60 y/breast lesion under skin. This is biopsy.

Your differential dx.

What IHC will you do if you think you need to do some IHC?

60岁女性，乳腺皮下病变，活检。

你的鉴别诊断？如果需要IHC，你要做哪些标记物？

 图2、3中红细胞浸润

有无提示意义？

 如果是我的病例，我先追问病史，有无骨髓瘤或白血病。

作为常规的诊断思路，老年患者在考虑NHL之前先排除转移性癌或恶黑。这些“浆细胞”似乎很成熟，诊断浆细胞瘤之前先排除浆细胞性肉芽肿。还要鉴别MALToma和淋巴浆细胞淋巴瘤。

需要的一组抗体包括：CK，S-100，κ，λ，CD138，CD79a，CD38，CD20，CD21，CD35。

 Good analysis.

It is unfair. I should tell you the history.

The patient had invasive ductal carcinoma with segmental mastectomy. She then received radiation and chemotherapy.

Now what are your differential dx and IHC?

abin译：

分析得好。

不公平，我应该为你们提供病史。

患者有浸润性导管癌并做过乳腺区段切除，然后接收了放疗和化疗。

现在你的鉴别诊断是IHC？

 The pt had surgery for breast ca  in 2003.

（患者2003年行乳腺癌手术。abin译）

诊断思路和鉴别诊断依然不变，同第8楼。

Good observation.

Clearly you can appreciate RBC in fig 2 and 3, plus pt's hx of breast ca with segmental mastectomy, radiation, chemotherapy. Also remember the time perioid is about six years (2003-2009).

Of cause we need IHC for this case. However, what lesion will be your first differential dx?