| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- B2229breast 髓样癌, yes or no?(cqz-26) 9-1-2009
| 姓 名： | ××× | 性别： | 年龄： | ||
| 标本名称： | |||||
| 简要病史： | |||||
| 肉眼检查： | |||||
标签：乳腺不典型髓样癌 基底细胞样乳腺癌
-
本帖最后由 于 2009-09-26 08:24:00 编辑
相关帖子
×参考诊断
-
jianshu322 离线
- 帖子：447
- 粉蓝豆：17
- 经验：1405
- 注册时间：2008-12-22
- 加关注 | 发消息
This case may be called as 不典型髓样癌（AMC）based on the traditional criteria. Clearly the tumor cells demonstrate the focal infiltrating margins.
1. The term of medullary ca (MC) is confusing. The pathologic diagnosis is very subjective and interobservers are very variable. Basically many pathologists do not use the term any more. We did not make any diagnosis of MA in the past three years. Its prognostic implications are not certain.
2. In fact most of MA are triple negative and some basal-like marker positive, and belong to the category of basal-like ca, the same as most metaplastic ca.
3.We just call invasive ductal carcinoma for these cases because we do not give oncologists' impression that they have good prognosis.
4. For above case:
a. sentinel lymph node was positive
b. IHC: ER very focal positive: H score 4%, PR negative, Her2 score 2
c. Her2 Fish 2.03 , equovical.
5. Finally, I released this case as:
Invasive ductal carcinoma, Nottingham histologic grade (NHG) 3 (tubule formation-3, nuclear degree-3, mitotic activity-3, total score 9/9).
6. Home message for this case: The use of the diagnostic term of MC is contradict now. At least you need to be cautious to make the diagnosis of MC.
I just mention how we handle these kinds of cases now. It does not mean it is the only correct way.
Just for your reference.
| 以下是引用abin在2009-9-4 23:23:00的发言：
WHO 2003 关于髓样癌有5个诊断特征，本例都符合。 典型的MC具备五大形态特征： |
| 以下是引用cqzhao在2009-9-6 21:01:00的发言： Hope you will not become more confused after you read above abstracts. If we want to know a subject or topic really, we have to read related original publications. It is not enough to read some description in text book only. 谢谢赵老师的指点！ |
-
本帖最后由 于 2009-09-09 13:06:00 编辑
In fact there is no special treatment for basal-lik ca currently.
In our hospital we make diagnosis based on the following:
1. All invasive mammary ca: ER/PR/Her2(plus KI67)
2. All triple negative cases, we will do ck5 (ck5/6)/EGFR/ck14/ck17.
3. if above some of the markers are positive, we will call invasive ductal ca with basal-like phenotype.
4. For these classic metaplastic ca we will call metaplastic carcinoma and will not do basal-like markers for them. We will not call them as basal-like ca even though most of them will be positive for basal-like markers.
5. In the USA pathologists in many hospitals will not stain the basal-like markers for triple negative tumors. In other words it is required by CAP now.
Finally, we should know that basal-like carcinoma is a heterogenous group of tumors.
事实上目前对基底细胞样癌没有特别的处理方案。
在我们医院，基于以下情况做诊断：
1.所有的浸润性癌：ER/PR/Her2（加KI67）.
2.所有三阴性病例，我们将标记ck5 (ck5/6)/EGFR/ck14/ck17。
3.如果上面的指标部分阳性，我们称之为具有基底样表型的浸润性导管癌。
4.对这些典型的化生性癌我们称之为化生性癌并且不再对其做基底样标记。我们不诊断为基底细胞样癌即使它们中大部分基底样标记为阳性。
5.在美国许多医院的病理医生对三阴性的病例不做基底细胞样的标记。换句话说，现在它不是CAP(
College of American Pathologists
)要求必做的。
最终我们应当知道：基底细胞样癌是肿瘤的一种变异形态。
（quyibl译）
| 以下是引用cqzhao在2009-9-6 20:52:00的发言：
Also for wfbjwt :Your reading is so fast. Basically basal-like ca and medullary ca are two different calssification systems. We cannot say the dx of MA should exclude basal-like ca. In fact most cases of MA belong to the category of basal-like ca. I am pasting some related abstracts here. |
- 博学之，审问之，慎思之，明辨之，笃行之。
