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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
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。
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
