Old women with breast lesion

F1-3 100x

F 4-5 200x

F6-7 400x

 The same as most of you I first considered it was lobular carcinoma in situ in this core biopsy specimen. However, IHC results indicated it was a not lobular lesion. Now we know there are three possibilities, normal hyperplasia, ADH, and DCIS. Seeing the H&E slides more carefully, we know it is definitely abnormal. Generally the morphologic features of ADH are not like this. So only one possibility is DCIS with lobular extension or DCIS involving acini of lobules. If the specimens contain DCIS and DCIS with lobular extension, it is relatively easy to recongnize. If only lobular extension of DCIS is present in the specimen, it is difficult to make the diagnosis. But we should consider the possibility. Most of you did not consider the diagnosis. The reasons are you only see the photos, not true slides. Also the photos are not in the high power.

I reported lobular extension of intraductal carcinoma. The women had segmental mastectomy. The mastectomy specimen showed the DCIS closely to the previous core biopsy area.

This is for this case. Thanks.

 谢谢赵老师，真是好病例，学习了

正常乳腺、乳腺增生症、导管癌，E-Ca.膜阳性，P120膜阳性。

ALH  ,  LCIS,  浸润性小叶癌，E-Ca.阴性，P120胞质阳性。

感谢望月和abin的翻译。

 细看63楼HE图片：有难度，考虑DCIS呢，细胞相对单一，有一些异型性，小管腔圆。但又觉得细胞胞界不清，心里没底，呵呵。

是否标记：ER,    PR,    CK5/6,  Ki67？

期待赵老师讲解。。。

 正常乳腺、乳腺增生症、导管癌，E-Ca.膜阳性，P120膜阳性。

ALH  ,  LCIS,  浸润性小叶癌，E-Ca.阴性，P120胞质阳性。

回顾22楼，对比此例IHC,E-Ca.、P120可能均为膜阳性（我总感觉有部分浆阳性，可能是错觉，如果看实际片子会更好）。

现在排除了小叶病变，需在腺病、UDH、DCIS、浸润导管癌进行选择，要回头结合HE了。

到上班时间了，晚上再来回答。

 Thank Dr.zhao! So odd the case!

 E-cad和P120标记细胞团内，均有膜阳性和浆阳性细胞，图2，P120，小细胞团浆阳性。

考虑：1、LCIS和DCIS混合性病变？2、小叶癌累及小叶导管？3、小叶增生？

不知道了，还是请赵老师详细讲解吧，期待哦。。。

I am happy that most people can consider the lobular lesion. Me too. It is why I did following IHC 

F1 E-cad

F2 P120

Both 200x

Now what is your diagnosis now?

名称：图1
描述：图1

名称：图2
描述：图2

 还是UDH吧