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讨论真激烈

 虽没参与前面的讨论，但看了各位的回复，学习受益。

这样的病例我还没碰到过，但这样的快速风险还是太大，没有100%把握和说话算数的人支持，我会选择退一步。。。

 Thank Dr.  wfbjwt for the follow up. Now no doubt it is angiosarcoma because patient has recurrent and also distant metastasis.

 Now we can go back to review the case.

1. Clearly cytology is very bland.

2. Why is it a malignant tumor?

多发结节状生长，无包膜，周围组织界限不清 and tumor size. These features seem important for evaluation of the breast vascular lesions.

I once asked several experts to review the photos and got different oppinions. I think there are two reasons. Firstly this is a difficult case. More important fact to affect the evaluation is that they only saw a few photos, but not true all slides and gross specimen.

In fact after I got different oppinions from expert pathologist I mentioned above, I sent a few photos to other top soft tissue pathologists in the US or in the world. Dr. Christopher Fletcher(Harvard Medical School) thought it was a angiosarcoma, but another pathologist was not sure the diagnosis.

Anyway it is sad for the young women. However it is a good case for us to learn.

Thanks  wfbjwt again.

This is a challenge and debatable case in the begining. It is complete case from frozen to final dx to follow up result.  It was reviewed and consulted in several hospitals in China. The photos were reviewed by several internatonal famous soft tissue pathologists for their oppinions. Nice case for learning.

It is difficult to evaluate some challenge cases based on a few photos online.

大家在网站的討论建议仅供参考。特别是对基层医院的病理医生，无论别人怎样建议，你在签发病理报告时必须真正了解和同意这个诊断，即使是上级医院的专家会诊意见，because it is your own case.

总 置顶 few days for more people to learn the lesson.

We all should thank Drwfbjwt for providing the case.

cz

 乳腺的血管源性肿瘤是个特例，组织学良性，可表现为高度恶性生物学行为。

本例符合血管肉瘤

请问大体是什么样的？前两天我做了个快速，半透明囊性肿物体积10*8*5厘米，囊内呈多房性，部分区伴有出血，囊内充满清亮液体，囊壁厚薄不均

 就是血管肉瘤

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      所有图片均显示没有细胞异形、没有不典型性、没有坏死、没有浸润，窦样间隙内也看不到红细胞，其中一张图见病变围绕小叶但小叶结构正常，血管肉瘤的诊断能成立吗？乳腺血管肉瘤可以分化好，但必须具有血管肉瘤的特征。

      本例形态特征符合乳腺假血管瘤样间质增生。其形成原因可能与哺乳后的内分泌紊乱有关。镜下特征有复杂的血窦样间隙，内衬内皮细胞样梭形细胞，缺乏异形性和核分裂象，间质为透明变性的增生纤维组织，低倍镜易误认为低级别血管肉瘤，但其细胞学特征和生长方式缺乏恶性证据可资鉴别。免疫组化可表达CD34、vim、actin、calponin，不表达CD31、S-100、EMA、CD68、CK、8因子等。