50-55 y/f breast lesion

Fig 1-3 H&E

Fig 4 myoepithelial stain (p63)

You dx or differential dx

To 天山望月 , Abin and 197:

Thank for your analysis.

 I got these photos from one of our GYN/breast fellows who took the figures for publication. I do not have high power photos. Please open the second and third H&E photos to see if there are some similarities to and difference from the photos in my third cases.  Then please think about your diagnosis or differential dx. In term of discussion, differential diagnoses are very important.

In fact it is a very interesting and rare case. Wonder why so few people join the discussion.   Do not know I should share with you some interesting cases or just normal or common cases. I do not know how good our pathologists' diagnostic skills are in China.  

 abin提到的：需要鉴别其它类型的乳头状肿瘤和导管内增生性病变。

复习陈国章教授的资料：

 http://www.ipathology.cn/forum/forum_display.asp?keyno=106223

又学习链接的一例，通过对比，觉得是实体型乳头状癌。

 实性或近似实性，夹杂粘液样成分--->提示实体型乳头状癌，见脂肪浸润灶。可有神经内分泌分化。

已有浸润则不存在鉴别诊断问题，否则需要鉴别其它类型的乳头状肿瘤和导管内增生性病变。

谢谢Dr.cqzhao，期待您讲解！

 上皮源性恶性肿瘤——癌；

就近的原则：考虑乳腺癌的继发灶，其他的转移癌尚未能除外。

谢谢cqzhao老师！

瘤细胞呈小腺管或梁梭状排列，浸润脂肪组织，感觉有菊形团样结构，梁梭和间质之间有点裂隙（看不太清），P63阴性，考虑恶性，1、需要标记鉴别神经内分泌的肿瘤，小腺管太密集了2、微腺管腺病是不是可以排除？

是否请cqzhao再给点高倍图，并期待免疫组化和老师的精彩讲解！