就是血管肉瘤

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

 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

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

 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.

 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。。。

讨论真激烈

 学习学习

 今天终于找到答案了。回答zhao老师：我们一般认为KI67阳性率小于5%就是阴性，今天看国外资料，才知道PI，也就是增殖指数的计算是计数10000个肿瘤细胞中KI67的阳性数量，ZHAO老师前面推荐文章中认为cutoff值是175左右，也就是1%-2%左右，在我们判断就是阴性的，故结论不同了。复习我们的切片，高分化区域，包括我发的图片，都可以见到少量阳性细胞，大约1%左右，中分化区域大约5%左右，与国外文献是符合的。只是我试着计数10000个细胞，尤其是这种肿瘤细胞数量少的病例，太难了。谢谢zhao老师让我总是留心相关的问题，学了不少，谢谢zhao老师了！另外，大家可以讨论一下，PI虽低，但也有诊断价值的问题。