A practical approach to intraoperative consultation in gynecologica...
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):353-65. doi: 10.1097/PGP.0b013e31815c24fe.A practical approach to intraoperative consultation in gynecological pathology.1, .1Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.AbstractThe use of frozen section in gynecological pathology has not been emphasized in the literature to the same degree as in other surgical fields. This review focuses on the indications, contraindications, and limitations of frozen-section diagnosis specific to the female genital tract. An intraoperative consultation in gynecological pathology is indicated (a) to ensure that the tissue sampled is adequate for diagnosis, (b) to determine the nature of a disease process, (c) to plan for appropriate ancillary studies, (d) to determine tumor spread, and (e) to assess the margins. In the ovary, mucinous tumors in particular may present a challenge and potential for misdiagnosis at the time of frozen section. It is important to determine the nature of the ovarian involvement, as tumor size greater than 10 cm or bilateral involvement strongly suggests a metastatic process. Also, the distinction between ovarian carcinoma and tumors of borderline malignancy may be difficult in a limited sampling. In the germ cell category, an important distinction is that of a dysgerminoma from a large cell lymphoma, due to different treatment regimes. Pregnant and postpartum women present a unique challenge as the effects of high levels of pregnancy-related hormones may result in lesions that closely mimic malignancy. Although intraoperative frozen section should be discouraged as a primary diagnostic procedure for endometrial carcinoma, it can be very helpful to identify those patients who are at risk for extrauterine spread and who may require lymphadenectomy. Analysis of a cone biopsy of the cervix by frozen section may be warranted particularly if the previous biopsy showed equivocal stromal invasion, an uncertain depth of invasion, there are issues
however, the process is time consuming and may compromise the permanent sections if the lesion is very small. Frozen-section diagnosis in squamous cell carcinoma and in Paget disease of the vulva is infrequently requested as these entities are multifocal resulting in an inaccurate frozen-section diagnosis. Lastly, intraoperative evaluation of lymph nodes including the role of sentinel lymph nodes is discussed.PMID:
[PubMed - indexed for MEDLINE]
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International Journal of Gynecological Pathology Official Journal of International Society of Gynecological Pathologists Description: International Journal of Gynecological Pathology (IJGyP) is the official journal of the International Society of Gynecological Pathologists (ISGyP), and provides complete and timely coverage of advances in the understanding and management of gynecological disease. Emphasis is placed on investigations in the field of anatomic pathology. Articles devoted to experimental or animal pathology clearly relevant to an understanding of human disease are published, as are pathological and clinicopathological studies and individual case reports that offer new insights. Members of the ISGyP receive the journal as a benefit of their membership. Now available on the iPad, the IJGyP app optimizes the best in tablet technology to enhance a print-like reading experience with seamless multimedia integration, easy navigation and more. Key features: -Easy-to-read full-text articles that can be shared via email or social media -Adjustable text sizing with pinch and zoom -Engaging multimedia videos, images, and supplements -Choose to store or delete downloaded issues -Speedy issue browsing capability via Quick View -Easily page through abstract summaries -Convenient notification when a new issue is available -Link
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可能是基底细胞增生或不成熟鳞状化生，要排除异性增生，最好做一下标记。
尖锐湿疣和低级别宫颈上皮内瘤变，这些低危型HPV（6和11型）感染的相关性疾病标本，p16 (INK4a)免疫组化染色只显示点状弱阳性。
高危型HPV（16和18型）阳性的宫颈活检标本p16 (INK4a)免疫组化染色呈强阳性，低危型HPV（6和11型）阳性的活检标本p16 (INK4a)免疫组化染色呈局灶性的弱阳性，中危型HPV（31、33和51型）阳性的宫颈活检标本p16 (INK4a)免疫组化染色也多有表达。
总之，p16 (INK4a)免疫染色可以很好的标记出皮高危型HPV感染相关性疾病，有助于提高宫颈上皮异形增生和**反应性疾病的诊断准确性。它在鉴别不成熟性鳞状上皮化生和高级别宫颈上皮内瘤特别有帮助，这两种疾病单靠形态学很难鉴别。
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宫颈慢性炎伴鳞化
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