3级，呵呵

3级．

同意．

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.

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!

 谢谢学习了。