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| 名称： | |
| 描述： | |
- B1760Breast LCIS involving sclerosing adenosis+ADH (cqz 11)
图1
图2
图3
图4
| 姓 名： | ××× | 性别： | 年龄： | ||
| 标本名称： | |||||
| 简要病史： | |||||
| 肉眼检查： | |||||
I assume that all of you still are enjoying your New Year Holiday. Send here a case for your consideration.
F/50y Breast core biopsy (5 cores)
Lesion 1
Fig 1 10x
Fig 2 20x
Lesion 2
fig 3 10x
Fig 4 20x
标签：LCIS ADH
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本帖最后由 于 2009-02-22 10:46:00 编辑
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×参考诊断
谢谢赵老师！春节假期非常开心分享您的病例！
我觉得：1、鉴别小叶和导管病变,E-Ca和P120。2、鉴别UDH、ADH、DCIS或小叶病变累及导管、浸润癌标记：ER, PR, CK5/6,P63,SMMH.3、需鉴别肌上皮病变。
Lesion 1纤维化组织穿插在腺泡、导管间，一些导管上皮单一，异型，圆形细胞，胞浆有些透亮，可见钙化。纤维组织中有单个大异型细胞（需排除小叶病变），一些管腔周围有肌上皮和基底膜。
Lesion 2管腔内上皮不太单一，但有异型，可见核仁，边窗有些涨大，也有些细胞流水样排列。
请赵老师赐教！再次感谢！
（注：好像看的越多，考虑的越多，越不敢猛下诊断了
，还是功夫不到啊，期待赵老师多出练习和考题了，相信功夫不负有心人！）
- 广州金域病理
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本帖最后由 于 2009-01-31 03:53:00 编辑
Dr. 天山望月 :
Internet is interesting. I even do not know you are male or female. I guess you may be a female because you work hard and study carefully. These features often are characteristic of female. Men should not feel angery because I am male also.
I like the way of your analysis.It does not mean they are right or wrong. I do not want to influence other people's oppinion.
好像看的越多，考虑的越多，越不敢猛下诊断了. It means that you become more and more expert. I choose some cases and send here with some difficulties. It is not easy to make dx by H&E only. You should think over.
About the call for people: In the US you can call the first name for your boss or your professor. In hospitals generally people call physicians--Dr. Wang, Li, Zhang et al. Even you meet world famous doctors, you stil call Dr. xxx. For friends among physicians you can call first name. In China, people use teachers too often. I favor that your guy call me zhao or Dr. Zhao, but not teacher zhao. I feel more comfortable for zhao or dr. zhao. I can call you name or Dr. xx
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本帖最后由 于 2009-01-31 17:23:00 编辑
Ok! Dr.zhao: You are right. I was happy to read your words. I will call you Dr.zhao, you can call me “望月”too. Your guess is correct. i am a lady ,Because I like the moon, in the quiet of the night, often looking at the moon reverie......hehe
,My name is wangyue(望月）。 - 广州金域病理
Hi, Dr. Zhao,
Happy Spring Festival!
In my opinion, both are at least atypical hyperplasia(case 1 lobular and case 2 dutal?). carcinoma should be futher ruled out with p63 CK5/6 immunostaining. Note the micro-calcification in case 1, which is implying "bad lesion".
Looking forward to the final diagnosis and explanation.
Many thanks！
- If you have great talents, industry will improve them; if you have but moderate abilities, industry will supply their deficiency. 如果你很有天赋，勤勉会使其更加完美；如果你能力一般，勤勉会补足其缺陷。
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本帖最后由 于 2009-02-02 23:52:00 编辑
Dr. Zhao的意思，大家以后可以直接称呼Zhao或者Dr. Zhao
这个病例很有趣，鉴别范围很广泛（不许笑话我，呵呵），包括UDH，ADH，IDC
因为不存在小叶结构，图1和图2中硬化性背景上那些模糊的小管结构和近似实性的条索，需要排除浸润癌（尽管不太像，因为可以辨认肌上皮细胞，可是……小心一些没坏处，呵呵），可以染肌上皮标记。
这例UDH与ADH的区分对我来说真的太困难了。似乎皆有（我汗，再次强调，不许笑话我）。是否还有可能ALH/LCIS累犯小叶，E-ca和p120有帮助。
期待Dr.Zhao解惑，谢谢！
华夏病理/粉蓝医疗
为基层医院病理科提供全面解决方案，
努力让人人享有便捷准确可靠的病理诊断服务。
I am just a normal pathologist as your guys. I may know a little more gynecologic and breast pathology. However I almost forget all other subspecielties of pathology. You know all areas of pathology.
Most people's analyses are very reasonable. Let see if others want to join in the discussion.
| 以下是引用abin在2009-2-2 23:48:00的发言：
Dr. Zhao的意思，大家以后可以直接称呼Zhao或者Dr. Zhao 这个病例很有趣，鉴别范围很广泛（不许笑话我，呵呵），包括UDH，ADH，IDC 因为不存在小叶结构，图1和图2中硬化性背景上那些模糊的小管结构和近似实性的条索，需要排除浸润癌（尽管不太像，因为可以辨认肌上皮细胞，可是……小心一些没坏处，呵呵），可以染肌上皮标记。 这例UDH与ADH的区分对我来说真的太困难了。似乎皆有（我汗，再次强调，不许笑话我）。是否还有可能ALH/LCIS累犯小叶，E-ca和p120有帮助。 期待Dr.Zhao解惑，谢谢！ |
