浸润性小叶癌中见到两个小叶/导管增生性病变。每个病变不超过一个4倍视野。拍摄时使用的最低倍为10倍。

它们出现在同一张切片中。

图1 HE 10X

图2 HE 20X

图3 CK5/6 20X （背影太强，深棕色视为阳性，土黄色视为阴性）

图4 34BE12 20X

图5 E-Ca 20X

图6 ER 20X

图7 PR 20X

UDH

UDH generally displasys either diffuse or a mosaic pattern of positivity with high molecular weight cytokeratins[1963,2126] such as CK5, CK1/5/10/14 (clones CK34BetaE12 or clone D5/16 B4).

____from WHO 2003, Pg65

ADH----immunoprofile

Nearly 90% of ADH are negative for high molecular weight cytokeratins 1/5/10/14 (clones CK34BetaE12 and D5/16 B4), an important feature in separating ADH from UDH[1963,2126].

____from WHO 2003, Pg67

Hormone receptor expression

There is agreement that nearly all examples of ADH express high levels of ER in nearly all the cells[72,1301,2667]. The relationship between ER positive cell numbers and patient age, as found in normal breast epithelium, is lost in these ADH lesions, indicating autonomy of ER expression or of the cells expressing the receptor[2667].

____from WHO 2003, Pg71

Ref

73. Allred DC, Mohsin SK, Fuqua SA, et al. Histological and biological evolution of human premalignant breast disease. Endocr Relat Cancer, 2001, 8:47-61

1301. Iqbal M, Davies MP, Shoker BS, et al. Subgroups of non-atypical hyperpasia of breast difined by proliferation of oestrogen receptor-positive cells. J Pathol, 2001, 193:333-338 

1963. Nagle RB, Bocker W, Davis JR, et al. Characterization of breast carcinomas by two monoclonal antibodies distingushing myoepithelial from luminal epithelial cells. J Histochem Cytochem, 1986, 34: 869-881

2126. Otterbach F, Bankfalvi A, Berger S, et al. Cykeratin 5/6 immunohistochemistry assists th edifferential diagonsis of atypical proliferation of the breast. Histopathology, 2000,37:232-240

2667. Shoker BS, Jarvis C, Sibson DR, et al. Oestrogen receptor expression in the normal and precancerous breast. J Pathol, 1999, 188:237-244

PS：

We are not access to the original papers in China for further study. What a pity!

Thanks!

abin

 It is true that there were some studies about IHC in adh, dcis, udh 7-8 years ago. Now few people use them in the US because they are not reliable. All papers you mentioned were published long time ago.

abin译：

确实，7-8年前有研究IHC对ADH/DCIS/UDH的鉴别。现在美国几乎没有人再使用了，因为它们不可靠。你上面提到的论文都是很久前发表的。

谢谢Dr.cqzhao和Dr.Stenvenshen帮助纠正了观念。

上网查了，最近确实没有关于免疫组化鉴别UDH/ADH/DCIS的有价值的论文。2003版的WHO蓝皮书在国内仍然是“圣经”（国内知识更新好慢）。

不断学习，缩小差距，路还很长啊……

顶

 请问各位老师ck５／６在良恶性病变中到底有没有价值？

  轻松一下。上传本例的目的是学习与讨教。

第一楼，我认为是UDH+ADH

第二楼，我认为是ILC+LCIS