，后再阅读大家讨论学习。
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- B1581Breast lesions cqz (12) (2-16-2009)
图1
图2
| 姓 名： | ××× | 性别： | 年龄： | ||
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Breast core biopsy with 8 cores. There are multiple breast lesions. Try you diagnosis one by one.
Lesion 1 20x and 400x
标签：LCIS CCC FEA ADH 导管内乳头状肿瘤 放射状瘢痕
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本帖最后由 于 2009-03-19 23:29:00 编辑
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×参考诊断
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Fig. 11.11. Intraductal carcinoma, flat (“clinging”) micropapillary type. A: The papillary structures in this cystically dilated duct contain fractured calcifications of the ossifying type typically associated with columnar cell lesions. B: Carcinoma cells with pleomorphic nuclei and a disorderly distribution line the duct and overlie the calcification. C: The flat carcinomatous epithelium displays apical apocrine-type cytoplasmic “snouts.” D,E: Another example of flat, “clinging” intraductal carcinoma
_ from Rosen Breast Pathology. Compare with lesion 3, just for learning.
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本帖最后由 于 2009-03-14 10:40:00 编辑
Compared Rosen fig 11.11 (page 298 in the third edition) with the above lesion 3, we can appreciate the difference in term of cytology, uniform without atypia in lesion 3 and moderate cytologic atypia in Rosen's fig 11.11.
It is very good for the disagreement. I hope more pathologists join in the diacussion.
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本帖最后由 于 2009-03-19 10:28:00 编辑
Peter Rosen is an excellent breast pathologist. His Book " Rosen's Breast Pathology in the best comprehensive book in the area of breast pathology. His calssification about columnar cell lesion is different from most others. He used the term columinar cell hyperplasia, mild, moderate, and severe atypia. I really do not like his concept about CCC. It is true that intraductal carcinoma, flat pattern, is present. However, I fell reluctant to call the 5 photos Elizabeth took from Rosen's book as carcinoma based on the photos only.
Thank Dr. Chiang' s interpretation.
Lesion 2: Apocrine metaplasia or change with micropapaillary or papillary pattern. The nuclei are very uniform, small, evenly spaced, located the botton of the cells. I do not appreciate any cytologic atypia in this case. Cystic papillary apocrine changes are commonly seen in the breast pathology specimens. Generally people will ignorred the lesion even though mild cytologic atypia is present in the apocrine change. True atypical apocrine metaplasia is rare.
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Lesion 3: 导管囊性扩张伴分泌物潴留 is a good call. If you call CCC it is ok. Anyway I cannot appreciate atypia here. It is not a FEA or carcinoma in situ. Compared with the photos on 41 floor we will know what is carcinoma, flat type, even though these figures are not very typical ones.
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本帖最后由 于 2009-03-20 02:28:00 编辑
| 以下是引用cqzhao在2009-2-17 9:21:00的发言：
Lesion 7 Fig 1 100x Fig 2-5 200x Fig 6 400x Hope you can appreciate three diagnoses (or three terms) in this focal area. |
There are some different oppinion about this lesion. Pasted the figs again.
CCC, FEA, ADH.
Question is if the dianosis of DCIS should be rendered.
Is the severe lesion in this area ADH or DCIS?
Please share your oppinion and the reasons.
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
名称：图6
描述：图6
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Lesion 7 demostrates focal ductal epithelial cell proliferation with uniform size in the back ground of CCC or focal FEA. It is reasonable for diagnosis of ADH. The lesion does not meet the DCIS criteria by 2-3 mm or 2-3 ducts. Hope your guys will agree.
