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- 乳腺肿物
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本帖最后由 于 2007-01-15 14:53:00 编辑
学习Lucia老师讲解并翻译如下：
病史：女，50岁，乳腺肿块。
这是一例浸润性小叶癌，实性型。超过90%肿瘤细胞呈ER阳性，40%呈PR阳性。
肿瘤有边界，主要形成大的、缺乏间质的实性细胞巢。在部分区域肿瘤细胞排列成典型的Indian列兵结构。
这些细胞缺乏粘附性，小而一致，胞浆稀少。本例未见原位病变。
两个特点有助于鉴别淋巴瘤：1、典型的Indian列兵样浸润结构。2、细胞一致，核轮廓光滑，核膜不清楚，核染色质纤细。
我得承认切片(镜下形态)比照片清晰得多。
华夏病理/粉蓝医疗
为基层医院病理科提供全面解决方案，
努力让人人享有便捷准确可靠的病理诊断服务。
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本帖最后由 于 2006-10-24 18:03:00 编辑
谢谢lucia，通过此例我又学到了以下几点：
（1）老年人首先要考虑癌或排除癌 （2）出现列兵样排列首先要考虑癌或排除癌，尽管列兵样排列偶尔见于淋巴瘤，但一般不会这么明显和广泛，尤其是在透明变性的胶原内，相信淋巴细胞没有这么强的侵袭力、细胞粘附能力和促纤维反应性增生能力 （3）浸润性小叶癌细胞并不全像书中所讲的那样都表现为细胞核表面光滑，大小一致，核膜不明显等，图4右下方部分细胞核有明显的核裂(indentation)，像B淋巴细胞。
乳腺小细胞肿瘤主要包括浸润性小叶癌、淋巴瘤、粒细胞肉瘤和神经内分泌癌等。我会诊中还曾遇到过一例腹膜后神经母细胞瘤转移至乳腺的少见病例。
- the more we discuss, the more we learn from each other !!
This is an invasive lobular carcinoma, solid variant. More than 90% of tumour cells are ER positive and 40% of tumour cells are PR positive.
The tumour has a demarcated border and predominently formed by large solid nests of cells devoid of stroma. But in some areas tumour cells are arranged in typical Indian file pattern. These cells are discohasive, small and uniform with scan cytoplasm. No in situ lesion is identified in this case.
Two features to help to differentiate from lymphoma: 1. Typical Indian file infiltrating pattern. 2. Uniform cells with smooth nuclear contour, indistinct nuclear membrane and fine chromatin.
I admit that slides are much more clearer than photos.
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Histopathology can sometimes present paradox, and this case clearly is one such case with features of both infiltrating lobular carcinoma of the classic tyoe and lymphoma. By incidence, infiltrating lobular carcinoma is much more frequent than lymphoma. Therefore I favor this being an infiltrating lobular carcinoma. Immunohistochemistry (CD45 ans CK7) will resolve the matter easily.
聞道有先後,術業有專攻
