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楼主发表于 2009-04-26 05:34|举报|关注(2)
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姓名：	×××	性别：	年龄：
标本名称：
简要病史：
肉眼检查：

50 y/f with breast mass 1.5 cm.

U/S guided breast core biopsy

40x

400x

图1
图2

标签：组织细胞样型乳腺癌颗粒细胞瘤

本帖最后由于 2009-05-08 10:26:00 编辑

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• 乳腺癌少见形态

添加参考诊断

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0706 离线: 帖子：173; 粉蓝豆：31; 经验：675; 注册时间：2008-10-30; 加关注 | 发消息

41 楼发表于2009-05-16 09:12:00举报|引用
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好病例，学习了！

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长脖离线: 帖子：338; 粉蓝豆：1; 经验：339; 注册时间：2008-08-21; 加关注 | 发消息

42 楼发表于2009-05-16 17:31:00举报|引用
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受益匪浅

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笑傲江湖离线: 帖子：548; 粉蓝豆：14; 经验：748; 注册时间：2009-04-07; 加关注 | 发消息

43 楼发表于2009-05-19 21:02:00举报|引用
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学习中，谢谢

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天天田田离线: 帖子：493; 粉蓝豆：5; 经验：493; 注册时间：2009-05-15; 加关注 | 发消息

44 楼发表于2009-05-19 21:30:00举报|引用
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很是长见识啊，感谢赵老师。

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天山望月离线: 帖子：4902; 粉蓝豆：83; 经验：5092; 注册时间：2007-02-03; 加关注 | 发消息

45 楼发表于2009-05-23 23:57:00举报|引用
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以下是引用cqzhao在2009-5-8 10:28:00的发言：

以下是引用天山望月在2009-5-4 0:13:00的发言：

谢谢！明白了。

另外我试着找找有无这方面的资料，如找到就上传。

we are waiting for your data.

Dr.zhao:

不好意思，到现在为止，我没找到关于这方面的资料，抱歉啊。

0

: 广州金域病理

huangzhx 离线: 帖子：331; 粉蓝豆：1862; 经验：732; 注册时间：2008-05-21; 加关注 | 发消息

46 楼发表于2009-05-28 17:23:00举报|引用
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学习了！好病例！

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yds06107 离线: 帖子：317; 粉蓝豆：104; 经验：1112; 注册时间：2009-02-03; 加关注 | 发消息

47 楼发表于2009-05-29 15:55:00举报|引用
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学习了，思路上受益匪浅！

0

: the more glass you see ,the better your eye will be. No book can give you that kind of experiential knowledge.On the other hand, you can have the best eye in the world and misinterpret what you are seeing for lack of factual knowledge.

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48 楼发表于2009-05-30 10:46:00举报|引用
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学习了！好病例！

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49 楼发表于2009-06-03 21:37:00举报|引用
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本帖最后由于 2009-06-06 19:53:00 编辑

再次学习！在斯坦福大学网站上找到的关于组织细胞样癌的诊断及鉴别诊断。先贴上再慢慢翻译。

http://surgpathcriteria.stanford.edu/breast/histiocabr/

Histiocytoid Carcinoma of the Breast

Definition

Rare type of breast carcinoma characterized by abundant vacuolated cytoplasm
乳腺癌的罕见类型，特征为有丰富小空泡胞浆

Alternate / Historical Names

Myoblastomatoid carcinoma 肌母细胞样癌

Diagnostic Criteria 诊断标准

Abundant finely vacuolated cytoplasm 富有微小空泡的胞质
- Amphophilic to faintly eosinophilic 双嗜性，轻微嗜伊红
- May appear granular 也可呈颗粒状
- PASd may show granular cytoplasmic mucin stain .PAS染色可显示颗粒状的粘液斑点胞质。
Indistinct cell borders 细胞边界不清
Uniform, low grade small nuclei 低级别的细胞核，大小一致、较小。
- Small nucleoli 小核仁
- Mitotic count generally 1-2/10 hpf 核分裂象1-2/10HPF。
Intracytoplasmic lumens rare to frequent 胞质内容从稀少到丰富
- Highlighted by Alcian Blue or EMA stains 阿尔新蓝或EMA染色时更突出
- May result in areas with signet ring appearance 部分区域可出现印戒样细胞
- PASd may stain intralumenal mucin
Frequent single file and targetoid infiltrative pattern 常呈列兵状和靶心状浸润性生长。
Frequent central hyaline fibrosis 较多玻璃样变性的纤维组织
Fat frequently invaded by single non-cohesive cells 常见无粘聚性的细胞呈列兵状浸润脂肪
Considered by some to represent a variant pattern of lobular carcinoma or of apocrine carcinoma,有人认为它是小叶癌或大汗腺癌的一种变型。 see Differential Diagnosis

Differential Diagnosis

Lipid Rich Carcinoma 富于脂质癌
Glycogen Rich Clear Cell Carcinoma 富于糖原、透明细胞癌
Secretory Carcinoma 分泌癌
Granular Cell Tumor 颗粒细胞瘤
Fat Necrosis, Inflammation, Histiocytic Infiltration 脂肪坏死、炎症、组织细胞浸润
Apocrine Carcinoma大汗腺癌
Lobular Carcinoma小叶癌

Lipid Rich Carcinoma	Histiocytoid Carcinoma
Lipid stain positive脂肪染色阳性	Lipid stain negative脂肪染色阴性
GCDFP15 variable to weak GCDFP15弱阳性	GCDFP15 strong positive 强阳性
Mucin negative 粘液染色阴性	Mucin positive intracytoplasmic lumens or granular cytoplasm粘液染色阳性，胞浆小空泡状或颗粒状
May have any grade cytology 可以有各级别的细胞（指非典型性？）	Low grade cytology 低级别的细胞学表现
Lacks intracytoplasmic lumens缺乏胞质内小空泡	May have intracytoplasmic lumens可以有胞质内小泡

Glycogen Rich Clear Cell Carcinoma	Histiocytoid Carcinoma
Clear cytoplasm	Finely vacuolated cytoplasm
PAS shows abundant glycogen	PAS shows granular mucin
GCDFP15 variable	GCDFP15 strong positive

Histiocytoid Carcinoma	Secretory Carcinoma
All reported cases >40 years	Most cases <30 years
Scant or granular mucin	Abundant cytoplasmic mucin
GCDFP15 strong positive	GCDFP15 variable
Aggressive behavior	Excellent prognosis

Histiocytoid Carcinoma	Granular Cell Tumor
Keratin, EMA positive	Keratin, EMA negative
GCDFP15 positive	GCDFP15 negative
S100 negative or trace	S100 positive

Histiocytoid Carcinoma	Fat Necrosis, Inflammation, Histiocytic Infiltrations
Keratin, EMA positive	Keratin, EMA negative
GCDFP15 positive	GCDFP15 negative
CD68, HAM56 negative	CD68, HAM56 positive
Low grade atypia	Completely bland nuclei
Granular mucin positivity	Mucin stains negative

Histiocytoid Carcinoma	Apocrine Carcinoma of the Breast
Amphophilic to weakly eosinophilic cytoplasm	Intensely eosinophlic cytoplasm
Cytoplasm vacuolated, occasionally granular	Cytoplasm granular
Indistince cytoplasmic borders	Sharp cytoplasmic borders
Small nuclei and nucleoli	Large vesicular nuclei with prominent nucleoli
Appears to have more aggressive behavior than usual carcinoma	Appears to have better behavior than usual carcinoma in some series

Some consider histiocytoid carcinoma to be a variant of breast carcinomas with apocrine features

Is Histiocytoid Carcinoma a variant of Lobular Carcinoma?

Most cases of histiocytoid carcinoma show linear and targetoid infiltration, are E cadherin negative and have at least focal intracytoplasmic lumens and many have adjacent LCIS
- These features suggest that at least in many cases, histiocytoid carcinoma could be considered a variant of lobular carcinoma
A minority of cases have been reported that show infiltration more characteristic of ductal carcinoma and are E cadherin positve