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

 I just play half hour of Ping ba. The lesion 2 demonstrates relatively uniform cell population, similar to low grade DCIS and  focally second population of cells similar to the UDH. Some round lumens are noted. The lesion is very focal. After the lobular lesion was ruled out, ADH is a reasonable call, I think.

Lession: Breast lesions can be very complicated. They can be easily missed. We have to read the slides very carelly. We need to work out the cases (IHC, consult with others), think over and over if we are not sure.

Thank for reading the case and shared your oppinion.

cz

 Agree with Dr. Elizabeth and  天山望月 .

1. LCIS involving the sclerosing adenosis, as mentioned by 漫游人 .

It looks like sclerosing adenosis or invasive tumor in the low power. We have to do myoepithelial stain. This is the priciple for pathologists. We must work out for these cases if we are not 100% sure of the diagnosis in clinical practice. Myoepithelial stain indicates no evidence of invasive tumor. When you observe the cells carefully especially in the high power you will notice that the cells show monotonous proliferation. We must do the stain for lobular lesion. p120 and e-cadherin stains confirm the lobular lesion.

Now the question is that it is ALH or LCIS. There are no good criteria to distingush ALH from LCIS. In this case, the lobular lesion extensively involves the sclerosing adenosis. It is better to call LCIS involving sclerosing adenosis. It is strange if we call ALH involving sclerosing adenosis.

Ok, my wife calls me to play Bing Ba ball (now. I have to observe wife's decision. I will come back to finish the discussion for lesion 2.

 I reviewed above dx, differential dx and interpretation. I think most of you catch the main points.

IHC results:

Lesion 1: Fig 1-4

F1 smooth muscle myosin heavy chain

F2-4 dual stains (p120 and E-cad)

F5: dual stains for lesion 2.

Now your diagnosis please. If you are not familar with the dual stains, please check http://www.ipathology.cn/forum/forum_display.asp?keyno=111923

where I have detailed explaination.

Thanks,

cz

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

 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.

 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

 Hope you can do as the above.

Write down possible diagnoses, and IHC if you think you need.