May be ductal ca. However I cannot evaluate if the stains of tumor cells are weaker  than normal ductal epithelial cells based on photos.

Remember that E-cadherin can be negative or reduced stain for E-cad

 Invasive ductal carcinoma and DCIS.

H & E appears to have invasive lobular carcinoma, but E-Cad exluded that.  Some ductal Ca has poor glandular formation and thus mimics lobular ca.

好病例！谢谢

 免疫组化结果很有意思，好像确实是E-Ca阳性。那么应该是导管癌了。

可是HE图像也确实有细胞粘附性丧失，还有胞质内空泡。小叶癌的特征也不能视而不见。除非有一种可能：制片不佳产生的粘附性差（假象），而质空泡也可见于导管癌。

如果是我的病例，我可能会报：浸润性乳腺癌伴部分浸润性小叶癌特征，但免疫组化示E-Ca阳性较符合浸润性导管癌。不影响分级，也不影响临床处理。

谢谢楼主和各位老师。

 It may be a ductal lesion. This is why we need to stain.

E-cad is membranous stain for ductal lesions. Your photos of stains are not clear. Can you show us the photos with high power and high quality? Do you have negative control? Can you do P120 stain?

thanks

Iy you are not sure, it is reasonable for the stains.

CD31 may be better than CD34. The specificity of CD34 is low. Should have D2-40 stains in your lab

 综合cqzhao老师的回复：

做免疫组化要有一定的考虑，为什么选择上述指标（ER、PR、E-cadherin，CK5/6，P63，SMA，CD34）呢？

该例含有浸润性成分及原位成分，因此免疫组化CK5/6, sma, p63 并非必需，并且为什么染CD34呢？

当然，E-cad是为了区分导管癌及小叶癌， ER, PR, Her2 是为治疗

我的诊断：

浸润性小叶癌，组织学分级2级（小管形成-3，核级-2，核分裂-1，总6/9）

浸润性肿瘤大小：xx mm

小叶原位癌，经典型，核级-2，伴微钙化

小叶原位癌伴浸润性成分.

淋巴结浸润有/无

切缘阴性，浸润性癌距离切缘最近为xx mm

无肿瘤的乳腺组织见：xx, xx, xxxx

浸润性肿瘤部分 ER/PR/Her2 结果：

 I think most likely it is loblular lesion. Of cause I will wait the stains before I sign out the report.

我认为很可能这是一例小叶性病变；当然我会等待染色结果后再签发报告。

 Dr. byq 

Thank for sharing the case.

Tell us your stains when you are done

 My dx:

Invasive lobular ca, histological grade 2 (tubular formation-3, nuclear grade-2, mitotic activity-1; total score 6/9)

Invasive tumor measures xx mm

Lobular ca in situ, classic type, nuclear grade 2, with microcalcification

Lobular ca in situ mixed with invasive component.

No lymphovascular invasion present/or present.

Margins are negative for invasive ca; In vasive tumor is xx mm to the clostest xx margin

Non-neoplastic breast tissue showing xx, xx, xxxx

Invasive tumor ER/PR/Her2 results