mingfuyu老师回复：

（提供给临床）未见淋巴瘤证据这样的病理报告是不够的。我会这样考虑这个病例：

  1.仔细寻找有无转移癌证据，特别在被膜下窦区域。在这个年龄段我们一般担心的是乳腺肿瘤。 图4、5有硬化。  有时候这可能是转移性小叶癌的唯一线索。 如果没有明显证据证明是转移癌的话，我们一般将淋巴结全切。当然也可以在可疑切片上作一下CK-Pan染色。  还需要跟临床沟通一下，看有无更多信息。  但是请注意，有些小叶癌在乳腺是没有明显肿物的。

2.  确实不像淋巴瘤。当然也可以做点免疫组化排除一下。

3.  此例可能是个良性病变。但是淋巴结反应性改变也是有许多疾病的，如Roasi-Dorfman病，寄生虫感染，病毒感染，或未知病因的疾病等。以前我还是记得这些东西的，有几年没有做淋巴结病理了，这些疾病已经不容易想起来了……

 No evidence of lymphoma is not enough for a pathologic report.  I would approach this case as following:

1.  Look hard for evidence of metatstaic carcinoma, especially the subcapsular sinuses.  We should worry about breast primary in this age group.  Photos #4 and 5 show sclerosis.  Sometimes this would be the only clue for metastatic lobular carcinoma.  We usually submit all the lymph nodes if no gross evidence of metastatic tumor is seen.  You can also do immunostain with pan cytokeratin in most suspicious sections.  You need to talk to your clinician and get more information.  Please note that some lobular carcinoma doesn't even present as brease masses.

2.  It is true that it does not look like lymphoma.  We usually still do a limited panel to rule out lymphoma.

3.  This case may represent a benign/reactive process.  Reactive lymph nodes have diagnosable diseases too, such as Rosai-Dorfman disease, parasite infection, viral infection, or disease with unknown etiology.  I used to know this stuff.  Without signing out lymph nodes for  a few years, those specific diseases don't come  to my mind easily anymore.