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- B2421乳癌术后胸水检测 (cqz-29)
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60 y/f with history of breast ca and had segmental mastectomy sereral years ago in other hospital. Patient present with pleural effusion.
F1. ThinPrep 400x
F2. cell block 400x
F3-4. cell block 600x
What will you do?
标签：乳腺多形性小叶癌
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本帖最后由 于 2009-12-31 11:18:00 编辑
相关帖子
- • 右乳肿物诊断？
×参考诊断
（胸水）转移性乳腺多形性浸润性小叶癌，细胞学伴放化疗影响
| 以下是引用viivi薇在2010-8-31 16:29:00的发言： 请问赵老师，如果没有条件做IHC，如何从形态学上鉴别放疗后的细胞和具有恶性增殖特性的细胞？胞浆空泡，核仁不明显，染色质淡染且分布均匀，就算是放疗后细胞出现一定的异型，这些特征仍可提示其为良性细胞？谢谢！ |
This is a large question. I cannot answer this with a few sentenses.
The key is that you should tell the cells in fluid are mesothelial cells or epithelial cells. Mostly epithelial cells in fluid are metastatic carcinoma. Reactive mesothelial cells can be urgly, but they may be benign.
Anyway IHC stains are needed in many times. If you cannot do the stains and you are not sure, you can use some words "suggestive of" et al. Clinical history is always important. Of cause cytology experience is also important.
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本帖最后由 于 2010-01-30 10:44:00 编辑
Now I know that patient had breast pleomorphic lobular ca.
Also the patient recieved radiation chemotherapy.
The malignant cells in pleural effusion showed radiation and chemotherapy effect. This is why they are so ugly.
Wish more people like cytology.
Pathologists make diagosis based on the evidence, but not on the guess.
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本帖最后由 于 2010-01-30 10:30:00 编辑
Now we know most likely it was metastatic tumor from breast.
Next question is what type of breast tumor.
The cells in pleurAL fluid have some features of lobular carcinoma (photos in the top)
I stained e-cad and p-120.
F1. E-cadherin
F2. P-120
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本帖最后由 于 2010-01-30 10:41:00 编辑
CK7 and CK20 are useful markers for unknown primary.
CK7+/CK20-: breast, gynecological, lung.
CK-/CK20+: GI (especially low GI)
TTF-1: relative specific for lung
ER: gyn and breast
This patient had history of breast ca. I added mammaglobin.
F1. CK7
F2. CK20
F3. Mammaglobin
TTF-1 negative
ER positive
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本帖最后由 于 2010-01-30 10:15:00 编辑
First step:
I always do some stains for these kinds of fluid cytologic cases to distinguish mesothelial cells from epithelial cells first.
Calretinin (mesothelial) and BerEP4 (epithelial)are the best two markers to choose.
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| 以下是引用笃行者在2010-1-1 21:19:00的发言：
对细胞学不是太熟悉，但感觉这些细胞核较大，核浆比增大，染色质较粗，核仁明显，有核分裂像，考虑是癌细胞。期待Dr.zhao解惑，谢谢！ HAPPY NEW YEAR TO YOU, Dr.Zhao. |
We sent message here in the same time. You just did a few second before me.
Happy New year to you too. Thank you I learned the new word "笃" in 2009. cz
