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- B2230不典型小叶增生累及乳头状瘤(cqz-27)
Interested to ses above differential dx. This is a consult case. The primary pathologist (from a local hospital) thought it maight be a DCIS (papillary type). Some general pathologists in the usa are not good////.
One of our breast path fellow reviewed the case and thought it may be denomyoepithelioma as most of you.
同意腺肌上皮瘤的诊断。
乳腺腺肌上皮瘤(adenomyoepithelioma)是一种少见的特殊类型的乳腺良性肿瘤，临床均为女性，发病年龄27～80岁，平均58岁。临床表现主要为乳腺中央或周边部可触及肿块。肿块直径平均1.5～2.5 cm大小，少数可达7 cm。
镜下：肿瘤由增生的肌上皮细胞和腺上皮细胞组成，但与乳腺良性增生病及良性肿瘤中肌上皮细胞增生不同，后者仅围绕导管呈灶性增生，而腺肌上皮瘤则以肌上皮细胞活跃增生为主，细胞弥散，密集呈片，并见轻度异型，增生显著时常压迫腺管，致使管腔闭塞。病变中的肌上皮和腺上皮成分的比例，根据Loose等观察大多为1∶1，少数可达6∶1，且常有一定规律，复发性肿瘤中肌上皮成分明显增多。Tavassoli将此肿瘤分为3型：(1)梭形细胞型：常以肌上皮细胞增生为主，细胞梭形、短梭形呈束状结构。当腺上皮成分少时易与平滑肌瘤混淆。(2)腺管型：本型特点是由腺上皮和肌上皮细胞围绕未稍导管呈聚集性增生，形似一般腺泡、管状或导管腺瘤。当上皮增生显著时，腺管可受压闭塞。此型边缘常不规则，瘤细胞常浸润周围的乳腺组织，因此切除后常易复发。(3)小叶型：增生的肌上皮细胞呈实性、巢状，细胞浆常透明或嗜酸，有的似浆细胞样，它们常围绕受压上皮细胞。肿瘤性肌上皮细胞轻度异型，可见少数核分裂象(1～3/10HPF)，瘤周边纤维性包膜向瘤内伸展，把肌上皮分隔呈结节状或小叶状。间质有玻璃样变及钙化。
Accepted Dr. 197's suggestion. I am sending the larger photos. My microscope and camera are new and cost almost US$25,000. However I seldom took good photos. There are too many function I never know.
Humans are more important than eqiupments. Mao once said that victory of a war depends on humans, but not the weapons.
Ok, I need to start to read my today's breast cases now.
| 以下是引用cqzhao在2009-9-4 22:20:00的发言：
Accepted Dr. 197's suggestion. I am sending the larger photos. My microscope and camera are new and cost almost US$25,000. However I seldom took good photos. There are too many function I never know. Humans are more important than eqiupments. Mao once said that victory of a war depends on humans, but not the weapons. Ok, I need to start to read my today's breast cases now. |
谢谢赵老师再次传图！
看来赵老师有一个非常高档的相机，不过，正如赵老师引用的语录所言，人是最重要的因素，所以，我认为上传的好病例伴好照片之精彩的真正缘由是因为上传病例和拍摄照片的是精彩的人！
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breast lesion (cqz-27) 乳腺病变 (cqz-27)
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This is my one today's consult cases
about 60 y/f with breast lesion
What is your diagnosis?
这是我一天的一个会诊病例
大约60岁，女性，乳腺病变
你的诊断是什么？
adenomyoepithelioma. 腺肌上皮瘤
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Thank above discussion. I especially appreciate the detailed desc ription of 乳腺腺肌上皮瘤by Dr. Zhang. Of cause it does not mean that I agree or disagree the diagnosis. Others can still have your oppinion based on the photos. |
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感谢以上的讨论。我特别感谢张医生关于乳腺腺肌上皮瘤的详细描述。当然，这并不代表我同意或者不同意这个诊断。其他人可以基于照片持有自己的观点。 |
Accepted Dr. 197's suggestion. I am sending the larger photos. My microscope and camera are new and cost almost US$25,000. However I seldom took good photos. There are too many function I never know.
Humans are more important than eqiupments. Mao once said that victory of a war depends on humans, but not the weapons.
Ok, I need to start to read my today's breast cases now.
我接受了197医生的建议，上传大一些的图片。我的显微镜和照相机都是新的，价值大约25000美元。然而，我很少照到好照片。很多功能我从不知道。人比设备重要的多，毛曾经说过，战争的胜利决定于人，而不是武器。。
好了，我需要开始我今天的乳腺病例读片了。
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翻译
breast lesion (cqz-27) 乳腺病变 (cqz-27)
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姓 名： |
××× |
性别： |
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年龄： |
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标本名称： |
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简要病史： |
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肉眼检查： |
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This is my one today's consult cases
about 60 y/f with breast lesion
What is your diagnosis?
这是我一天的一个会诊病例
大约60岁，女性，乳腺病变
你的诊断是什么？
adenomyoepithelioma. 腺肌上皮瘤
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Thank above discussion. I especially appreciate the detailed desc ription of 乳腺腺肌上皮瘤by Dr. Zhang. Of cause it does not mean that I agree or disagree the diagnosis. Others can still have your oppinion based on the photos. |
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感谢以上的讨论。我特别感谢张医生关于乳腺腺肌上皮瘤的详细描述。当然，这并不代表我同意或者不同意这个诊断。其他人可以基于照片持有自己的观点。 |
Accepted Dr. 197's suggestion. I am sending the larger photos. My microscope and camera are new and cost almost US$25,000. However I seldom took good photos. There are too many function I never know.
Humans are more important than eqiupments. Mao once said that victory of a war depends on humans, but not the weapons.
Ok, I need to start to read my today's breast cases now.
我接受了197医生的建议，上传大一些的图片。我的显微镜和照相机都是新的，价值大约25000美元。然而，我很少照到好照片。很多功能我从不知道。人比设备重要的多，毛曾经说过，战争的胜利决定于人，而不是武器。。
好了，我需要开始我今天的乳腺病例读片了。
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本帖最后由 于 2009-09-05 06:52:00 编辑
Lunch time, Check this caes. Thank Dr. Wang's translation. Now there are a lot of pathologists with high level of English in China. This is a good sign.
似纤毛又非似纤毛: these kinds of structures are very common in columnar cell changes, papilloma, FCC et al. You will notice them often when you pay attention to. Forget these structures. They are not important for the dx of this case.
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翻译 Recently I am very busy with other things. Sorry I did not follow up this case on time. Anyway I will continue to work with your guys for this case. 1. 腺肌上皮瘤 is a differential dx. However the IHC did not support the dx 2. Now most of people think it is introductal papilloma. It is true it is introductal papilloma. 3. I would not show you a classic introductal papilloma case. So it must have some other lession related to the papilloma. Please check the photos more carefully, especially in high power. 4. In order to make it easy for you. I will paste some photos with areas close to the papilloma. |
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最近我一直忙于其他的事情，很抱歉我没有及时跟踪这个病例。但是，无论如何，我将和你们一起继续探讨这个病例。 1腺肌上皮瘤 是个鉴别诊断。然而免疫组化不支持这个诊断。 2 现在很多人认为这例是导管内乳头状瘤。确实这是导管内乳头状瘤。 3 我不会展示给你们一个典型的导管内乳头状瘤。所以一定有和乳头相关的其他病变，请仔细看图片，特别是高倍视野。 4 为了看起来容易些，我将贴一些和乳头相邻病变的照片。 |
Some areas close to the papilloma
和乳头相邻的地方
what diagnosis will you made for these areas close to the papilloma?
这些和乳头结构相临地区的病变你诊断什么？
Forget the papilloma now. What is the diagnosis for the photos in floor 29?
现在忘记乳头状瘤，29层的图片你诊断什么？
Most netfriends are interested to the cancer cases, but not some uncertained cases.
Thank 青青子矜 for above reasonable analysis. Based on her instruction, I paste here dual IHC for p120 and E-cadherin for the lesions (floor 29), areas close to the large papilloma.
许多网友对诊断癌的病例感兴趣，而对不确定的病例不感兴趣。
感谢以上青青子矜的合理的分析。基于她的建议，我在这里贴上（29层）病变的p120 和 E-cadherin免疫组化照片，这个地方是和大乳头相邻的视野
If you do not know how to interpretate the stains, please check this topic
如果你不知道如何解释染色结果，请看链接：
http://www.ipathology.com.cn/forum/forum_display.asp?classcode=129&keyno=111923&pageno=2
1. It is 残存导管.
2. It is difficult to separate LCIS from ALH for some cases even though there are good calssification or definition. For this case it is ALH not LCIS
3. Lobular neoplasia (ALH and LCIS) is only an indicator of the risk for more severe lesions. In the
No need to treat lobular neoplasia.
1E-CA阳性为残存导管
2 虽然有很好的定义和分类，小叶原位癌和不典型小叶增生的区分仍然很困难这一例是不典型小叶增生，而不是小叶原位癌。
3. 小叶肿瘤(不典型小叶增生 和 小叶原位癌)只是一个衡量更严重病变的风险指标。在美国，许多人认为如果针刺活检诊断小叶肿瘤，这个病人应该做（肿块）切除活检
没有必要治疗小叶肿瘤
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F1, E-cadherin F2. P-120 F3. dual stain（双染） 200x F4. dual stain（双染） 400x So it is atypical lobular hyperplasia involving papilloma. I signed out this case as atypical papilloma with comment.所以这例是不典型小叶增生累及乳头状瘤。我签发为不典型乳头状瘤并注解。 Important points for this case: 1. ALH can involve many different lesions, such as sclerosing adenosis, fibroadenoma, radial scar, papilloma...... 2. Atypical papilloma can have different meaning. |
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这例的要点在于： 1不典型小叶增生可以包括很多不同的病变，比如硬化性腺病、纤维腺瘤、放射状瘢痕、乳头(状)瘤等等 2 不典型乳头状瘤可以有很多涵义。 |
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If it was a breast core biopsy, patient should have excisional bx. This was excisional biopsy specimen. So follow up with mammogram is propriate. 如果病人是针刺活检（诊断小叶肿瘤），这个病人应该做（肿块）切除活检 这个是（肿块）切除活检，所以乳腺X线照片随访就可以了。
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zhao 老师, 您做的工作更多, 我们更应该感谢您才对!
翻译
Lunch time, Check this caes. Thank Dr. Wang's translation. Now there are a lot of pathologists with high level of English in
似纤毛又非似纤毛: these kinds of structures are very common in columnar cell changes, papilloma, FCC et al. You will notice them often when you pay attention to. Forget these structures. They are not important for the dx of this case.
午饭时间,来看看这个病例.感谢王医生的翻译.现在中国国内很多病理学工作者英语水平都很高,这是个好现象.
似纤毛又非似纤毛: 这种结构在柱状细胞变化，乳头状瘤，FCC（？）等病变中都很常见。当你留意的时候，你常常会注意到（这种结构）。忘掉这些结构，这种结构在这个病例的诊断中不重要。
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