Hypercellular spindle cell neoplasm with cytologic atypia, mitoses and necrosis = malignant neoplasm.  Would consider following (in decreasing frequency): sarcomatoid (metaplastic) carcinoma, high grade angiosarcoma, other sarcomas...Sampling, search for in situ or invasive carcinomatous component and IHC will be necessary. Look forward to hearing the final answer. Thanks.  

abin译：梭形细胞肿瘤，细胞丰富，异型明显、核分裂、坏死=恶性肿瘤。考虑以下（发生率递减）：肉瘤样癌（化生性癌），高级别血管肉瘤，其他肉瘤……

取材寻找原位性或浸润性的癌成分，需要IHC。

期待最后诊断，谢谢。

 如肿瘤位于乳腺实质,首先考虑化生性癌,其次叶状肉瘤.

否则考虑软组织肉瘤,请做免疫组化应该有帮助.

 Spindle shaped cells with marked nuclear atypia, hypercellularity, mitosis ? (fig 1, 5), necrosis. My diagnosis is malignant spindle cell lesion now. Then you need to do IHC, epithelial markers (AE1/AE3, cam 5.2, CK7,), squamous marker for metaplastic tumor (ck5/6, p63), Vimentin (stroma), smoother muscle marker (SMA, caldesmon). If all above markers are negative and only vimentin positive, the dx will be pure sarcoma (without glandular component in the tumor mass) or malignant

 phyllodes tumor (with some or few benign glandular component). I guess and favor these two diagnoses if no IHC results are known.  The chance of malignant myoepitheloma is very low.

Thank for u interesting case.

Waiting for ihc result.

cqz

abin译：

有明显核非典型性的梭形细胞肿瘤，细胞丰富，核分裂？（图1，5），坏死。我现在的诊断是恶性梭形细胞肿瘤。然后需要IHC。

上皮标记（AE1/AE3，CAM5.2，CK7）

鳞状上皮标记，针对转移性肿瘤（CK5/6，p63）

平滑肌标记（SMA，caldesmon)

如果以上标记全部阴性而只有VIM阳性，诊断为纯肉瘤（肿块中无腺体成分）或恶性分叶状肿瘤（有部分或少数良性腺体成分）。如果没有HIC，我猜测并侧重于这二者。恶性肌上皮瘤的可能性很小。