胆总管 可疑腺癌？讨论病例【中美加非妇科病理交流群病例228】

小王

李斌
女，63岁，胆总管下段狭窄刷检















荆欣
Adenocarcinoma @李斌上海徐汇 
Loss of normal honeycomb arrangement, nuclear crowding, nuclear enlargement with high N/C ratio, marked variation in nuclear size ( 4:1 ratio within the same group) and shape, prominent nucleoli. The features are consistent with adenocarcinoma.

程宁莉
@李斌上海徐汇 I do not see the obvious features of adenocarcinoma. The honeycomb architecture is slightly disturbed. The nuclear variation in  size is not so obvious either. There is air drying artifact at the edge which does not so count for the variation. I would not call it adenocarcinoma straightly. Also any more clinical history and clinical procedure done?

李斌
@程宁莉 上海国际医学中心 临床就是狭窄，造影有充盈缺损，他们考虑恶性

曹箭
@李斌上海徐汇 也许是分化好的腺癌，但直接报还是不太敢？

程宁莉
@李斌上海徐汇 我做过一个冰冻，临床也是这样充缺和肿块，结果就是慢性炎狭窄和石头

张学东
从结构和染色质来说，符合恶性腺癌，片子有点退变

李斌
@程宁莉 上海国际医学中心 有石头

张学东



这个是个乳头

程宁莉
@李斌上海徐汇 除非你show me some irregularity like above picture



汪俊
报可疑腺癌吧

程宁莉
@李斌上海徐汇 恶性不够at all.


张松林
@李斌上海徐汇 我觉的这个病例应该保守一点，我没看到明显细胞的异型性。另外，这个是刷片，癌细胞应该是会有较多单细胞而不应该都如此黏附。

程宁莉
@张松林 UT Houston 





荆欣
@张松林 UT Houston  I completely understand why you folks don’t want to call it straightforward. Nonetheless, it is common to see  loose, disorganized clusters/ groups with or without single cells in bile duct brushing of adenocarcinoma based on our group experience.

张松林
@荆欣@Univ. of Michigan 我觉的胆管刷片是要谨慎一点，上皮细胞可以因为修复反应出现一些异常形态。谢谢你分享你们的一些经验。