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- B3826硬化性腺病？浸润性小叶癌？
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| 性别 | 女 | 年龄 | 38 | 临床诊断 | 1.乳腺癌2.纤维腺瘤 |
|---|---|---|---|---|---|
| 临床症状 | 发现左乳肿块1月余。 | ||||
| 标本名称 | 左乳肿块 | ||||
| 大体所见 | 灰白色灰黄色组织，质中等，切开灰白色，其中有一大小约0.8x0.5x0.3cm质硬区。 | ||||
| 镜下形态 | |||||
| 原诊断意见或问题 | |||||
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
标签：乳腺硬化性腺病 乳腺浸润性癌
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本帖最后由 易难 于 2011-11-28 19:20:32 编辑
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×参考诊断
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zengchao1979 离线
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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.
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本帖最后由 cqzhao 于 2011-11-27 19:55:15 编辑
引用 4 楼 cqzhao 在 2011-11-27 10:46:35 的发言:
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.
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。
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