good case

 非常钦佩Dr.zhao 和Dr.shen！

对于每个病例，老师都做了精彩的讨论，从形态学、免疫组化，以及相关的治疗指导，都做了详细的阐述。对于一争议的病例，引用文献、论据，诠释观点，讨论到底，彻底明了每一例，使我们受益匪浅！这种严谨工作学习方式，值得我们借鉴！

谢谢Dr.cqzhao!

大致翻译如下：

 thank for sharing your comment and opinion. We are learning

（abin译：谢谢分享您的评论和观点。我们都在学习。）

• It has been shown that distant metastasis pattern of "invasive ductal carcinoma with lobular features" such as seen in this case,  is more similar to invasive lobular carcinoma (more bone or pleura), but their prognosis is similar to ductal carcinoma. We should read any publications with a open and critical mind.  
• 2nd of all, the recognition and report the diagnosis will further alert the pathologists to think about the primary site of breast if a metastatic carcinoma showing pattern of infiltration of single or rows of cells. As a matter of fact,

• Some hospital will treat the sentinal lymph node similarly to that of "pure infiltrating lobular carcinoma", i.e. cut H&E levels and perform pan-CK stains if an initial H&E evaluation of nodes is negative.  

• If "invasive ductal carcinoma with lobular feature" will confuse the clinician, so will many other terminology - tubular, mucinous, "basaloid" etc. Plus pathologists often and can make contribution to recognize new "entities" or "variant" to guide the treatment and surgeons and oncologists. 

• （主要内容翻译如下：

  许多（人）开始报道这种特殊“形态学特征”，我理解其原因有二：
  像这例一样，已报道“伴小叶癌特征的浸润性导管癌”的远处转移类型与浸润性小叶癌更相似（多累及骨和胸膜），但其预后与导管癌相似。
  其次，如果转移癌呈单个细胞或单行浸润时，这种诊断的识别和报告会进一步提醒病理学家考虑乳腺原发部位。事实上，对于这种病变，一些医院处理前哨淋巴结的方式与“纯的浸润性小叶癌”相似，即：如果最初的淋巴结HE切片阴性，需要深切并作CK染色。__abin）

 We can see different oppinions in publications for most of the topics.

For above case we all agree the tumors have the nature of ductal origin. We call lobular feature just becases the tumor cells invade the stroma in linear strands with growth pattern like classic lobular ca. We can call mixed ductal and lobular ca for this case, If it was the time when pathologists made dx based on the morhology only. Now we pass over this stage.

 In other words, the terminology "Invasive ductal carcinoma with lobular feature" will confuse clinicians and make no any add to patients' treatment. So I still think it is better just to call inv ductal ca.

Of cause, all hospitals or institutes have their own tradition for these diagnosis terms.

For your reference.

Thanks

I have a different opinion.  I think it is very reasonable to make a diagnosis of "invasive ductal carcinoma with lobular features'.  There are publication and I personally believe that this type of cancer (carcinoma with combined morphologic and immunophenotyical) does exist.  

It is not a good diagnosis. Just call invasive ductal carcinoma

（abin译：这样诊断不好。直接称为浸润性导管癌吧。）

谢谢笃老师的指导！非常赞成您的观点！

免疫组化是在外院做的，他们报的结果。