廖芝玲_广西肿瘤医院 06-26 21:25

女，女，61岁，左宫角肿物

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

最大径1.5cm

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

廖芝玲_广西肿瘤医院 06-26 21:25

内膜样腺癌，还是浆液性癌？

廖芝玲_广西肿瘤医院 06-26 21:25

end

张杰-聊城 06-26 22:58

@廖芝玲_广西肿瘤医院 高级别子宫内膜癌。治疗同浆液性癌。

廖芝玲_广西肿瘤医院 06-26 23:00

p16、p53的表达

廖芝玲_广西肿瘤医院 06-26 23:01

同时，er.pr也强表达

张杰-聊城 06-26 23:05

@廖芝玲_广西肿瘤医院 反正是高级别癌，结合免疫组化和细胞异形性，我感觉发浆液性更好！

廖芝玲_广西肿瘤医院 06-26 23:07

使得治疗更恰当？

张杰-聊城 06-26 23:20

@廖芝玲_广西肿瘤医院 是的，临床治疗一样，往浆液报更安全！不用纠结。

廖芝玲_广西肿瘤医院 06-26 23:21

好，我觉得这是集二者于一体的癌

掌心0164@汪俊 06-28 22:24

@廖芝玲_广西肿瘤医院 看看您这个病例符合不符合p53阳性的子宫内膜样腺癌?

掌心0164@汪俊 06-28 22:29

掌心0164@汪俊 06-28 22:30

D EFINITION —A common conundrum in endometrial cancer classification in which an endometrioid histology coexists with strong p53 staining.

掌心0164@汪俊 06-28 22:31

C LINICAL F EATURES E PIDEMIOLOGY
• Outcomes for serous carcinoma are distinctly less favorable relative to both low- and high-grade endome-trioid carcinomas.
• Some tumors do not readily fall into either category,specifically those with both endometrioid histology and a high level of p53 expression.P RESENTATION
• Abnormal uterine bleeding and abnormal cervical cytology.P ROGNOSIS AND T REATMENT
• High (more than 50%) expression of p53 is indepen-dently associated with a worse clinical outcome in patients with endometrioid adenocarcinomas.
• In serous carcinomas, p53 expression is not indepen-dently associated with survival.
• Cases with ambiguous results, either histologically or diagnostically (i.e., interobserver disagreement), are more likely to be p53 positive.
• p53 immunohistochemistry might provide prognostic information in cases that would otherwise be classified as endometrioid adenocarcinomas.

掌心0164@汪俊 06-28 22:31

P ATHOLOGY H ISTOLOGY • Diagnostically ambiguous, p53-positive tumors fall into three general categories:

掌心0164@汪俊 06-28 22:32

1. Tumors with variable histology, part of which is clas-sically serous carcinoma. The latter exhibits the typical papillary, micropapillary, and slit-forming glandular growth with conspicuous nuclear atypia.
2. Tumors with endometrioid glandular morphology but increased (grade 2) nuclear atypia. The latter may take the form of less stratified more cuboidal cells,higher nuclear-to-cytoplasmic (N/C) ratio, andnuclear enlargement.
3. Rare tumors that are indistinguishable from endome-trioid adenocarcinomas. These may not prompt sus-picion but are nonetheless diffusely positive for p53.

掌心0164@汪俊 06-28 22:32

I MMUNOPATHOLOGY (I NCLUDING I MMUNOHISTOCHEMISTRY )
• p53 staining is most useful in delineating these tumors and should be found in at least 50% of the tumor cells and typically is higher.R ECOMMENDED D IAGNOSTIC T ERMINOLOGY
• Endometrial adenocarcinoma, endometrioid-type grade(specify 1, 2, or 3).
• Comment: Immunostain for p53 is positive (more than 50% of cells). p53 has been independently associated with a more adverse outcome in endometrioid adeno-carcinoma. Clinical correlation is advised.M AIN D IFFERENTIAL D IAGNOSIS
• Serous carcinoma is the obvious exclusion and is done by the application of histologic criteria.

掌心0164@汪俊 06-28 22:33

掌心0164@汪俊 06-28 22:33

慧馨 06-29 00:08

@掌心0164@汪俊 学习了，谢谢

掌心0164@汪俊 06-29 11:27

@张杰-聊城 书里的，我贴的就是原文的拷贝

张杰-聊城 06-29 11:28

@掌心0164@汪俊 能拍一下书面给我吗？谢谢

张杰-聊城 06-29 11:29

好的，@掌心0164@汪俊 谢谢您

掌心0164@汪俊 06-29 12:34

张杰-聊城 06-29 13:03

@掌心0164@汪俊 谢谢您！