可上下拖动图文，可点击点击单张图片并放大
病例一
50y/fwithbreastmass1.5cm.U/Sguidedbreastcorebiopsy40x，x
InfactthisisaveryeasyandunusualcasewhichIhadwhenIwasatAFIP.Ifirstsawthecase.Clearlyitwasgranularcelltumorbycytomorphology.Tumorcellsshowsmallroundandnuiformnucleiandabundentandgranulareosinophiliccytolasm,classicfeaturesofGCT.SurprisinglyIHCstainsindicatedthetumorcellswerestronglypositiveforCK7,AE1/AE3,andnegativeforS-,CD68.Soitishistiocytoidcarcinoma,avariantoflobularcarcinoma.
OfcauseIamsureallofusknowthatthesetwotumorshavemuchdifferentprognosis.
Thelessionforthiscaseisthatpathologistsmustruleoutallotherpossibledifferentialdiagosesbeforewemakeourfinaldiagnosisinourclinicalpractice.Thispricipleshouldbeusedforallcaseseventhoughwethinkweknowthedxofthecases.
病例二
Itransferthiscasefrompreviousbreastlesion.Hopemorepeopleseeandjoininthediscussion:
50yearwomenwithbreastmass
Fig1isalowpowerviewofthelesion,wheretheoverlyingskinadjacenttothenippleisseenoverlyingawell-circumscribedmass.
NowIshareasecondcasewithsamediagnosisasabovecase.
HEandp63stain.
Whoeversawthecasepleasewritedownwhatyouthinkandjoininthediscussion.
Thesephotoswillbepublishedsoon.Pleasedonotcopythemforyourpublication.
HowcanIaddamarkertothephotoslikeinthelecturephotos?Thenotherscannotcopythem.
Abin:Canuhelptodoit
Thanks,
cz
P63
网友讨论：
第3楼也是囊内乳头状癌，p63染色有小灶DCIS。
是，我现在也同意第一例为囊内乳头状癌，但第二例似乎不同，囊壁无内衬上皮，乳头是实体型的。请教赵老师。
赵澄泉老师：Great.Mostofugottheanswer.Bothofthecasesareintracysticpapillarycarcinoma.
TheHEslideinthesecondcaseisnotverygood.Youcanseeitmoreclearlyinthep63stainedslide,whichdemonstratespapillaryglandularstructure.Thepatternisnotlikesolidpapillaryca.Idiscussalotaboutthefeaturesofsolidpapillaryca(SPC)inonecaserecently.ButIcannotfinditnow.
Intracysticpapillarycaiscalledencapsulatedpapillaryca(EPC)now.Microscopically,itischaracterizedbyonenoduleofpapillarycasurroundedbyathickfibrouscapsule.ThehistologicapperanceofthepapillaryproliferationcanhaveanyofthefeaturesofpapillaryDCIS.MyoepithelialcellsarenotpresentinthepapillaeofEPC,sameasinpapillaryDCIS.However,incontracttopapillaryDCIS,myoepithelialcellsarealsoabsentintheperipheryofthetumornoduleofEPC.ThisisthemostimportantfeatureofEPC.Seemyabovetwocases.CurrentlymostpeopleconsiderthelesionisavaiantofpapillaryDCIS,eventhoughsomethinkitmayrepresentalowgradeinvasivecarcinoma.StudieshavedemonstratethatEPCshaveexcellentprognosiswithadequatelocaltherapyalone.OneofourfellowsrecentlydemonstratedthatcollagenIVstainmaybeusefulfordifferentialdxofEPC.ThestainispositiveinEPC,butnegativeforinvasivecarcinoma.
TwocasesofEPCwithcollagenIVstain(peripheryofthetumornodule).
病例三
50-55y/fbreastlesion
Fig1-3HE
Fig4myoepithelialstain(p63)
Youdxordifferentialdx
网友讨论
abin:这个很难，我再想想，呵呵。谢谢cqzhao老师！
天山望月:瘤细胞呈小腺管或梁梭状排列，浸润脂肪组织，感觉有菊形团样结构，梁梭和间质之间有点裂隙（看不太清），P63阴性，考虑恶性，1、需要标记鉴别神经内分泌的肿瘤，小腺管太密集了2、微腺管腺病是不是可以排除？
是否请cqzhao再给点高倍图，并期待免疫组化和老师的精彩讲解！
该例，abin都说难了，一定有名堂，期待ing........
:上皮源性恶性肿瘤——癌；
就近的原则：考虑乳腺癌的继发灶，其他的转移癌尚未能除外。
实性或近似实性，夹杂粘液样成分---提示实体型乳头状癌，见脂肪浸润灶。可有神经内分泌分化。
已有浸润则不存在鉴别诊断问题，否则需要鉴别其它类型的乳头状肿瘤和导管内增生性病变。
谢谢Dr.cqzhao，期待您讲解！
赵老师：SorryIdonothavephotosinhighpower
天山望月:abin提到的,需要鉴别其它类型的乳头状肿瘤和导管内增生性病变。
复习陈国章教授的资料：
#;单纯的乳头状病变:
–中心出现肌上皮并且ER阳性不均质支持良性病变
#;具有实性或筛孔状区域的乳头状病变:
–要评估是否为UDH、ADH或DCIS
–CK5和ER染色有帮助(ADH和DCIS为CK5-,ER+)
赵澄泉老师：
To天山望月,Abinand:
Thankforyouranalysis.
IgotthesephotosfromoneofourGYN/breastfellowswhotookthefiguresforpublication.Idonothavehighpowerphotos.PleaseopenthesecondandthirdHEphotostoseeiftherearesomesimilaritiestoanddifferencefromthephotosinmythirdcases.Thenpleasethinkaboutyourdiagnosisordifferentialdx.Intermofdiscussion,differentialdiagnosesareveryimportant.
Infactitisaveryinterestingandrarecase.Wonderwhysofewpeoplejointhediscussion.DonotknowIshouldsharewithyousomeinterestingcasesorjustnormalor心系山区北京中科医院温情相伴白癜风多久能治好
