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- 急!请各位老师会诊,宫颈组织
国庆长假，翻译团队的人不在家，197值班为楼主客串一回。呵呵。不当之处，请两位老师指导。谢谢！
喻老师回复：同意上述观点。至少HSIL累腺，疑鳞癌（高倍下胞核异型明显且见异常角化）。照片很清晰，但无低倍视野，且未能显示表皮-真皮交界，而这些对判断是否浸润至关重要。
在美国，当诊断CIN时也就相当于诊断了HPV感染，因为几乎所有的CIN都是HPV感染所致，也因此人们才接受HPV疫苗。我们从来不这么诊断：“CIN2，疑HPV感染。”外阴上皮内瘤变和宫颈上皮内瘤变不太一样，小部分外阴上皮内瘤变并非由HPV感染所致。
Dr.Zhao回复：同意上述观点。CIN3累腺。需要看到表皮-真皮交界处以查看是否存在间质浸润。推测认为所有的CIN2以上病变都源于高危型HPV感染。宫颈鳞癌病例中的95～100%和腺癌病例中的80～92%都能查到HPV。经第二代杂交捕获实验（在美国仅此法获得FDA批准）的结果表明：细胞学报告为HSIL的病例中之93～100%的患者能显示高危型HPV阳性。
- “人生没有彩排，每一天都是现场直播”
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Agree with above. CIN3 with glandular involvement. Need to see the juction to check if stromal invsion is present. Suppose all CIN2+ squamous lesions are caused by high risk HPV. HPV is detected in 95-100% cervical squamous cell carcinomas and in 80-92% cervical adenocarcinoma. HR HPV is detected in 93-100% women with HSIL cytology are positive for HR HPV by Hyrid Capture II test (only HR HPV test approved by FDA in the US).
Agree with above. At least HSIL involving glands, suspicious for squamous cell carcinoma (severe nuclear atypia and abnormal keratinization in high power fields). Nice photos but you didn't show us the epithelium/submucosal junction and low power fields which are crucial to judge invasion.
In US, whenever you diagnose CIN, you also diagnosed HPV infection, because almost all CINs are caused by HPV infection, that is the basic concept behind HPV vaccine. We can never give a report like; CIN 2, suspicious for HPV infection. Vulvar intraepithelial neoplasia (VIN) is different from CIN; a small portion of VINs is not caused by HPV infection (differentiated VIN).
