病历摘要：

“发现左乳肿物1年余，右乳肿物1周”入院。

2010年12月6日双乳钼靶片示：双乳呈混合型Ⅳb（纤维囊性增生为主），左乳外上区多发肿块不除外恶变可能，建议手术，右乳外上区良性增生结节，BI-RADS：III，左乳BI-RADS：V；

查乳腺彩超示：符合双侧乳腺增生声像，左乳头外上象限低回声团块，考虑为实性占位，不除外恶变可能，建议病理检查，右乳低回声肿块，考虑纤维腺瘤可能。

专科检查：双乳外形欠对称，左乳12－2点位距乳头2cm可触及一肿物，大小约4.0×5.0cm，质硬，边界欠清，表面欠光滑，活动度欠佳，与皮肤、胸壁无粘连。右乳11点位距乳头2cm可触及一肿物，大小约1.5×1.5cm，质韧，边界尚清，表面尚光滑，活动度一般，与皮肤、胸壁无粘连。

临床诊断：

1.乳房肿物（左乳癌？）2.乳房肿物（右乳增生结节？）3.乳腺增生（双侧）

大体病理检查：

送检（左侧）乳腺肿物切除标本：6.0cm×4.0cm×1.0cm，切面见大小为1.5cm×1.3cm灰红结节。

其中一张切片，免疫组化顺序为：ER，CK5/6，CD10

另外的一些切片，取了十几块，均有类似病变，这是其中的几块。

免疫组化为Calponin。

 您的诊断：

1）周围型乳头状瘤（导管内乳头状瘤病）；

2）周围型乳头状瘤伴UDH；

3）周围型乳头状瘤伴ADH；

4）周围型乳头状瘤伴DCIS；

5）乳头状原位癌；

6）其他。

 -atypical papilloma

-ADH

-Sclerosing adenosis

 好，期待。

Papillomas can display focal proliferations of a mildly
atypical, monotonous cell population identical to lowgrade
DIN (DIN 1/ADH/DCIS, grade 1; Figures 5, A
through F, and 6, A through C). When DIN 1 occupies
less than a third of the papillary lesion, the term atypical
papilloma has been used. If at least a third, but less than
90% of the lesion displays such changes, the designation
of carcinoma arising in a papilloma has been used.

When completely excised, these 2 groups do not seem to differ in clinical behavior, as observed in a retrospective study that used this quantitative approach. It is noteworthy that
although 90% was used as the cut-off point, none of the
lesions had atypical areas that occupied more than 65%
to 70% of the papillary lesion. Currently, to avoid the term
carcinoma, we designate all such lesions as papillomas with
DIN 1/atypical papilloma (Table 1).

-Ueng, S.H., T. Mezzetti, and F.A. Tavassoli, Papillary neoplasms of the breast: a review. Arch Pathol Lab Med, 2009. 133(6): p. 893-907.