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- B1803少见乳腺肿物，鉴别诊断？ (cqz-18, 5-7-2009)
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about 60 y/f, right breast mass 2 cm by imaging, breast core biopsy.
1. Your differential diagnosis?
2. What will you do next?
Please do not just give a diagnosis. Your dx is a guess dx even though your diagnosis may be right.
As pathologists we should learn how to analyse our cases with logic thought.We should have differential dx for all cases in our mind even for the easy cases. We can use available sources (such as IHC, molecular methods, history, consultation) to rule in or rule out the differential dx, then make the final dx.
Learning the priniciple for diagnosis is much more important than learning a few cases.
标签：乳腺化生性癌 叶状肿瘤 平滑肌肉瘤 肉瘤 鉴别 ck7 VIM
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本帖最后由 于 2009-05-07 18:28:00 编辑
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×参考诊断
Leiomyosarcoma of the breast（乳腺平滑肌肉瘤）
| 以下是引用zrj711在2009-5-7 19:44:00的发言：  化生性癌吗?需要更多证据低倍图呢! |
如果我遇到这样的病例，我的第一印象是：梭形细胞化生性癌---可以用CK7、CK8/18等确定其上皮性质；周围可能有原位癌成分；另外，梭形细胞癌也常标记肌上皮标记物（如P63、S-100、calponin等故需注意与肌上皮癌鉴别）。
当然一定要有其他鉴别诊断：1、恶性叶状肿瘤---寻找良性上皮成分；梭形细胞CK阴性而Vimentin阳性；或可有异源性分化（如骨、肌源性分化等）。2、乳腺间质肉瘤。3、乳腺非特异性软组织肉瘤。……
期待Dr.zhao的结果与分析。
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本帖最后由 于 2009-05-10 21:39:00 编辑
笃(du)行者 ：“反复看，查文献，多取材，做特免，实在不行请外援”。Very good. I think I will not forget the word "笃".
This case was a breast core biopsy, only one tissue block. The photo represents the lesion in the available specimen.
More IHC results: ER, PR, Her2 negative.
Will you sing out the case (?diagnosis) or do more study? If you want to work more on this case, what will you do? What immunostains will you order? Why? You can order the immunostains. I am your lab technologists and do the stains for you and tell your the stain results.
I am in Los Angeles to enjoy my vocation time. Glad to work for this case with your guys.
cz
| 以下是引用abin在2009-5-10 21:46:00的发言：
老年，乳腺的梭形细胞恶性肿瘤 鉴别诊断包括：上皮性--梭形细胞癌，肌上皮性--肌上皮癌，乳腺间质--叶状肉瘤，软组织肉瘤，其它（恶黑，少见淋巴造血肿瘤）。 已知AE1/AE3和Cam 5.2均阴性，Vimentin弥漫强阳性，排除上皮性。进一步分类： 叶状肿瘤：ER，PR， 肌上皮：SMA，CP，p63 恶黑：S-100，HMB45，Melan 神经源：S-100，Syn，Cga 脂肪肉瘤：S-100 肌源性：SMA，Desmin，MyoD1， 血管：CD34，CD31 纤维母/肌纤母：CD34 其它：纤维肉瘤，…… 也可以等待手术标本再诊断。
Very good analyses with differential dx. Two things I do not agree: 1. 已知AE1/AE3和Cam 5.2均阴性，Vimentin弥漫强阳性，排除上皮性。Mostly you are right. But you may be wrong. Tell us why. 2.也可以等待手术标本再诊断. Completely do not agree.
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