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

It's time to learn some breast pathology.

Lesion 1: Sclerosing adenosis with ALH

Lesion 2: Probaly only UDH

Thanks and will look forward to the final ansers.  

 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

  lesion 1: lobular carcinoma in situ.

  lesion2:atypical duct hyperplasia.

 Dr.zhao:谢谢分享漂亮的组化图片！

lesion 1: LCIS

  lesion2:.ADH

 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 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

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