以下为术中冰冻切片的HE图片

图1  x25

图2  x25

图3 x100

图4 x100

图5 x200

图6 x200

图7 x400

图8 x400

浸润性小管癌

 谢谢赵老师精辟点评！

赵老师点评：

此例冰冻诊断有困难：图片显示，致密间质内腺体不规则。有些腺体无肌上皮环绕。很有可能是浸润性导管癌伴有小管形态。当然，仅根据图片，本人不能100%肯定它就不是良性（特别是发生在这个罕见的部位）。本人可能要到看了实际切片时，才确认是癌。

现场冰冻如果不能确诊，无论如何只能是将其延缓报告（待石蜡切片），并告诉手术医生几个鉴别诊断以及倾向性诊断。要让外科医生知道，有待石蜡切片再做些工作，才做最后诊断。底线是本例冰冻报告结果（良或恶性）并不会改变马上的临床处治。当然， 如果冰冻时觉得有信心诊断，那也可确诊。

建议石蜡切片标记肌上皮标志物和ER、PR（证实乳腺起源）。

需知腋窝异位乳腺组织可发生纤维腺瘤和浸润癌。

希望知道后续结果。

 Difficult case for frozen: Photos show Irregular shaped glands within the dense stroma.Some glands appear no myoepithelial cells surrounding. Invasive ductal carcinoma with tubular feature is most likely. However I cannot be sure 100% it is not a benign based on the photos only, especially in the rare situation. I may have confidence to call ca when I see the true glass slides.

Anyway in true practice if you are not sure for frozen, just defer the case and tell your surgens the differential diagnosis and your favor diagnosis. Let them know you will work on the perminent sections and make the final dx. Bottomline is the frozen will not change the immediate clinical managment.  Of cause if you feel confident in frozen you can give your final dx.

I will stain myoepithelial markers and ER/PR (confirm the breast origin) in the block.

Axillary ectopic breast tissue can develop fibroadnoma and invasive cancer.

Thank Dr. Wang's case. Hope to see your follow up result.

副乳腺来源的小管癌

注：肿块周边见乳腺腺病结构，并与其旁汗腺导管明显对比，结合临床双乳未发现肿块，考虑肿瘤来自副乳腺可能。临床也需进一步检查除外转移癌。

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 非常感谢这么好的病例