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- （已有最后诊断）乳腺肿瘤
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| 姓 名： | ××× | 性别： | 女 | 年龄： | 45 |
| 标本名称： | 乳腺肿瘤 | ||||
| 简要病史： | |||||
| 肉眼检查： | 右乳腺肿物，2*2cm，切面灰白质硬 | ||||
患者，女，45岁，右乳肿瘤，2*2cm，切面灰白质硬。镜下肿物呈分叶状，肿瘤细胞小，界清，排列方式多样，核偏位或居中，可见核分裂，粘液样背景显著，部分区域小血管丰富。肿瘤周边似有癌的区域。免疫组化：S100强阳性，CK、vimentin少部分细胞阳性，Ki67阳性指数大于90％，其余抗体ER,PR,cerbB2，E-cadherin，syn,HCK,EMA,P120,P53,SMA,CEA,CgA,P63均阴性。
本例肿瘤背景粘液非常丰富，血管较多，周边有类似癌的区域，但很少。免疫组化也不好解释，请各位发表意见。
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本帖最后由 于 2010-04-13 05:02:00 编辑
×参考诊断
伴肌上皮分化的化生性癌，属于产粘液样基质的化生性癌范畴
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本帖最后由 于 2010-02-04 12:47:00 编辑
免疫组化：S100强阳性，CK、vimentin少部分细胞阳性，Ki67阳性指数大于90％，其余抗体ER,PR,cerbB2，E-cadherin，syn,HCK,EMA,P120,P53,SMA,CEA,CgA,P63均阴性。
Intersting and challenge case.
Please show some photos about s-100, CK, SMA EMA.
1. Carcinoma:
CK should be positive. Stain AE1/AE3, Cam5.2.
Metaplastic ca with matrix-production is good consieration, but the carcinoma component should be positive for CK, EMA, S100.
Suggest to add CK5/6, CK14, CK17, EGFR. If this is a metaplastic ca, it also may be a basal-like ca.
Other breast tumor, like mucinous ca.
2. Chordoma:
Do not know if there is primary breast chordoma. However rare cases of metastatic breast are in the literature. Chordoma can be positive for Pan-CK, and S-100, negative for GFAP.
3. chondrosarcoma:
Pure breast chondrosarcoma is very rare, but it can occur in the breast. I once saw three cases at AFIP. The tumor is positive for S100, GFAP, but negative for CK. The IHC features can distinguish chordoma from chondrosarcoma.
GFAP marker may be a good one to add.
4. Myoepithelioma:
If only S-100 is positive and all other myoepithelial markers are negative, the chance of myoepithelioma is very low. Add some more myoepithelial markers if you think it may be myoepithelioma.
5. Other metastatic tumors, such as salivary glands
6. Summary: Logic thinking: Common thing is common. I favor breast metaplastic ca based on the morphology and IHC results provided. However I want to know more IHC photos before I can make a diagnosis. Is EMA negative?
7. Our experience: In our department, we always require the block to do the stains in our own lab for consult cases and we never make the dianosis based on the IHC stained slides performed by other hospitals (no matter what kinds of hospitals).
