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文章阅读:Re: 第四届住院医生申请见习及面试辅导/老刀会
[同主题阅读] [版面: 医学职业] [作者:dokknife] , 2017年05月11日00:14:02
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发信人: dokknife (老刀_温柔一刀客), 信区: MedicalCareer
标  题: Re: 第四届住院医生申请见习及面试辅导/老刀会
发信站: BBS 未名空间站 (Thu May 11 00:14:02 2017, 美东)

5-10-2017 实习笔记

YJZ

1.今天我和J两个人都在NP lab实习,跟着L大致了解了urine cytology (ThinPrep,
liquid-based preparation method, including (1) cell dispersion; (2) cell
collection to the filter; and (3) cell transfer to a positively charged
slide under a slightly positive air pressure, slide is dropped immediately
into 95% ethanol fixative, followed by staining with Gills’ hematoxylin –
stain cell nuclei blue; orange green 6 – stain matured and keratinized
cells; and eosin azure – stain cytoplasm) and fluorescence in situ
hybridization (FISH), only sample processing and cell fixation ((1)
concentrate urine by centrifugation; (2) discard supernatant and wash with
PBS once; (3) discard supernatant and resuspend cell pellet; (4) fix
suspended cells with methanol/acetic acid (3:1) at -20°C for 30 min or
store up to 1 year). FISH is used to map the genetic abnormalities
associated with cancer.

2. 见到了prostate core biopsy embedding, section cutting and slide mounting
, 这个case的core biopsy 共包含A-L 12个cores, 我注意到prostate core biopsy的
操作与其他specimen不同,W老师embedding地很仔细,确保maximal tissue
representation, 而这之后的section cutting也是非常小心, 留取subsequent
sections of a single core at two different levels, 而ribbons between the two
levels 则留作immunohistochemistry 的检测。何老师解释说这样做的目的是为了确
保感兴趣的细胞团块的存在,特别是Atypical small acinar proliferation (ASAP)
存在,需要做IHC (AMACR P63 CK905) 时,这在上周五读prostate adenocarcinoma时
也提到过。何老师又告诉我们这种留取section的方法也同样使用于melanoma 以及
sentinel lymph node.

2. 下午何老师带来了Tubulovillous adenoma (TVA) 的slides 为我们讲解,与TA(腺
体光滑平整)不同的是 TVA中含有villous component (cells are crowded with
hyperchromatic nuclei,mucin production decreases/poor maturation,glands呈
尖角样)>25%。同时IHC(MSH6, CDX-2(for colon) , Ki67镜下见明显核大深染 )的染色
更加直观。并延伸讲解IHC的在实际工作中的其他用途,如遇到lung mass,首先判断是
原发还是转移,而这时可以同时测CDX-2, CK7, CK20, 如CDX-2阳性则可判断其为colon
cancer转移至lung。在colon adenoma中,villous adenoma and TVA have higher
malignant potential than TA. 也介绍了Juvenile polyps,类似hyperplastic polyp
,但间质inflammatory cells大量浸润,腺腔内见坏死,白细胞。

3. Duodenitis,镜下见intraepithelial neutrophils, villous atrophy (height :
width <1:16).

4.今天何老师带我们读片,告诉我们拿到一张slide,先用肉眼看大概有几片组织,染
色情况,养成良好的阅片习惯。我也想起上周五prostate adenocarcinoma读片时也是
这样引导着我们用肉眼看染色是否均一,而不均一的部分则可能提示病灶所在,再去镜
下证实。
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