硬化性腺病？浸润性小叶癌？

其余免疫组化SMA（+）、P63（+/-）、E-cadherin未做（做了一个P120）。

比较困惑的一个病例，期待有个正确诊断。
继续添加SMA图片

低倍镜下  列兵明显   但是您的高倍没提供这样的区域

免疫组化P120膜阳性

这些合起来，您疑惑在何处？

强子老师，低倍镜下列兵明显，那就是考虑浸润性小叶癌了，免疫组化P120膜阳性应该不是浸润性小叶癌的免疫表型（小叶癌应该在胞浆，原来没做过这个抗体，看迈新产品说明上的）。且肌上皮也是阳性证明有肌上皮的存在，不知如何解释。谢谢？

且图8和11采的是病变周围正常的导管小叶标记，看其标记部位和病变区域应该是一致的，那就说明病变区的标记靶细胞和正常的导管小叶标记是一样的，那样的话还可以继续诊断浸润性小叶癌吗？

Based om H&E, two main ddx, sclerosing adenosis (SA) and invasive cancer (IC). These two diagnoses are totally different, benign and malignant. It is the responsibilty for pathologists to distingush them correctly.

Two steps for two different questions:

1. Luozhu said that P63 positive. Please show the photos. If It is not clear, pelease add another myoepithelial stains, such as smmhc.

The presence or absence of myoepithelial markers can tell easily it is a SA or IC.

2. If it is a invasive cancer, you need to figure out it is ductal or lobular ca. P120 stain above is not clear, too strong. Please add E-Cadherin stain. Of cause if it is SA case, you do not need to do p120 and e-cadherin stains.

Frequently speaking if you have good stains, this is a very easy case for dx.

Hope it can help.

易难 ,

we hope to see your follow-up result for this case. Thanks, cz

赵老师回复：

根据HE，两个主要的考虑，硬化性腺病（SA）和浸润性癌（IC）。这两个诊断截然不同，良恶性分明。正确区分二者，是我们病理工作者的责任。

提供两个意见：1.楼主说P63阳性，请提供图片。如果不清晰，请加做一种肌上皮标记，如SMMHC。肌上皮标记物存在与否，可以很轻松的告诉我们是SA还是IC

2.如果是浸润性癌，则需要鉴别是导管癌还是小叶癌，上述P120不清晰，太强了。加做E-cad吧。当然，如果是SA，则不需要做P120及E-cad了。

一般讲，染色好的话，此例诊断应不难。

希望看到楼主对这例的后续工作。

应考虑浸润性小叶癌

Difficult to read your p63 and SMA stains. P63 should be nuclear stain.  Too strong background. You should have good positive and negative controls.

If you are not sure the dx, please repeat the stains.