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

 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！

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！

 感谢赵老师的病例！祝你春节快乐！

本例考虑为纤维腺病伴导管上皮增生，须与小叶上皮内瘤变鉴别，免疫组化标记34βE12、E-cadherin、P63。

 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

 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！）

 Hope you can do as the above.

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

 Dr. Zhao,

 Thank you and happy Chinese New Year to you.

For lesion 1 and lesion 2, I consider atypic duct hyperplasia. Immunostaining for p63, ER and CK5/CK6 should be done.

 是的，大家都在享受春节，大餐还没有吃完，赵老师又上了一道鲜美的鸡汤。我先尝一口。

考虑为乳腺增生性腺病加导管内增生（intraductal hyperplasia),普通性增生加部分非典型性增生。