
好病例，学习了！！！
文献资料有报道微偏腺癌病例在宫颈刮片中找到癌细胞，但在印象中，微偏腺癌细胞一般分化都比较好，请教下各位老师，其脱落细胞学有没有特征性的改变，怎样在宫颈刮片中更好地认识它
我认为细胞学诊断微偏腺癌是个盲区
In fact Pap test is not desiged for cervical adenocarcinoma
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