Microscopically it is a 0.8 cm lesion as photo.

Your diagnosis and differential diagnosis.

（镜下病变直径0.8cm，如图。请诊断和鉴别诊断）

名称：图1
描述：图1

Am J Surg Pathol. 2009 Apr;33(4):496-504.

Molecular evidence for progression of microglandular adenosis (MGA) to invasive carcinoma.

Shin SJ, Simpson PT, Da Silva L, Jayanthan J, Reid L, Lakhani SR, Rosen PP.

Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA. sjshin@med.cornell.edu

 3 questions:

1. E. loosely or poorly cohesive.

2. E. about 60-70% TC with DCIS

3. BCF

I see only abin and  天山望月 . i feel not encouraged. People even do not like to pick A, b,c /////. 

You are right.

Like other low grade ca, TC is very difficult to make dx in FNA cytology, especially from the benign lesions. It is important you can call atypia and require core biopsy. Cell block may be helpful, but not IHC.

 I did FNA for the last case and never consider it as tubular ca before the biopsy. The good part is that I called sth atypia.

最后一例我做了FNA穿刺，在活检之前根本没有考虑它是小管癌。好在我称它为有一些不典型性。

You work so hard and should get some awards.

你如此勤奋，应该获奖。

Fig 1 and 2 are two classic pathology or cytopathology board photos. Whe you see them during a test, just pick the answer tubular ca immediately and go to the next question.

图1和图2是两个经典的病理学或细胞病理学样本图片。考试时看到它们时，只要立即选择小管癌即可，直接跳到下一题。

Fig 3-6 are cases of tubular ca FNA confirmed by biopsy. In true practice, you must be cautious to call tubular carcinoma for these cases. It is better to call atypical, favor... et al. Ask to do the biopsy. It is very difficult to diagnose tubular ca by FNA cytology.  Find a good FNA book to read the cytopathologic features of these lesions.

图3-6是小管癌的FNA表现，由活检证实。在实际工作中，必须非常小心诊断小管癌。最好称为“不典型细胞，倾向……”等等，然后要求活检。FNA细胞学诊断小管癌非常困难。找一本FNA好书，阅读一下这些病变的细胞病理学特征。

Now you have all my photos and no more to teach you.

现在我已经全部奉献出有关小管癌的所有图片，没有更多内容用来教学了。

（abin译）

名称：图1
描述：图1

名称：图2
描述：图2

名称：图3
描述：图3

名称：图4
描述：图4

名称：图5
描述：图5

名称：图6
描述：图6

 Made some questions for our follow teaching. Choose three and put here.

You are wellcome to write your answers. Please pay attention: One question may have more than one answers

 I appreciate Abin's professional translation. You know and can type both languages so well. Just wonder you are in the US or China.

Thanks,

cqz

abin回答老师：我在宁波妇儿医院。翻译您这么高水平的内容，是一种享受也是我的荣幸。

Send you a rare breast lesion case.

Slide keys

Fig 1-3. 4x

Fig 4. 10x

Fig 5-7. 20x

Fig 8. 40x

Fig 9. 20x

Fig 10. 40x

Fig 11. 20x

Fig 12. 60x

You will not see this kind case often even if you are breast pathologists. Hope whoever see the photos write down your dx and short discussion if you like to. Interested to know your dx. I assume that dx is not difficult for you in this website. Here is free and you can say what you want to. You will not have any responsbility. Just think it is your patient and how you will deal with the case.

I will come back three weeks later and have a short discussion with ones who are interested in this case.

Thanks,

cqz

abin译：这一例即使是乳腺病理专科医生，也不常见。希望看过的朋友写下诊断和简单讨论。很想知道你们的诊断。我猜这对你们网站上的人来说不难。这里是自由讨论，可以发表你的任何观点。不需要负责。只是把它作为你的患者，你将如何一日处理这一病例。

我会在三周后回来，与喜欢这一例的朋友作简短讨论。

谢谢。

Just released another tubular carcinoma and share with people who love breast pathology.

Slide Key:

H&E 10x

Lymph node 20x

Lymph node 20x ER stain

This is a very low grade tumor of 0.7 cm with Nottingham grade 1. However axillary SNB shows 1 mm micrometastases.

Definition:

Isolated tumor cell: single cells or small clusters of cell not greater than 0.2 mm. （孤立的肿瘤细胞：单个细胞或小簇，不超过0.2mm）

Micrometastases: >0.2 mm to <2 mm. pN1mi （微小转移：>0.2mm 但<2 mm）

Thanks

 To the Second floor:

There are no consensus concerning the proportion of tubular structures to establish the dx of TC. Some suggest the different cut-off points 75%, 90%, 100%. New WHO mentioned that for pragmatic reason, a 90% purity requirement offers a practical solution. For my daily practie, I use 100% as cut off point. Otherwise I call invasive ductal carcinoma with (focal) tubular feature. Few percentage of high grade carcinoma may cause poor prognosis. 

In the right side, few ducts show UDH and no ADH present.  

abin译：

关于诊断所需的小管结构的比例，尚未一致，有三种观点75%，90%和100%。新WHO提出90%作为实用标准。

我在日常工作中采用100%的诊断标准。否则我称为浸润性导管癌伴（局灶）小管癌特征。很少比例的高级别癌也可能预后差。

切片右侧一些导管为UDH，没有ADH。

This is a typical tubular ca.

Fig 1 20x H&E

Fig 2.10x SMMHC stain

Fig 3. 10x P63 stain

Fig 4. 10x K67, very low proliferative index

Tubular carcinoma (TC)is composed of small angular, oval, and tubular glands in the fibrotic background. Generally it is easy to make diagnosis. However it may be confused with sclerosing adenosis and microglandular hyperplasia (MGH).

MGH glands also lack myoepithelial cells, but basement memberane stain (for example college IV) and S-100 stain are positive. These two stains are negative for TC. Microscopically, MGA is an infiltrative proliferation of small glands in fibrous or fatty stroma. MGA is composed of small uniform and regular glnads containing eosinophilic secretion.

It is not difficult to tell the difference between TC and sclerosing adenosis (SA). However, occasionally SA can be a mimic of TC. When the dx is unsure, stains of myoepithelial markers can be very useful like my first case.

Thank for reading

njwbhuang译：

第15楼提供的四张图，如下。这才是典型的小管癌。

小管癌是由一些小的有角的、卵圆形和小管状腺体组成，包埋于纤维性间质背景中。一般情况下较易诊断，然而它可与硬化性腺病和微腺体增生（MGH）混淆。

MGH中腺体也无肌上皮细胞，但基底膜染色（Ⅳ型胶原）和S-100蛋白染色阳性，而小管癌中则染色阴性。镜下，微腺性腺病（MGA）是小的腺体浸润于纤维或脂肪间质内，腺体较小，大小较一致，腺腔内含有嗜酸性分泌物。

小管癌与硬化性腺病（SA）的鉴别并不困难。然而，偶尔SA可能误诊为小管癌。当诊断不确定时，正如本例一样，肌上皮标记物有助于诊断。

谢谢阅读。

10x smooth muscle myosin heavy chain stain.

P63 stain also shows nuclear stain in the cells surrounding the tubules.

Now you know the diagnosis.

abin译：

图示SMA免疫组化。p63也显示小管周围的细胞核着色。

现在您知道诊断了吧。

 Thank above.

will do it tomorrow night

 The lesion shares the similar morphology. So this photo represents the entire lesion.

abin译：

其他病变的形态与此相似。因此，这一张图代表整个病变。