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| 名称： | |
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- 宫颈赘生物(已有最后结果)
| 姓 名： | ××× | 性别： | 女 | 年龄： | 37 |
| 标本名称： | 宫颈赘生物 | ||||
| 简要病史： | 发现宫颈赘生物一天 | ||||
| 肉眼检查： | 宫颈赘生物1*1*1厘米 | ||||
名称：图1
描述：图1
名称：图2
描述：图2
名称：图3
描述：图3
名称：图4
描述：图4
名称：图5
描述：图5
名称：图6
描述：图6
名称：图7
描述：图7
标签：宫颈 赘生物
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本帖最后由 于 2008-08-01 23:37:00 编辑
朱正龙
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jiangxiaoyu 离线
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| 以下是引用墨宝在2008-7-29 14:19:00的发言：
To my opinion, it is much more than condyloma accumulatum. It has the configuration of condyloma, like finger-like projections (figure 2 is cross-section of the fingers), high up blood vessels and koilocytes. But mitoses are very frequent and the last figure shows a mitotic figure almost on the surface. Nuclear atypia is also quite striking. Not very sure, but figure 4 appears to have an atypical mitosis; we call it tripod mitosis or Mercede Benz, if you like car. For this reason, i would report this as CIN 2. I wouldn't call this CIN 3 because i see squamous differentiation and there is still some cytoplasm. 试着翻译，不对请指正： 我认为这个不仅仅是尖锐湿疣。它有乳头状结构，象指状突起（图2是其横断面），富于血管及中空细胞。但是核分裂很多并且最后一图在表面亦可见核分裂相。核异型性也很显著。虽然不是很确定，但是图4可见异常核分裂相，我们叫它为“三脚架样核分裂”（不知翻译对否？），如果是喜欢车子的你也可以叫它“奔驰型核分裂”。由此，我倾向于报CIN2级，不报CIN3级是因为我看到一些鳞状上皮分化并依然可见一些细胞胞浆。（这句似乎有出入？意思可能为向鳞状上皮分化并且胞浆也较丰富吧？） 病人需要做宫腔镜和宫颈管取样（是指TCT或者活检吧） 请记住尖锐湿疣通常不会发展为癌而CIN2级有些时候会进展为癌。 谢谢！ |
翻译得好！谢谢！邀请你加入翻译团队！
“三极核分裂”（tri-三，pod极）
华夏病理/粉蓝医疗
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谢谢翻译，很好！colposcopy 是宫颈镜检查，用3-5%醋酸染白病灶，取活检。是TCT吗？endocervical sampling uses brush or spatula to curetting the endocervical canal, so high-up lesions and glandular lesions will be sampled. Endocervical curettings are important in older patients because their transformation zone moves up toward the endometrial cavity, and colposcopy many times doesn't reveal the lesion. It means, cervical biopsies would be negative, but endocervical curettings would be positive. Most cervical biopsies come with endocervical curettings in my practice.
CIN 1 encompasses condyloma in cervix. In another word, we don't hink there are condylomas not associated with CIN1. Same concepts for CIN and HPV effects. Almost all the CINs are caused by HPV infection. So we don't add "with HPV effect" after CIN.
Some older pathologists still separate HPV effects and CINs.
很高兴和大家交流。我们两边的practice可能不一样，互相学习。
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本帖最后由 于 2008-08-01 11:41:00 编辑
| 以下是引用mingfuyu在2008-7-27 0:50:00的发言：
To my opinion, it is much more than condyloma accumulatum. It has the configuration of condyloma, like finger-like projections (figure 2 is cross-section of the fingers), high up blood vessels and koilocytes. But mitoses are very frequent and the last figure shows a mitotic figure almost on the surface. Nuclear atypia is also quite striking. Not very sure, but figure 4 appears to have an atypical mitosis; we call it tripod mitosis or Mercede Benz, if you like car. For this reason, i would report this as CIN 2. I wouldn't call this CIN 3 because i see squamous differentiation and there is still some cytoplasm. She needs a colposcopy and sampling of endocervical canal. Remember condylomas usually don't progress to cancer and CIN 2 has some chance to progress to cancer. Thanks. |
同意！！！
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本帖最后由 于 2008-08-02 02:02:00 编辑
| 以下是引用wy1992在2008-8-1 23:36:00的发言： 高级专家会诊:鳞形细胞癌大细胞非角化型 |
意外！
我爱唱反调（用蚂蚁的话说，叫抬杠）：
无法理解，直接报癌？镜下图像连原位癌都不够。年龄：31岁，病变1cm。
汗！
以下是周先荣老师发的一例尖锐湿疣中的一张图。其中也有病理性核分裂（三极核分裂，tripod）。
记得老师讲过，“异型性”程度不是CIN分级依据。这些“异型性”特别是出现浅表部位者，是HPV引起的核退变。
本例觉得与普通尖锐湿疣不同之处：鳞状细胞巢分散在间质中，确实会担心鳞癌或高级别CIN累腺。但它也可能是尖锐湿疣平切引起的，一种人为假象。
本例最多报：尖锐湿疣伴CIN2。因组织较少，切面影响，鳞癌不能除外。
欢迎继续抬杠。但愿是我错了，这样可以更正自己的错误观点。
病例很好！非常感谢！
华夏病理/粉蓝医疗
为基层医院病理科提供全面解决方案，
努力让人人享有便捷准确可靠的病理诊断服务。
| 以下是引用abin在2008-8-2 1:39:00的发言：
意外！ 我爱唱反调（用蚂蚁的话说，叫抬杠）： 无法理解，直接报癌？镜下图像连原位癌都不够。年龄：31岁，病变1cm。 汗！ 以下是周先荣老师发的一例尖锐湿疣中的一张图。其中也有病理性核分裂（三极核分裂，tripod）。 记得老师讲过，“异型性”程度不是CIN分级依据。这些“异型性”特别是出现浅表部位者，是HPV引起的核退变。 本例觉得与普通尖锐湿疣不同之处：鳞状细胞巢分散在间质中，确实会担心鳞癌或高级别CIN累腺。但它也可能是尖锐湿疣平切引起的，一种人为假象。 本例最多报：尖锐湿疣伴CIN2。因组织较少，切面影响，鳞癌不能除外。 欢迎继续抬杠。但愿是我错了，这样可以更正自己的错误观点。 病例很好！非常感谢！
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To 13 floor: we may be using different criteria. It is well accepted that high-up mitosis (more than 1/2 the thickness of the epithelium) and atypical mitoses are supportive of HSIL (CIN 2 and 3). Striking nuclear atypia is also one of the evidences for HSIL. Dyskeratosis and apoptosis sometimes mimic mitosis and cannot be used to support HSIL.
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