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- 宫颈腺上皮(有问题吗?)
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本帖最后由 于 2008-03-21 21:32:00 编辑
Whenever you see "mucin-depleted" glands in endocervix, as seen in this case, you need go through a laundry list in your differential diagnoses:
1. AIS. First and the most important one is to rule out AIS. Morphologic features include nuclear atypia, mitosis and apoptotic bodies.
2. Tubal metaplasia. You look for cilia and stratified but bland nuclei. Sometimes you can see those cells with vaculated cytoplasm in between ciliated cells. Occasionally you can see mitosis.
3. Endometriosis. Of course you are looking at the periglandular endometrial stromal cells. Often these glands will go through tubal metaplasia. Sometimes you can see mitosis. Please be very careful when you use p16 in this situation, since both dysplastic glands and tubal metaplastic glands will be positive for p16, albeit AIS glands are more diffuse than metaplastic ones.
4. Reparative changes with inflammation. Often you have lower N/C ratio, eosinophilic cytoplasm and sometimes mitosis. But you should not see apoptotic bodies.
5. Mesonephric reminant or hyperplasia. These often are smaller and rounder glands with single layer of cuboidal cells with pink secretion inlumens.
This is what I go through everyday in signing out cases with any "mucin-poor" or "mucin-depleted' endocervical glands. In this case, I favor it as "tubal metaplasia" since it clearly demonstrate cilia in most of lining cells. I hope this is helpful to you.
如本例，见到“无粘液”的宫颈腺体，都需要如下列表鉴别：
1. AIS原位腺癌：第一个、也是最需要排除的。形态学特征包括：核异型、核分裂和凋亡小体。
2. 输卵管上皮化生：寻找纤毛、复层化但核温和。有时在纤毛细胞之间见到空泡状胞浆的细胞。偶见核分裂。
3. 子宫内膜异位：当然需要看到腺体周围的子宫内膜间质细胞。通常要仔细检查是否为输卵管上皮化生。有时可见凋亡。此时使用p16一定要小心解释，因为异型增生的腺体和输卵管上皮化生的腺体均可p16阳性，尽管AIS比化生者阳性更弥漫。
4. 炎性修复：通常核/浆比低，胞浆嗜酸性，有时见核分裂。但不见凋亡小体。
5. 中肾管残留或增生：腺体通常较小、较圆，内衬单层立方细胞，腔内有嗜酸性分泌物。
对于任何“粘液稀少”或“无粘液”的宫颈腺体，这些是我日常签发病例时都要仔细检查的内容。对于本例，我倾向于“输卵管上皮化生”，因为大多数衬覆细胞明显存在纤毛。希望对你有帮助。(abin译）
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