Old women with a breast lesion.

Fig 1 20x

Fig 2-3: 100x

Fig 4-5: 200x

Fig 6. 400x

What are your differential diagnoses?

 谢谢Dr.cqzhao详尽的讲解，谢谢古城翻译！

我们实际工作中有三例，签发为“浸润性导管癌（3级），根据最近的研究进展，免疫组化结果亦符合乳腺基底细胞样癌。”

I suddenly notice that I made a typing mistake about the classification. Sorry about this.

I describe the concept again

Gene expression profiling studies identified various breast carcinoma classes with prognostic significance. The 5 distinct classes indentified by expression progiling include 1)luminal A, 2)luminal B, 3)Her2 overexpression, 4) basal-like, 5) normal breast-like. Remember this classification was based on the many gene expression resutls. We can call them as genotypes of breast cancer.

Genotypes of Breast Cancer and Correponding Immunophenotype Markers

Genotype                            Immunophenotypic Marker

Luminal A                            ER+, and/or PR+, Her2-

Luminal B                            ER+, and/or PR+, Her2+

Her2 overexpressing                  ER-, PR-, /Her2+

Basal-like                           ER-PR-Her2-                     

                                     positive for some markers  

                                    (CK5/6, EGFR, CK14, 17)

Normal breast-like                No immunophenotypic marker.

Gene expression profiling studies identified various breast carcinoma classes with prognostic significance. The 5 distinct classes indentified by expression progiling include 1)luminal A, 2)luminal B, 3)Her2 overexpression, 4) basal-like, 5) normal breast-like. Remember this classification was based on the many gene expression resutls. We can call them as genotypes of breast cancer.

Genotypes of Breast Cancer and Correponding Immunophenotype Markers

Genotype                            Immunophenotypic Marker

Luminal A                            ER+, and/or PR+, Her2-

Luminal B                            ER+, and/or PR+, Her2+

Her2 overexpressing                  ER-, PR-, /Her2+

Basal-like                           ER-PR-Her2-                     

                                     positive for some markers  

                                    (CK5/6, EGFR, CK14, 17)

Normal breast-like                No immunophenotypic marker

对不起，我突然发现有些打字错误，我再重述一下概念。

根据基因表达谱确定不同类型的乳腺癌有不同的预后意义。5个不同的亚型包括1）腺腔型A,2）腺腔型B,3）Her2 过表达型，4）基底样型，5）正常乳腺样型。要注意这种分类是根据很多基因表达的结果，我们称为乳腺癌的基因分型。

乳腺癌的基因分型和相应的免疫标记

基因分型                          免疫标记

腺腔型A                           ER+, 和/或 PR+, Her2-

腺腔型B                           ER+, and/or PR+, Her2+

Her2过表达型                 ER-, PR-, /Her2+

基底样型                         ER-PR-Her2-，但其他一些标记阳性

                                        (CK5/6, EGFR, CK14, 17)

正常乳腺样型                没有明确的免疫标记

 Basal-like carcinoma is common. I had four cases last week and send photos of 3 cases for sharing

基底样癌常见。我上周有四例，上传其中3例供分享。

Case 1

名称：图1
描述：图1

名称：图2
描述：图2

名称：图3
描述：图3

 Case 3.

When you see more cases you can have the feeling that some cases may be basal-like ca before you order the IHC.

见过较多例后，在做免疫组化之前，你会有感觉，某些病例可能是基底样癌。

名称：图1
描述：图1

名称：图2
描述：图2

 谢谢Dr.zhao无私奉献这么多好病例！对我们非常有帮助！

反复仔细阅读这几例，深深领会，肿瘤的膨胀性、浸润性生长方式，不规则片状排列，胞界不清，浆少、多形性的瘤细胞，核细沙粒样，有核仁，易见核分裂，疤痕样胶原化，地图样坏死等特点。

 谢谢Dr.zhao!

好的病例，需要反复阅读，体会微细特点，加深印象。

请赵老师可以根据病例多出些启发性的问题，提供给我们更多的思考。

 Send yoy another 2 cases

Case 1

fig 1 100x

fig 2 200x

名称：图1
描述：图1

名称：图2
描述：图2

 case 2

Fig 1 100x

Fig 2-3 200x

名称：图1
描述：图1

名称：图2
描述：图2

名称：图3
描述：图3

 52楼、53楼图示：肿瘤巢片状分布，2种细胞（1、胞界不清，浆嗜酸或双嗜性或透亮，核圆淡染，染色质细腻沙粒状，小核仁；2、核短梭形或多形性，常有角，染色深，无核仁）、高核分裂像、间质胶原化或地图样坏死，癌巢周围多量淋巴细胞浸润。

考虑基底细胞样乳腺癌，待IHC：ER、 PR、 Her-2、 CK5/6和 CK14。

 IHC above case 1. All 200x

f1 ER

f2 PR

F3 Her2

F4 CK14

F5 ck17

F6 CK5

F7 EGFR

F8 Ki67

名称：图1
描述：图1

名称：图2
描述：图2

名称：图3
描述：图3

名称：图4
描述：图4

名称：图5
描述：图5

名称：图6
描述：图6

名称：图7
描述：图7

名称：图8
描述：图8

f1 ER

f2 PR

F3 Her2

F4 CK14

F5 ck17

F6 CK5

F7 EGFR

F8 Ki67

名称：图1
描述：图1

名称：图2
描述：图2

名称：图3
描述：图3

名称：图4
描述：图4

名称：图5
描述：图5

名称：图6
描述：图6

名称：图7
描述：图7

名称：图8
描述：图8

 Ok, every one, totally I sent here 6 basal-like ca here with three cases showing the IHC panel we used. Also I briefly discussed characteristics of this cancer.

You should learn from   天山望月  to summary some main cytomorphologic and IHC featrures by yourself.  Generally breast pathologists will know the case may be a basal-lik ca by H&E. Hope you know it also. Variations occure always. My friend's study indicated that CK5 is most sensitive marker. However Ck5 essentially is negative for above case 1. We always should order few markers, but not one only. Ki67 is not cecessary for dx. But you can see most of the cases showed very high proliferative index.

I will enclose this topic here.

Thank you all for reviwing the this topic, especially for some ones who joined the discussion.

 Dr. Zhao,

Thank you very much. I learn a lot from these typical caeses.