最后考虑原位癌，大部分肌上皮消失了，仅有周围导管肌上皮存在。

这点还没问病史，不知道有没有接触过化学物质啊

 Patient is very young. It is challebge case.

Do E-cad to rule out lobular lesion.

Proliferative cells show relative similarity, focal bridging. Need to consider if it is ADH. Cannot make definite dx based on the photos.

小叶腺原位癌，不看年龄看侵袭，不看形态看浸润。注意，患者有没有接触化学毒物。

 不好意思，导管周围肌上皮存在且连续，导管内细胞增生单一，大部分是导管上皮超过90%。

E-cadherin阳性，肌上皮标记我们一般用P63，SMA，calponin和CK34E12

等我找一下免疫组化传一下

不典型增生我觉得都有点过了。呵呵核分裂没有明显的呀。只是细胞有点异型，我觉得定不典型增生更把握点，学习了

E-cad positive excludes lobular lesion.  Myoepithelial stains are no meaning in this case. The key point for this case is the lesion is DCIS or ADH. Except for this young women has DCIS in other area, the photos may represent DCIS with lobular involvment. Other wise I feel it is better to call ADH.

If the specimen is breast core biopsy the patient need to have excisonal biopsy it does not matter what we call dcis or adh.

If this is a excisional biopsy with clear margins, our pathology report will be very important for next clinical management of the young lady.

If we call ADH, we do not need to report the margin and the women will have close clinical and imagingfollow up. If we call DCIS, pathologists need to report the size of DCIS, margins, do ER, PR stains. Breasy surgeons or oncologists need to consider the possibility of sentinel lymph node biopsy, radiation, adjuvant chemotherapy or total mastectomy based on individual patients.

So pathology diagnnosis guides the clincial managment. This is why we must be very cautious to make our dx.