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- B1727Breast encapsulated (intracystic) papillary carcinoma (cqz 3)
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图2
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图4
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I transfer this case from previous breast lesion. Hope more people see and join in the discussion:
（这个病例是从以前一个乳腺病例的帖子中转移过来的。希望更多人看到并且参与讨论。）
50 year women with breast mass
（女，50岁，乳腺肿块）
Fig 1 is a low power view of the lesion, where the overlying skin adjacent to the nipple is seen overlying a well-circumscribed mass.
（图1 低倍，乳头附近的皮肤下方见界清肿块）
Fig 2 mid power
Fig 3 Hihg power
Fig 4 p63 stain
What is your diagnosis or differential dx?
（您的诊断和鉴别诊断？）
标签：乳腺囊内乳头状癌 EPC
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本帖最后由 于 2009-02-17 09:43:00 编辑
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×参考诊断
囊内乳头状癌
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zhoubingjuan 离线
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Great. Most of u got the answer. Both of the cases are intracystic papillary carcinoma.
The H&E slide in the second case is not very good. You can see it more clearly in the p63 stained slide, which demonstrates papillary glandular structure. The pattern is not like solid papillary ca. I discuss a lot about the features of solid papillary ca (SPC) in one case recently. But I cannot find it now.
Intracystic papillary ca is called encapsulated papillary ca (EPC) now. Microscopically, it is characterized by one nodule of papillary ca surrounded by a thick fibrous capsule. The histologic apperance of the papillary proliferation can have any of the features of papillary DCIS. Myoepithelial cells are not present in the papillae of EPC, same as in papillary DCIS. However, in contract to papillary DCIS, myoepithelial cells are also absent in the periphery of the tumor nodule of EPC. This is the most important feature of EPC. See my above two cases. Currently most people consider the lesion is a vaiant of papillary DCIS, even though some think it may represent a low grade invasive carcinoma. Studies have demonstrate that EPCs have excellent prognosis with adequate local therapy alone. One of our fellows recently demonstrated that collagen IV stain may be useful for differential dx of EPC. The stain is positive in EPC, but negative for invasive carcinoma.
| 以下是引用cqzhao在2008-11-18 11:42:00的发言并翻译：
非常好。大多数回答对了。两例都是囊内乳头状癌 第二例的HE切片不太好，在p63染色可以看得更清楚，它显示了乳头状结构。结构不像实体性乳头状癌（SPC）。最近我在一个病例中详细讨论了SPC，但现在找不到了（回赵老师，在这里http://www.ipathology.org.cn/forum/forum_display.asp?classcode=129&keyno=102920&pageno=2 ）。 囊内乳头状癌现称为包膜型乳头状癌（encapsulated papillary ca，EPC）。镜下特征为一个乳头状癌结节围绕一层纤维性厚包膜。乳头状增生的组织学表现可能具有乳头状DCIS的任何特征。EPC的乳头中肌上皮细胞不存在，与乳头状DCIS相同。然而，与乳头状DCIS相比，肌上皮细胞在EPC肿瘤结节的周围也不存在。这是EPC最重要的特征。见上二例。目前大多数人认为这种病变是乳头状DCIS的变型（亚型），尽管也有人认为它代表一种低级别的浸润性导管癌。研究证实，EPC预后非常好，仅需要适当的（足够的）局部治疗。我们的一个fellow最近证实胶原IV染色有助于EPC的鉴别诊断。EPC阳性，浸润癌阴性。 |
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