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以下是引用葵葵在2008-6-5 10:29:00的发言:
此例嗜伊红上皮化生基础上发生,鉴别为嗜伊红胞浆的子宫内膜非典型性增生及腺癌鉴别. 我有这样几个疑问:请大家讨论: 图1,右上方明显共壁,右下方坏死,中间三团实性透亮细胞团 图2也存在 图3正中为3个腺体的融合?基底膜不完整,有破坏现象,左上方间质有碎腺体引起的炎性反应 图4腺体没有极性,内膜间质炎性细胞,透亮区增多 图7左方两腺体共壁,上方腺体是否为出芽,腔内可见炎性细胞 图11腺腔破坏后间质的炎性反应 这些我们用非典型性可以解释过吗? |
首先感觉这一例有难度,不过个人观点还是良性。你所涉及的几点说一下我的看法,大家互相学习交流,图1,2共壁,实性透亮细胞团不能作为癌的证据,右下方“坏死”我这么看:它是内膜有出血的改变,我觉得它体现的是局灶间质细胞的聚集,间质可见核碎,这些只能提示内膜有出血。图3腺体融合不是癌的依据,基底膜不完整,有破坏(比如在出血的时候或月经期,腺体也可以破坏。在内膜的浸润我们不以这为依据)图4腺体没有极性,内膜间质炎性细胞,透亮区增多这些也不能作为癌的依据。图7左方两腺体共壁,上方腺体是否为出芽,腔内可见炎性细胞图11腺腔破坏后间质的炎性反应这些同样不是癌的依据。只能说增加了我们往癌上考虑的因素,但不能作为癌的依据。所以个人观点认为认为目前诊断癌缺乏证据。
另嗜伊红乳头合体细胞样改变,我最初接受的观点是一种化生,后来又在华夏网上听到了说它不是一种化生而是出血的一种表现。现在我是两种说法都接受。
我认为两种观点都有道理,但谁对谁错我觉得不重要了。我现在是这样理解“是一种化生,大部分出血引起”
liziqiang88 离线
Not cancer yet! Whenever you see stroma in between glands, it is not cancer yet! You must see an relatively large area of glands without stroma in between to call it cancer. Two glands without stroma in between is not cancer. Inflammatory cells has nothing to do with cancer. You see neutrophils all the time with stromal and epithelial breakdown, not even infection! Those cells are very atypical, some people may call this EIN-endometrial intraepithelial neoplasia, something like a mini cancer. I would call it complex hyperplasia with severe cytologic atypia. I would suggest a formal dilatation and curettage( if this is only a biopsy) to rule out carcinoma, and also recommend vigirous treatment and close follow-up.
Sorry i type chinese very slowly and also not familiar with the chinese versions of some terminology.