图1-6为乳腺肿块，肿瘤细胞异型性显著，呈肉瘤样。但仍可辨认导管结构。图7-10为腋下淋巴结，导管结构更明显。

考虑乳腺浸润性导管癌（低分化癌，或间变性癌，或肉瘤样癌）伴腋下淋巴结转移。建议免疫组化检测CK、VIM确诊。

 重新取材乳腺肿瘤没有上皮样结构.见成熟软骨和破骨样细胞骨样基质和上图内梭形   细胞 结构                                                                                                                                                        .                                                                                                                                                                                                                                          

免疫组化:CK(pan)(-)Vimentin (+)

 化生性癌。

它是指乳腺导管癌中主要成分不表现上皮和腺体而包括肉瘤样.癌可以有软骨和骨样基质和梭形细胞.

免疫组化Vimentin (+)偶而保留上皮标记.预后比导管癌更具侵袭性.

The lesion has a biphasic component. In areas the lesion resembles a classic infiltrating poorly differentiated duct carcinoma with nests and cords of malignant appearing epithelial cells. Elsewhere, the lesion has a distinct chondroid appearance. The chondroid areas merge imperceptibly with the epithelial areas. The cells within the chondroid appearance have similar malignant features to that of the surrounding infiltrating carcinoma. The presence of both a malignant cartilagenous and epithelial component is diagnostic of metaplastic carcinoma. Metaplastic carcinoma is a general term for breast carcinomas in which there is an additional component other than epithelial and glandular. In this case, with both epithelial and malignant spindle cell features this lesion would be regarded as a sarcomatoid carcinoma. Some individuals make the distinction between sarcomatoid carcinoma where the epithelial and spindle cell carcinoma merges with each other in contrast to 揷arcinosarcoma?where the two components are distinct. However, there is overlap between the two both histologically and immunohistochemically, and prognostically there is no difference. Consequently, we regard both sarcomatoid carcinoma (carcinoma with spindle cell differentiation) and carcinosarcoma as the same entity.

The presence of an epithelial component typical of infiltrating duct carcinoma rules out a pure chondrosarcoma. Malignant phyllodes tumor has a malignant mesenchymal component yet the epithelium appears benign. In carcinoma with chondroid metaplasia, the cartilage would have a totally benign appearance and would not merge in with the carcinoma.

 http://pathology2.jhu.edu/sp/case.cfm?case=95&CFID=4280614&CFTOKEN=25839639

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