本帖最后由 pathology 于 2017-9-11 19:03 编辑
本周病例（2017.4.24—2017.5.7）
1、你考虑什么诊断？
混合性子宫内膜样癌（子宫内膜样+浆液性癌）（Mixed endometrial carcinoma (Endometrioid and serous carcinoma)）
Mixed endometrial carcinoma, as defined by the WHO, is composed of two or more different histological types of endometrial carcinoma, at least one of which must be type II. The second component must constitute at least 5% of the tumor. The most frequently encountered combination is endometrioid carcinoma and serous carcinoma.
In this case, the edometrioid carcinoma component has classic histology: stratified columnar cells lining complex tubules with a smooth luminal border in a background of scant stroma ("back to back" arrangement). The serous carcinoma component consists of highly atypical, mitotically active cells with scant cytoplasm and a high N/C ratio arranged in a tubulo-papillary pattern with a scalloped apical border. Detached tufts of cells are also seen.
Recognition of a type II component is important and must be mentioned when found even in small biopsies. As little as 5% serous component may adversely affect patient outcome, although a definitive estimate for each component is only possible in an excisional specimen (hysterectomy). Rigorous criteria must be used for diagnosis as endometrioid carcinomas may demonstrate papillary arrangements, and occasionally serous carcinomas may demonstrate glandular architecture. High grade nuclear features in association with glandular architecture should raise the possibility of a serous component. Precursor lesions like serous endometrial intraepithelial carcinoma or atypical endometrial hyperplasia may also raise suspicion of a mixed carcinoma. Ancillary studies may be helpful.
2、需要做什么鉴别诊断？
子宫内膜样癌I型、子宫内膜样癌II型、子宫内膜非典型增生等
3、本病预后如何？
预后取决于高级别的成分，FIGO分期是最重要的预后因素。
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本期病例比较典型，组织学非常有特点，结合临床病史、组织学形态，辅以免疫组化则不难诊断。综合回答思路，wqz、fusuyong加一分，xhyong、HSW小雨无声鲜花鼓励！
希望大家一如既往的支持病理每周一题， | 
发表于 2017-4-25 18:53
哥们
发表于 2017-4-26 22:25
