子宫活检-宫颈腺癌 - 华夏病理网论坛

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子宫活检-宫颈腺癌

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楼主发表于 2006-12-17 14:21|举报|关注(1)
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53 years old female with abnormal vaginal bleeding. No previous history. She underwent an endometrial biopsy. All tissue in her biopsy looks like what presented in the pictures shown here. What is your diagnosis? What other stains/studies do you need if necessary?

53岁,女,阴道不规则出血, 图为子宫活检(所得到的所有组织都是这样),你的初步诊断是? 如果有必要,你还需要什么免疫组化和/或其他方法来确诊?

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本帖最后由于 2007-05-11 21:50:00 编辑

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宫颈腺癌

曹大夫离线: 帖子：331; 粉蓝豆：510; 经验：429; 注册时间：2006-09-28; 加关注 | 发消息

1 楼发表于2007-03-22 11:30:00举报|引用
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诊断任何一个肿瘤形态学仍然是基础, 离开了形态学的免疫组化是没有意义的, 免疫组化只是用来确认你的诊断. 并且宫颈adenocarcinoma p16 弥漫性阳性(要求100% 肿瘤细胞) 应该用原位查交的方法来确认 (如果可能的话). 有些肿瘤是有些细微的特征的, 这些细微地特征有时就指引方向.

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2 楼发表于2007-01-29 13:22:00举报|引用
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本帖最后由于 2007-01-29 13:27:00 编辑

以下是引用shihuaiy 在2007-1-28 22:12:00的发言：

谢谢曹大夫的好例子和精彩讲解，学习了。想请教曹大夫一个问题：

因为文献上确实报道过少数子宫内膜样腺癌可以P16弥漫阳性，HPV也可以在部分子宫内膜样腺癌阳性（尤其是伴有鳞状化生的例子），不知曹大夫是否遇到过这样的情况。另外，此例活检的确切部位是那里，有无切除标本的相关信息？谢谢。

McCluggage, W Glenn FRCPATH Re: Distinction of Endocervical and Endometrial Adenocarcinomas: Immunohistochemical p16 Expression Correlated With Human Papilloma Virus (HPV) DNA Detection. American Journal of Surgical Pathology. 28(7):974, July 2004.

这可能是误诊了uterine cervical adenosquamous cell carcinoma as endometrioid adenocarcinoma with squamous differentiation. Therefore one can report that endometrioid adenocarcinoma esp those with squamous differentiation have HPV. I asked my advisor Dr. Robert Kurman about this question. He thinks thoses reported cases are misdiagnosed cases.

In addition, we have seen several cases in which in cervix only in situ adenocarcinoma was seen in the entirely submitted specimen (cervix and uterine body) but the carcinoma have invaded into endometrium (replacing endometrial surface and invading the endometrial stroma). You can image if you only submitted 2 sections of the cervix (anterior and posterior), you will miss the adenocarcinoma in situ of the endocervix. Then one can call the carcinoma in the endometrium as endometrial origin and HPV in situ hybridization will be positive.

The case I presented here came from endometrial curettage. The purpose of this case is to show people that carcinoma from endometrial biopsy and curettage is not necessarily from endometrium. Another point I want to make is to show people endocerical adenocarcinomas sometimes can retain ER and PR expression. This case had hysterectomy proven endocervical carcinoma later.

P16弥漫阳性is also a very tricky description. How much do you need to call P16弥漫阳性. For us (at Johns Hopkins Hospital) we need 100% tumor cells to be positive.

以下是引用shihuaiy 在2007-1-28 22:12:00的发言：

谢谢曹大夫的好例子和精彩讲解，学习了。想请教曹大夫一个问题：

因为文献上确实报道过少数子宫内膜样腺癌可以P16弥漫阳性，HPV也可以在部分子宫内膜样腺癌阳性（尤其是伴有鳞状化生的例子），不知曹大夫是否遇到过这样的情况。另外，此例活检的确切部位是那里，有无切除标本的相关信息？谢谢。

McCluggage, W Glenn FRCPATH Re: Distinction of Endocervical and Endometrial Adenocarcinomas: Immunohistochemical p16 Expression Correlated With Human Papilloma Virus (HPV) DNA Detection. American Journal of Surgical Pathology. 28(7):974, July 2004.

这可能是误诊了uterine cervical adenosquamous cell carcinoma as endometrioid adenocarcinoma with squamous differentiation. Therefore one can report that endometrioid adenocarcinoma esp those with squamous differentiation have HPV. I asked my advisor Dr. Robert Kurman about this question. He thinks thoses reported cases are misdiagnosed cases.

In addition, we have seen several cases in which in cervix only in situ adenocarcinoma was seen in the entirely submitted specimen (cervix and uterine body) but the carcinoma have invaded into endometrium (replacing endometrial surface and invading the endometrial stroma). You can image if you only submitted 2 sections of the cervix (anterior and posterior), you will miss the adenocarcinoma in situ of the endocervix. Then one can call the carcinoma in the endometrium as endometrial origin and HPV in situ hybridization will be positive.

The case I presented here came from endometrial curettage. The purpose of this case is to show people that carcinoma from endometrial biopsy and curettage is not necessarily from endometrium. Another point I want to make is to show people endocerical adenocarcinomas sometimes can retain ER and PR expression. This case had hysterectomy proven endocervical carcinoma later.

P16弥漫阳性is also a very tricky description. How much do you need to call P16弥漫阳性. For us (at Johns Hopkins Hospital) we need 100% tumor cells to be positive.

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曹大夫离线: 帖子：331; 粉蓝豆：510; 经验：429; 注册时间：2006-09-28; 加关注 | 发消息

3 楼发表于2007-01-27 12:59:00举报|引用
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答案: 宫颈腺癌.

这个肿瘤是HPV 原位杂交阳性(HPV１６）．　Ｐ１６　免疫染色也diffuse阳性．

宫颈腺癌绝大多数是ER和PR阴性,但是这个肿瘤是阳性. 但是形态学上有一点提示: 分裂相非常靠近腺体的腔面(luminal surface) (abundant mitotic figures near the luminal surface of the neoplastic glands).

我们一般不用CEA和VＩＭＥＮＴＩＮ，而是用Ｐ１６　（必要时加ＨＰＶ原位杂交），　ＥＲ，ＰＲ．　

宫颈腺癌是Ｐ１６diffuse + (HPV+), ER-,PR- (不是所有的）. 少数则ER+,PR+ (比如这个病例).

宫体高分化内膜癌: P16 patchy positive (有些地方阳性,有些地方阴性)(HPV -), ER+, PR+ (不是所有的是ER+, PR+)

1: huangjy

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