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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
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（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
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学习一下Dr.cqzhao对这例“乳癌术后胸水”中的异型细胞的逐步逼近目标的诊断方法。
1 用间皮标记calretinin和上皮标记BerEP4区分间皮瘤或癌。结果示癌。
2 用一组抗体确定转移癌的原发部位。CK7+，CK20-、TTF-1（-）、ER+、mammaglobin+，示乳腺癌。
3 用E-cadherin和p120确定导管癌or小叶癌。结果示小叶癌。
以上可确定为（胸水）转移性乳腺小叶癌。
4 设法获得原乳腺切片，为多形性小叶癌。并得知放化疗病史。
至此获得完美诊断：（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。
谢谢Dr.cqzhao！
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。
| 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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