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| 名称： | |
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- 请教请教（乳腺癌病理报告）
| 姓 名： | ××× | 性别： | 女 | 年龄： | 33 |
| 标本名称： | 乳腺 | ||||
| 简要病史： | |||||
| 肉眼检查： | |||||
病理诊断：（左）乳腺癌肿物切除术后乳腺癌改良根治标本，原手术切口未见癌残余，乳头、皮肤、基底切缘未见癌累及，周围乳腺小叶增生型及盲管型腺病，部分导管上皮轻度不典型增生。
腋窝淋巴结0/25个未见癌转移，另送（胸肌间淋巴结）脂肪及横纹肌组织，未见癌，未见淋巴结。
病理诊断：冰余（左乳区段）多发性导管内乳头状瘤，部分区域癌变呈导管内乳头状癌，部分区域呈多灶性早浸现象—浸润性导管癌，大小约1*0.7*0.8CM。癌周乳腺腺病，盲管型为主并囊肿病，皮肤未见明显病变。
（上切缘）乳腺腺病，混合型（盲管型、大汗腺型），冰余组织未见癌浸润。
（内切缘、外切缘、下切缘）乳腺腺病，盲管型，未见癌浸润。
（基底切缘）脂肪横纹肌组织未见癌浸润。
免疫组化：ER：+ PR：- E-CA：+ GCDFP-15:+ P63：- SMA:+- KI-67:约5%
我是患者，不是医生，也许在这里发贴是有点不合适。请各位体谅一个年轻乳腺癌患者的感受，万分感谢，谢谢！
以上是我的病理报告，请问：“冰余（左乳区段）多发性导管内乳头状瘤，部分区域癌变呈导管内乳头状癌，部分区域呈多灶性早浸现象—浸润性导管癌，大小约1*0.7*0.8CM。”里头有“早浸”二字，应是属于早期浸润导管癌？可是结论部分又只写浸润性导管癌，我就弄不明白了。病理报告上的图片我看不懂。另外，早浸两字能否说明浸润程度不是很严重，如果浸润到血管壁或淋巴壁就不属于早浸了吧？
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本帖最后由 于 2009-04-13 23:56:00 编辑
×参考诊断
| 以下是引用楚江渔夫在2009-4-13 21:27:00的发言： 这样的病例没有必要寄到美国吧？！国内有很多乳腺病理的大家，完全可以确诊！的确，正确的诊断对于患者的重要性无需赘述，但仅凭mihuo的叙述，我认为最好不要进行评价，因为可能会产生误导，引起纠纷，还是仔细认真阅读切片后再谈较妥！mihuo楼主，我个人观点还是请您就近请专家会诊，可以解除您的疑惑，如301、中科院肿瘤医院、成都华西医院、北京军区总肿瘤、天津肿瘤医院、复旦大学附属肿瘤医院病理科等。但愿您能尽快不mihuo。 |
Dr. 楚江渔夫: Completely agree with you. Online discussion is just for some information. No one has any responsbility here. No one can make dx only based on patient's description or photos on line until we have Virtual microscopy.
True consultation indicats that consultant pathologist also has relation to the patient, the case. In other words consultant pathologist has the responsiblity in law. Pathologists in the USA have insurance for medical professional liability and excess medical professional liability, each covering for 1.5 million $US in our hospital. The insurance covers the law-suit if it happens in our daily work including our hospital cases and consultant cases through hospitals.The insurance will not cover any other individual cases which are not related or passed through the hospitals.
I think Dr. Qianxun just means that he would like provide some advice.
To Mihuo:
You are very young (33 y). You can ask your slides to be send to one (even more than one) of the hospitals Dr.楚江渔夫 mentioned for consultation.
Based on your report,
Focal ductal carcinoma in situ arising in introductal papilloma.
Mutifocal early stroma invasive (I do not know if it means micro invasion).
Papillary lesion is a very difficult disease for pathologic diagnosis, especially for micro-invasion.
Papillary lesions include bengin introductal papilloma, atypical papilloma (like ADH), DCIS involving papilloma, or intraductal papillary carcinoma (like DCIS), invasive papillary carcinoma. The prognosis and treatment are different. I did not see pictures of the case and cannot evaluate if the diagnosis is ok or not. In fact I still cannot make the diagnosis based on the photos only. Pathologists must see the true glass slides to make the diagnosis for some difficult cases.
I do not know what kind of pathologist made the diagnosis for your case. You as a patient have the right to ask your physician to send the slides to other breast pathologits to review your case (consultation) if you feel uncomfortable for the dx. The correct diagnosis is too important for you.
For your reference, cz
