Today I had two cases and send here to see what you think. I feel interesting.

今天上传两例，看看大家考虑什么。我觉得很有意思。

Case 1. About 80 y. Previous core bx was reported as focal ADH. Today I had segmental mastectomy. Only focal atypical proliferation (fig 1 100x, fig 2-3 200x) was noted. The focal area measures 2 mm (2 ducts), closely to the previous biopsy area.

病例1 约80岁。以前粗针活检报告为局灶性ADH。今天的区段切除标本，注意到也仅有局灶性不典型增生（图1 100倍，图2-3 200倍）。局灶区域大小2mm（2个导管），与以前活检区域很靠近。

Case 2. about 50 y. Previous core biopsy was reported as DCIS, nuclear grade 2. Atypical proliferation was noted in one duct as fig (fig 4 100x, fig 5 200x), closely to the previous biopsy area.

病例2 约50岁。以前粗针活检报告为DCIS，核级别2级。注意到一个导管内的不典型增生，如图（图4 100倍，图5 200倍），与以前活检部位接近。

All specimens were submitted for microscopically examination, one with 45 slides and other with 57 slides.

所有标本均切片，分别为45张和57张切片。

Pleae choose:

A. Both ADH

B. Both DCIS

C. Case 1 ADH, case 2 DCIS

D. Case 1 DCIS, case 2 ADH

请选择：

A。均为ADH

B。均为DCIS

C。病例1为ADH，病例2为DCIS

D。病例1为DCIS，病例2为ADH

Please choose one from A, B, C, D. Hope all people who see the photos can write your choice. Will appreciate if you can write why. Do not worry it is no right or wrong answer. Just interested to see how pathologists interpretate these kinds of lesions.

请从ABCD中选择一项。希望所有看过图片的人都写下选择。如果写上为什么（诊断依据）更好。不要担心对或错。仅仅想看看病理医生们是如何解释这种病变的。

You need to review breast books if you want to call them as UDH.

如果你想称之为UDH，那你需要复习一下乳腺病理的专著。

 Photos

Fig1-3 for case 1

Fig 4-5 for case 2

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

 case1.DCIS   细胞成分较单一,部分区域细胞极性消失.

case2. DCIS    细胞成分较多样,细胞之间粘着性差.

 我选A.

理由：

Case 1:ADH伴UDH,

Case2：ADH，一个导管病变，不够DCIS

Case 1 诊断低级别DCIS存在质的不足（混杂UDH）

Case 2 诊断低级别DCIS存在量的不足（范围不够）

因此均为ADH

另外还考虑到患者的心理因素。无论如何，诊断中出现一个“癌”字，会带给患者较大心理压力。她们不明白“导管内癌”不是“癌症”(cancer,恶性肿瘤）。

 B,好象没人选哦,

 赵老师：答案是什么呢？是不是想用病例再阐释呢？期待哦。。。