請問子宮頸HPV病理報告問題的解答-婦產科

請教子宮頸HPV病理報告問題？

黃醫師您好,我在今年1月抹片檢查正常,自費HPV羅氏(Cobas)DNA test卻驗出高危HPV16型,後來切片作病理組織檢查,報告如下:臨床診斷: HPV DNA(+)type16；R/O CIN 1病理診斷報告Diagnosis: Cervix uteri, punch biopsy, showing adenocarcinoma in situ.顯微鏡Micro:The cervical biopsy shows dysplastic cells in the transformation zone, either in compact, sheet-like arrangement along the surface epithelium or confined to the glands with focal cribriforming in normal lobular pattern. the dysplastic cells are characterized by high N/C ratio, pleomorphic and hyperchromatic nuclei, crowding but loss of polarity, and mitotic figures. The immunostain of P40 shows negative staining of the dysplastic cells in sheet-like arrangement, including of no squamous cells differentiation.診所醫師看完病理報告,說我是子宮頸原位腺癌,幫我轉診大醫院做子宮頸椎狀切除,切除後的組織又送檢體去作病理檢查,病理報告如下:Uterus, cervix, LEEP, adenocarcinoma in situ(AIS)Uterus, endocervix, curettage, suboptimal specimenThe specimen is submitted in two separated bottles labeled as A:LEEP and B:endocervical curettage, respectively, fixed in formalin.Specimen labeled as A consists of one tissue fragment 3.1x1.4x1.4cm. Grossly, it is tan, white and elastic.B consists of tiny aggregated tissue fragment 0.1x0.1x0.1cm. Gossly, they are yellowish white and soft.All for sections and labeled as: Jar 0A1-6:LEEP and B:endocervical curettage顯微鏡: the sections A1-6 reveal cervical tissue fragments with focal cauterizing artifacts, showing atypical in glandular structures. Occasional presence of mitosis or nucleoli can be also noted. No evident foci of stromal invasion can be seen in these sections. Immunohistochemically, these cells are positive for p16, but negative for ER. Adenocarcinoma in situ(AIS). The section margin is close.The section B shows blood clot and a few cervical epithelial cells. It is inadequate for evaluation.辛苦醫師看完以上這一堆病理報告, 因為我的主治醫師沒有仔細講解, 所以麻煩請黃醫師幫我解惑以下一些問題:1.因為我被驗出高危HPV type16,第一份切片病理報告又是AIS,所以就算我是CIN 1,也需要緊急直接作LEEP錐狀切除,而不能容後追蹤觀察, 是嗎?2.第二份病理報告中,immunohistochemically免疫組織化學染色法呈現p16(+),ER(-),表示我得的是Endocervical adenocarcinoma子宮頸腺癌, 而非 Endometrial endometrioid adenocarcinoma子宮內膜樣腺癌, 是嗎?3.若問題2的答案是正確的話, 表示我查過的網路資訊正確,也就是p16,ER,vimentin, CEA 四種用來區分Endocervical adenocarcinoma子宮頸腺癌 與 Endometrial endometrioid adenocarcinoma子宮內膜樣腺癌。
那第一份病理報告中,, 免疫染色immunostain的P40染色結果是negative, 這是為了分辨哪2種病變細胞或癌症嗎?4.第二份病理報告中, A檢體最後的那句話 "The section margin is close."是什麼意思? 是病灶已經在切下的錐狀邊緣, 所以其實切得不夠?5.第二份病理報告中, B檢體是子宮內膜刮下之物,但卻因為取樣不佳,無法檢驗,所以也不能判斷HPV是否已經感染到我的子宮內膜了, 對嗎?抱歉,很多問題,辛苦黃醫師工作一天後還要回答網路民眾的疑惑,感謝您!!