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- Anterior Mediastinal FNA
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译上楼：OK!好， I think that everybody agrees that this is a malignant germ cell tumor. 我想大家都同意为恶性生殖细胞肿瘤，The question is how to subtype it.问题是如何分型？ The immunoprofile is not for typical seminoma and it fits more for embrynocarcinoma. 免疫表达不象精原细胞瘤更象是胚胎癌，But, the morphology favors seminoma. 形态象精原细胞瘤。My colleague (he is a very good pathologist)signed this case out as "malignant germ cell tumor, unclassifiable", 我的同事一位非常有能力的病理学家签发报告为末能分类的恶性生殖细胞肿瘤。I am not entirely agree with him. 我并不完全同意他，The ponit is that if the clinical management is no difference, then it should not matter.尽管临床处理没有明显的不同， I also agree with Dr. Zhao that we hope that our Chinese cytopathologists will be more proactive to participate in discussions. 我同意赵老师的意见，希望咱们中国的病理医生们应该积极的参加讨论，We as american trained Chinese pathologists working in the US are usually very busy in our daily diagnostic work and we spend our time here on the web is because we want cytopathology in China will catch up sooner than later. 我们做为受美国训练的华裔病理学家，每天工作非常紧张，花费时间在网上的目的是为了使中国的细胞病理进步更快。Thanks all for participation.感谢所有参加讨论的人。 |
中国的细胞学病理医生实在是太少了,很多医院包括很多三甲医院都没有专门看细胞学的病理医生,都是看组织学的病理医生兼看的,这样带来了很大的问题就是,看贯了组织片的病理医生是不会重视细胞学的,觉得细胞学很多是术前诊断风险有大,细胞学有不好看,所以很多医生都不是很重视细胞学.如果连病理科都不重视细胞学更何况让医院去重视呢?不过现在越来越多的人认识到了细胞学的重要性,就是因为是术前诊断,所以就更显得细胞学的重要了.不过我还是建议应该让专人学细胞学,做细胞学的专家.毕竟细胞学入门容易,要想提高需要非常丰富的经验积累.现在很多医院的细胞穿刺都是临床来穿的,在把片送到细胞室.个人觉得还是应该让我们自己的细胞学医生来穿刺,好处很多,第一看到了病人,通过交流可以大致了解病情,比临床医生写在申请单上的病情详细多了,第二,通过自己触摸肿块的大小,硬度,边界,可以大致在心中对肿块有个大致的印象,经验丰富后,触摸肿块就可以大致的知道是什么疾病了,第三,如果第一针没有穿到,可以马上穿第二,第三针,为病人节省了很多时间很精力,等等等等.
这只是我对目前我们细胞学的这种氛围一点寓见,说得不对请各位专家批评,
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本帖最后由 于 2009-02-02 21:25:00 编辑
想请教陈博士和赵博士几个问题，请赐教，谢谢！
1、甲状腺FNA多吗？
2、滤泡性癌诊断准确率怎样？
3、FNA主要依据细胞的异型性，没有组织学结构，而高分化甲状腺癌，需根据生物学行为，即有无浸润包膜或间质等，此类报告难发，不知陈博士和赵博士有何看法？
4、结节性甲状腺肿与腺瘤FNA能区分吗？怎样区分？
呵呵，问题多了点，因为我特喜欢穿刺细胞学，曾做过许多乳腺和甲状腺细针穿刺，想了解一下国外的情况，并期待多发些穿刺的病例，包括典型的或不典型的。
再次感谢！
- 广州金域病理
Your questions are good and some require a long answer. If you are going to The Chinese Cytology Meeting this March in Guangzhou, that will be very beneficial to you, Dr. Zhao and I are both going. There will be a pre-conference Thyroid FNA work shop organized by 金域, it will pretty much answer all your questions in detail.
1, yes, thyroid FNA is one of the most common FNA samples seen here at US. I see an average 6-10 thyroid FNA a day here.
2, Well-differentiated follicular carcinoma is generally not a cytologic diagnosis. But, the majority of thyroid carcinoma are papillary carcinoma anyway.
3, you are right.
4, Many colloid nodules can be separated from follicular neoplasms with confident. 粉蓝医疗科技（杭州）有限公司官网入口 however cannot.
