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。

谢谢赵博士！如此详细的阐释，明明白白，牢记在心！大致翻译如下，不妥之处请指导，谢谢！

我几乎忘记了此例。谢谢天山望月提到此例。最初把这个病例放到这里的目的是为了表明，在某些情况下，病理的一些病例是交界性的。不同病理学家在不同的医院可以有不定的解释。乳腺增生性病变可以连续的， UDH-ADH-DCIS。我曾经在网站的这里提到过，即使有些病理学家不同意我的观点。当我们作出诊断，我们需要考虑的病变性质和所有其他条件。重要的是，当临床医师阅读我们的报告时，他们将做什么。针对上述情况我查阅了以前的乳腺针芯活检标本，以确定诊断。 

案例一： 80 岁，女，针芯活检ADH。同时切除的乳腺区段标本显示仅局限在2个导管的混合细胞群或筛孔状增生模式。我报告为ADH，对于80岁的老年女性，我不想给一个新的“癌”（cancer）的诊断，如上abin所述。
案例2 ： 50 岁,女，以前针芯活检DCIS.。同时切除的乳腺区段标本只显示非典型实性增生涉及一个导管，接近以前的针芯活检部位。和以往活检标本细胞形态学特征是完全一样的。我相信，这确实是针芯活检DCIS标本的一部分。我报告此例为DCIS，有人把局部病变叫做ADH，我觉得也可以 ,离边缘很远 ,无论你诊断什么将不会改变病人随后的治疗。如果局部病变接近或在边缘那是很困难的。如果我们报告DCIS的边缘，外科医师可能以另一种乳腺部分切除术。如果我们报告ADH（目前我们没有报告边缘的ADH），那妇人将不被手术。病理学家的诊断可能直接指导病人的治疗，它表明了我们的工作不仅仅是重要的，而且是有责任和风险的工作。

Case 1: 诊断ADH 可能较好.

Case 2: ADH 或DCIS.

你报告 UDH是底线.

我看过一个主题贴“转录乳腺纠纷鉴定报告，病理医生可以从中学到些什么”

大多数病理学家提到“谨慎、谨慎，更谨慎”、“询问”这是很竽要的。当然没有人是完美的，甚至高年资专家。

好吧，我现在可以结束此例。感谢加入讨论的人们。我认为此例是非常容易回答的，只需输入a 、b、 c、 d.无论如何有少数人作出您的选择。有趣的...

 I almost forget this case. Thank 天山望月 for mentioning this case. The original purpose i showed this case here was to demonstrate that some cases in pathology are bordeline cases. Different pathologists in different hospitals can have variable interpretation. Breast proliferative lesions can be continuous, UDH-ADH-DCIS. I once mentioned this somewhere in the website even though some pathologists did not agree with me. We need to consider the natures of the lesions and all other condition when we make a diagnosis. The importance is that what clinicians will do when they read our reports. For above cases I reviewed previous breast core biopsy specimens to confirm the diagnosis.

For case one: 80 y lady with ADH in core biopsy. Current segmental specimen only showed focal atypical proliferation involving two ducts with monotanous cell population and cribriform growth pattern. I sign out focal ADH. I do not want to give a new diagnosis of cancer for this 80 years older lady, as abin mentioned above.

For case 2: 50 y lady with DCIS in previous core biopsy. Current segmental specimen only showed atypical proliferation involving one dcut with solid pattern which was close to prvious biopsy site. Cytomorphologic features are exactly the same as that in previous biopsy specimen. I feel confident it was part of lesion of DCIS in core biopsy. I called this case focal DCIS. I am ok if some one called ADH for the focal lesion. It is far from the margin. Whatever you call will not change the following treatment of the patient. The very difficult situation is that if the focal lesion is close to or in the margin. if we call DCIS in the margin, the surgeons may do another segmental mastectomy. If we call ADH (currently we do not report margin for ADH), the women will have no other surgery. Pathologists' diagnoses may direct the treatment of the patients.  It indicates not only the importance of our work, but also the responsibility and the risk of work. 

Case 1: dx of ADH may be better.

Case 2: either adh or dcis.

Bottom line you should call UDH.

I reviewed the topic of 转录乳腺纠纷鉴定报告，病理医生可以从中学到些什么"

It is great that most pathologists mentioned "careful, careful, and more careful" "asking" when we release the cases. Of cause no person is perfect even older experts.

Ok, now I can close this case. Thank people join in the discussion.  I think this case is very easy to answer, just typing a, b, c, d. However there are still few people made your choice. Interesting...

 赵老师：答案是什么呢？是不是想用病例再阐释呢？期待哦。。。

 B,好象没人选哦,