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- Anterior Mediastinal FNA
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译上楼：Those are good differential diagnosis. 这些鉴别诊断提的非常好，This was a case I was on cytology service last week and the clinician did a FNA on this 3.5 cm anterior mediastinal mass.患者是上周我手上的病例， 临床只做了前纵隔针吸活检，包块大小为3.5CM，Patient has no history of other malignancy.患者没有肿瘤病史。I had a similar differential as yours on the rapid read. 我和大家快速读片意见一样，I worried that the cell block will not be enough for immunostains, 我担心该患者标本做出来的细胞块不足以做免疫组化，I suggest the clinician to do a biopsy. 因此我建议临床做活检。On the cytology, I favor a malignant germ cell tumor.单纯根据细胞学结果我倾向于恶性生殖细胞肿瘤。I will keep you posted on the follow-up.有了结果我继续粘帖。供大家高兴。
Those are good differential diagnosis. This was a case I was on cytology service last week and the clinician did a FNA on this 3.5 cm anterior mediastinal mass. Patient has no history of other malignancy.
I had a similar differential as yours on the rapid read. I worried that the cell block will not be enough for immunostains, I suggest the clinician to do a biopsy. On the cytology, I favor a malignant germ cell tumor.
I will keep you posted on the follow-up.
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本帖最后由 于 2009-01-06 23:01:00 编辑
谢谢陈博士！
好病例！值得推敲！
形态特点：淋巴细胞、中性粒细胞、红细胞背景上，散在、网状、镶嵌状（图3下方）排列的上皮样瘤细胞，大小不等，多边形或不规则形，胞浆丰富，红染，有胞浆突，核圆形、卵圆形，核膜不规则，核染色质稍粗，异型性明显，隐约见核仁，可见核沟、核内包涵体，易见双核、多核瘤细胞。
恶性肿瘤。根据部位、背景、上皮样细胞，考虑胸腺或淋巴结病变：1、胸腺癌？2、淋巴结转移癌(肺、甲状腺、食管等）3、淋巴瘤（大B细胞型）？4、神经内分泌肿瘤？再考虑生殖细胞肿瘤？
IHC标记：CK-pan, CK18, CK7, EMA, LCA, CD20, CD10, CD30, PLAP, TTF1, Tg, Calcitonin, Syn, CgA, Ki67
呵呵，需要太多了，可以先标记几项考虑的方向，然后再标。
不知当否？请专家赐教！谢谢！
- 广州金域病理
