学习了！

 尽管歪歪扭扭，好像基底膜很完整哦，标记

 DCIS III级,常有微侵, 用肌上皮标记,比仅看HE片可靠.

DCIS, nuclear grade 3 with central necrosis. If still suspicious for invasion, getting more levels (deeper cut of the paraffin block) sometimes is helpful. Not enought to make a diagnosis for microinvasion from this picture.  High grade DCIS and more extensive DCIS is associated with higher possibility of invasion. But, there is plenty of high grade DCIS without invasion. Current definition of microinvasion is "invasive carcinoma that is 0.1 cm or less).  Thanks.

还有几副图.

 有浸润

 最后一张可见早期浸润

 后续的图有微浸润。

 

后续的图都有微浸润。

Thanks for additional pictures.  For me, they are still not enough for definitive invasion. Some areas are involvement of lobules by tumor cells (cancerization of lobules). For a high grade DCIS, I will need to see reaction of tumor cells with stroma (desmoplastic). I have to admit that I have no absolute confidence...would like hear other's opinions, especially from 版主.  Beautiful pictures!

 好漂亮的图，有浸润了。

 最后一张可见早期浸润

 有的

 有

以下是引用stevenshen在2008-7-30 23:44:00的发言： Thanks for additional pictures.  For me, they are still not enough for definitive invasion. Some areas are involvement of lobules by tumor cells (cancerization of lobules). For a high grade DCIS, I will need to see reaction of tumor cells with stroma (desmoplastic). I have to admit that I have no absolute confidence...would like hear other's opinions, especially from 版主.  Beautiful pictures!

译：谢谢补充图片。我认为仍不足以判断为明确浸润。一些区域为肿瘤细胞累犯小叶（小叶癌化）。对于高级别DCIS，我需要看到肿瘤细胞与间质的反应，即促结缔组织增生性反应（以判断明确浸润）。我得承认我没有绝对信心……最好听听其他意见，特别是版主的意见。图很漂亮！

注：上次笃行者老师讲过，小叶内间质内的“浸润”不是微浸润。不知我是否记错了？

 够了

 谢谢楼主的病例！谢谢stevenshen老师的讲解！
我同意stevenshen老师的意见。
第一张图肯定不是浸润。补充图的第一和第三张图似乎有浸润，但不是很肯定，因为没有间质反应。也或许是小叶内间质的浸润，但是这种浸润还达不到WHO关于微小浸润的标准。
遇到这样的情况可以报告：可疑微小浸润。临床处理与原位癌相同。如果病人日后一旦出现淋巴结转移也好解释。

 下面是两例微小浸润的病例，请指正。

 I think there is invasion.  There are single tumor cells around DCIS. She needs at least lumpectomy.  If i am not absolutely sure on a core biopsy, i would rather overcall to assure the patient gets proper care.