非常赞赏金老师的诊断意见！ 
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- B291244 y/f vaginal bleeding, endometrial biopsy
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（女，44岁，阴道不规则出血，子宫内膜活检）
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标签：乳腺癌 子宫内膜样腺癌 WT1
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本帖最后由 于 2010-10-02 09:19:00 编辑
相关帖子
×参考诊断
腺癌。
注：描述乳腺和内膜标本的形态。根据细胞形态和免疫组化特征倾向乳腺原发。
| 以下是引用cqzhao在2010-11-11 4:49:00的发言： In fact later we found this patient had other organ metastasis. It is breast ca with multiple distant metastasis. |
Journal of Gynecologic Surgery
Metastatic Breast Cancer to the Uterus and Cervix
To cite this article:
Amy C. Klostermann Eichholz, John P. Geisler, Anil K. Sood. Journal of Gynecologic Surgery. September 2003, 19(3): 145-147. doi:10.1089/104240603770191096.
Amy C. Klostermann Eichholz, John P. Geisler, Anil K. Sood. Journal of Gynecologic Surgery. September 2003, 19(3): 145-147. doi:10.1089/104240603770191096.
| 以下是引用qianxun在2010-11-10 7:52:00的发言：
Dr. Zhao: I am not sure it is breast primary based on ER positive. Did you do DNA mapping for these two tumors? Thanks. Qianxun |
Thank your comment. We made the dx based on clinical hx, cytomorphology and stains. I am not 100% sure the breast primary
This is why my dx is Adenocarcinoma (see comment)
Comment: described the findings of breast and em bx specimens. Favor breast primary based on cytomophologic and IHC features
I did not do DNA mapping. Often I feel it is not very useful.
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本帖最后由 于 2010-10-27 22:04:00 编辑
Agree above evaluation.
Both breast and current em specimens show weak ER positive.
I signed out the case:
Adenocarcinoma.
Comment: described the findings of breast and em bx specimens. Favor breast primary based on cytomophologic and IHC features.
译：
同意上述分析。
乳腺标本和现在的内膜标本均呈ER弱阳性。
我签发的报告：
腺癌。
注：描述乳腺和内膜标本的形态。根据细胞形态和免疫组化特征倾向乳腺原发。
mammaglobin 的敏感性和特异性也不满意，鉴别作用不大。
阳性率：
Endometrium adenocarcinoma
1/9，2/14 (positivity in the two cases was focal, weak to moderate)，23/59，0/4 (using cell blocks from pleural fluid)
Breast ductal carcinoma
105/214, 9/14
References
1 Sasaki E, Tsunoda N, Hatanaka Y, et al. Breast-specific expression of MGB1/mammaglobin: an examination of 480 tumors from various organs and clinicopathological analysis of MGB1-positive breast cancers. Mod Pathol 2007; 20:208-14
2 Bhargava R, Beriwal S,Dabbs DJ Mammaglobin vs GCDFP-15: an immunohistologic validation survey for sensitivity and specificity. Am J Clin Pathol 2007; 127:103-13
3 Ciampa A, Fanger G, Khan A, et al. Mammaglobin and CRxA-01 in pleural effusion cytology: potential utility of distinguishing metastatic breast carcinomas from other cytokeratin 7-positive/cytokeratin 20-negative carcinomas. Cancer 2004; 102:368-72
4 Han JH, Kang Y, Shin HC, et al. Mammaglobin expression in lymph nodes is an important marker of metastatic breast carcinoma. Arch Pathol Lab Med 2003; 127:1330-4 FULL TEXT
5 Kataoka A, Mori M, Sadanaga N, et al. RT-PCR detection of breast cancer cells in sentinel lymph modes. Int J Oncol 2000; 16:1147-52
6 Zafrakas M, Petschke B, Donner A, et al. Expression analysis of mammaglobin A (SCGB2A2) and lipophilin B (SCGB1D2) in more than 300 human tumors and matching normal tissues reveals their co-expression in gynecologic malignancies. BMC Cancer 2006; 6:88
华夏病理/粉蓝医疗
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本帖最后由 于 2010-10-07 21:34:00 编辑
The glands in the endometrial biopsy specimenare weakly positive for ER, focally and weakly positive for mammaglobin, and negative for GCDFP.
1. What is your thought now?
2. Is it useful for mammaglobin stain in this case?
3. What percentage of breast carcinomas is positive for GCDFP?
（内膜活检标本中，腺体呈ER弱阳性，mammaglobin局灶弱阳性，GCDFP15阴性。
1、现在考虑什么？
2、乳腺癌的GCDFP15阳性率是多少？）
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本帖最后由 于 2010-10-07 21:32:00 编辑
Agree with Dr. Jin. WT1 can be useful for distinguishing breast ca from ovarian serous ca. Ovarian serous ca is the most common ovarian ca which are positive for WT1 in 85-90% of cases. Most breast carcinomas are negative for WT1. Most endometrioid carcinomas are negative for WT1. A ew percentage of cases are positive in my study, but all of them are weakly and focally positive.
Conclusion: WT1 is useless marker to differ the breast ca from endometrioid ca in most situation.
（同意Dr.Jin
WT1有助于区分乳腺癌和卵巢浆液性癌。卵巢浆液性癌是最常见的卵巢癌，WT1阳性率85-90%。大多数乳腺癌WT1阴性。大多数内膜样癌WT1阴性。我的研究中少数病例阳性，但仅为局灶、弱阳性。
结论：WT1大多数情况下不能区分乳腺癌和内膜样癌。）
WT-1 可以鉴别乳腺微乳头状癌和乳腺转移性卵巢浆液性乳头状癌。此病例HE形态不符合一般（conventional) 内膜样腺癌,有可能是子宫内膜浆液性癌等。
查阅文献后发现子宫内膜浆液性癌WT-1的表达率（10%）明显低于卵巢的浆液性癌。显然，WT-1 对此病例的鉴别诊断意义不大。
在Dr. Zhao的研究中内膜样腺癌WT-1的表达率为13%。
子宫内膜样腺癌中特殊类型中还包括伴有支持细胞样结构（endometrioid adenocarcinoma with sertoliform pattern）的变型, 但是此病例形态学不符合。
- xljin8
| 以下是引用cqzhao在2010-10-3 20:09:00的发言：
Above are my two papers related to WT1. Question: Is WT1 useful to distunguish breast ca from endometrial ca? Is WT1 useful to distinguish breast ca from endometrioid ca? |
译：
以上是我的两篇论文，与WT-1有关。
问题：
1 WT1有助于区分乳腺癌与内膜癌吗？
2 WT1有助于区分乳腺癌与内膜样癌吗？
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。
