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本帖最后由 于 2006-11-20 13:44:00 编辑
自mjma 老师（12楼）
图一：左下角显示一簇间皮细胞，具有非常圆的核，核膜光滑，核质比中等。右上角为分别由1个、2个、5个细胞构成的间皮细胞簇。与反应性间皮细胞相比，这些细胞核仁大且形态不典型，核膜不规则。且由5个细胞构成的间皮细胞簇不象反应性间皮细胞那样球形聚集。
图一：左下角显示一簇间皮细胞，具有非常圆的核，核膜光滑，核质比中等。右上角为分别由1个、2个、5个细胞构成的间皮细胞簇。与反应性间皮细胞相比，这些细胞核仁大且形态不典型，核膜不规则。且由5个细胞构成的间皮细胞簇不象反应性间皮细胞那样球形聚集。
图二：单独的或几个不典型细胞构成的小细胞簇。核仁大，核膜不规则（有裂口）。同样，4个细胞聚集，呈现除了线性之外有点成角度的轮廓。这点在反应性间皮细胞中较少见到。
图三：箭头所指罕见不典型细胞有胞浆空泡，这些空泡可能包含或不包含点样浓缩分泌物。
图四：一大簇不典型细胞，核大而偏心。
这是一例已被证实的乳腺低级别浸润性导管癌。源自于乳腺或肺的分化良好的癌性胸膜腔渗出液的细胞学检查不能轻易通过低倍镜观察作出判断。反应性间皮细胞、炎细胞（淋巴、单核、中性粒细胞）都会存在。只有通过高倍镜仔细观察，才能发现细微的细胞不典型性。一点很有帮助的提示就是恶性细胞簇的怪异形状－－经常是线性或成角的而非球样聚集。
图三：箭头所指罕见不典型细胞有胞浆空泡，这些空泡可能包含或不包含点样浓缩分泌物。
图四：一大簇不典型细胞，核大而偏心。
这是一例已被证实的乳腺低级别浸润性导管癌。源自于乳腺或肺的分化良好的癌性胸膜腔渗出液的细胞学检查不能轻易通过低倍镜观察作出判断。反应性间皮细胞、炎细胞（淋巴、单核、中性粒细胞）都会存在。只有通过高倍镜仔细观察，才能发现细微的细胞不典型性。一点很有帮助的提示就是恶性细胞簇的怪异形状－－经常是线性或成角的而非球样聚集。
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Figure 1 - Left lower corner shows a cluster of mesothelia with perfectly round nuclei, smooth nuclear membrane, and intermediate nucleocytoplasmic ratio. Right upper corner shows one, two- or five-cell clusters. These cells have large nucleoli and atypical features when compared with reactive mesothelia - much larger nuclei and irregular nuclear membranes. In addition, the five-cell cluster does not ball up like reactive mesothelia would.
Figures 2 - Isolated or small clusters of atypical cells with large nuclei and irregular (clefted) nuclear membranes. Again, four cohesive cells form a slightly angulated but linear profile, something not commonly found in reactive mesothelia.
Figure 3 - Rare atypical cells (arrow) have cytoplasmic vacuoles that may or may not contain dot-like inspissated secretion.
Figure 4 - A larger cluster of atypical cells with large and often eccentric nuclei.
This is a case of proven metastatic, low grade infiltrating ductal carcinoma of breast. Malignant pleural effusion resulting from metastatic well differentiated adenocarcinoma of mammary or pulmonary origin may not be easy to detect by casual low power evaluation. Reactive mesothelia and inflammatory cells (lymphocytes, monocytes, neutrophils) are always present. Only with careful high power examination would one detect subtle cytologic atypia. One very helpful hint is the odd shapes of malignant cell clueters - often linear or angulated and not rounded like balled aggregates.
聞道有先後,術業有專攻
