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- 宫颈肿瘤28岁，宫颈癌？内膜癌？（1834）
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28岁，未生育，既往外院内膜诊刮为复杂性增生，外院TCT检查无病变，我院发现宫颈病变，阴道镜下宫颈局部呈菜花状（8-11日补充的病史），遂行阴道镜下活检。
第一次检查：下图为宫颈活检标本：
可能看的不是很清楚，再上几张大一点的图片（8-11 9:24添加）：
第二次检查：（8-15添加）
诊断性刮宫，下面的图片是刮宫标本，患者没做分段诊刮，因为宫颈已经是菜花样的了。
第三次检查：
全子宫切除标本：宫颈宫体交界处偏向宫颈外口一侧局部粘膜表面粗糙呈菜花样，从宫颈外口可见。宫内膜较薄，子宫底部内膜稍增厚稍粗糙，重点取材宫颈病变处及底部子宫内膜（图片后面传）。
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本帖最后由 城北 于 2011-08-30 08:09:49 编辑
知之者不如好之者，好之者不如乐之者。（语出幽梦影）
×参考诊断
引用 43 楼 杨斌 在 2011-08-30 21:29:29 的发言:
Now given negativity of p16 and a mass at lower uterine segment/uterine isthmus region, she likely has an endometrial adenocarcinoma linked with Lynch syndrome. As matter of fact, a tumor located in lower uterine segment in a younger woman is one of the criteria for screening of an endometrial adenocarcinoma associated with microsatelite instability. Now she needs to be screened either with IHC of PMS2 and MSH6 or PCR-based molecular testing of MSI with at least 5 markers. If you cannot perform these tests, I can help you out if you can provide me several unstained slides from both tumor and non-tumor endometrium.
Now you may want to check her family history of colorectal cancer, gynecological cancers especially endometrium and ovary, and skin lesions such as sebacous hyperplasia/adenoma/carcinoma. If confirmed she is linked with MSI, then her siblings should be consutled with medical geneticist for education and screening of colorectal and gynecologic cancers linked with Lynch syndrome.
杨老师的发言给我很大的启示，我们要做临床病理学家而不只是做形态病理学家。
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