Infiltrating ductal carcinoma with lobular features (浸润性导管癌 with 小叶癌 features) or infiltrating mammary ca with mixed ductal and lobular features. In a new article (Rakha EA, Gill MS, Ellis IO et al Breast Cancer Res Treat 2008), it was reported that mixed type breast carcinoma comprises 3.6% of all invasive breast carcinoma. It is worthwhile to make such a diagnosis because their distant metastasis pattern is more similar to lobular carcinoma (more bone or pleura), but their prognosis is similar to ductal carcinoma.  Thanks!

Great case and beautiful pictures! I agree with many of the above discussion. The infitrative pattern resembles that of an invasive lobular carcinoma; but the neoplastic cells appear higher grade than ordinary lobular carcinoma (invasive pleomorphic lobular carcinoma is a great idea); E-cadherin immunopositivity supports ductal differentiation.  I guess the most appropriate diagnosis is an infiltrating ductal carcinoma with lobular features.  The tumor cells also has plasmacytoid features and the nuclei is not terribly pleomorphic (grade 2); I did not see too many mitosis, will need an accurate count. Still need ER, PR stains.  One of the thing to keep in mind is always consider metastasis when a primary tumor has unusual morphology.  Of course, if you find in situ carcinoma, it should primary breast carcinoma. Thanks.

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同意．

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