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- 纠结的子宫内膜病变。请老师指导。
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女，43岁，月经过多1月，灰褐破碎组织一堆，1.2x0.8x0.3cm，质软。镜下细胞较小，异型明显，呈实体巢状或片状排列，腺腔状结构少见，局部可见核巨样细胞。初步考虑低分化腺癌，但纠结的是送检内膜中部分可见正常的内膜腺体和间质。低倍镜下很像是鳞化，也考虑鳞癌，但想到子宫内膜鳞癌少见，此例又未见角化珠等鳞癌特征。又怀疑是否宫颈来源。请老师们指点。
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本帖最后由 kaidi 于 2011-10-03 09:52:46 编辑
×参考诊断
Determination of site is much more important than histologic type of the cancer in this case, because it is fundamentally different in treatment of cervical cancer than endometrial cancer . Based on morphology, this is a carcinoma likely derived from cervix rather than endometrium. Please perform p16, CK5/6 and p63 to confirm its squamous nature. Also please check her cervical cytology and HPV status. Also make sure she has no history of other malignancy, such as breast cancer.
- 不坠青云之志，长怀赤子之心
宫内膜样腺癌伴有鳞化，单纯从诊刮标本是很难判断来自宫体还是宫颈管的。免疫组化也只是个参考。临床规范的做法是同时做宫颈管诊刮和宫腔诊刮，而且先宫颈管，然后宫腔。
这例必须与临床沟通。如果没有时间或机会沟通，可以这样出诊断报告：低分化宫内膜样腺癌伴有鳞化。请结合临床及影像学检查判断肿瘤发生部位（宫体或宫颈）。
- 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。
