Can we see the low power for these photos?

No invasion here

Above are p63 stain.

Can we see H&E stain in these foci and also SMA or smooth muscle myosin heavey chain stains

Myoepithelial stain for above area

 Reading  true slides will be much easier for these kinds of cases.

For papillary lesions, myoepithelial stains will be useful to demonstrate myoepithelail cells lining the fibrovascular cores are present or not. If all myoepithelial layer within the papillae are lost, it is a papillary DCIS. If florid ductal hyperplasia  is present, you will not see the myoepithelial cells also.

The following photo may represent DCIS or UDH in term of IHC pattern. We still need H&E to make dx

 I cannot buy invasion so far. Need to see more.

Solid papillary carcinoma: Generally all of the areas are solid tumor nodules. They are not present in the way focal benign papilloma and focal solid papillary ca.

I increase my call now. Maybe it is case like DCIS involving papilloma.

 I spent  time on this case. I become more confused now. Anyway the only way to make reasonablly interpretation is to read the true slides. So all the analysis is just for reference.

Thank Dr. Jin to poste here so many photos. cz

 Based on all the new photos, I am convienced that DCIS is present.

But you still see the focal benign glands within the atypical glands.

 Origianlly it is a papillary lesion. Focal ducts keep proliferation-atypical -dcis. It is very arbitriary to divide atypical papilloma, DCIS involving papilloma, papillary carcinoma based on the % size involving by atypical proliferation. I feel it may be reasonable to call DCIS involving papilloma.

Invasive ca and DCIS are totally two different concepts. The prognosis and clinical management are different. We have to have very solid evidence to call invasion.

Till now I would not buy  invasion.  Of cause Dr. Jin will make his decision for his case. We are just talking and share no any responsibility. Ha, ha.

Again, thank Dr. Jin to share the case.

If all our Chinese pathologists have the 严谨的精神 as Dr. Jin, we will arrive the leading position in pathology area in the world.

cz

很抱歉我引用了自己的发言。金老师的病例很精彩，Dr.Jin和Dr.Zhao两位老师的发言很精辟，向您们表示敬意。谢谢!

请允许我再次发言。

我反复仔细看过前后的HE切片，尤其是最后的一批图片，增加了对这个病例诊断的信心。这例可能性最大的诊断是：伴有显著原位癌成分的浸润性导管癌。

我想做的下一步工作是用IHC标记证明是否存在脉管（主要是淋巴管）受累。在没有IHC证实之前，不能放弃这个考虑。

还想知道有没有查腋窝淋巴结肿大的证据。谢谢！