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- B1833乳腺肿瘤，请教什么类型
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| 姓 名： | ××× | 性别： | 女 | 年龄： | 46 |
| 标本名称： | 乳腺肿块 | ||||
| 简要病史： | 发现肿物3天 | ||||
| 肉眼检查： | |||||
标签：乳腺浸润性导管癌 神经内分泌分化
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本帖最后由 于 2009-06-13 13:40:00 编辑
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本帖最后由 于 2009-06-16 11:40:00 编辑
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| 以下是引用cqzhao在2009-6-15 22:39:00的发言：
Quan zi: please show us some low power phtos. I want to know the relation of the first 6 photos to others. Did you use different stains? Why did two groups of photos show different color? |
低倍图像
不同颜色是因为我的图像采集器不稳定
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本帖最后由 于 2009-06-17 10:44:00 编辑
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Based on IHC and low power photos
1. Mostly one tumor with two growth patterns
2. More like carcinoma, especially adenocarcarcinoma
3. Primary or secondary. Favor primary: no other organ lesions. Common things are common. Of cause most breast tumors are primary. However it is not a classic breast tumor. Did the pt have x-ray exam for most organs?
4. If it is a primary breast carcinoma the next question is what types. Ductal vs lobular. Favor ductal ca due to the glandular formation and positive E-cad (membrane stain).
5. ER, PR stains: If they are positive the tumor is from breast or gynecologic system. PR seems weakly positive in rare cells (not sure).
It will be more easy to read slides
Thank Quan zi for the challenge case. Wish more people share with us your oppinion. We still do not know the final dx yet.
cz
基于免疫组化和低倍镜下的图片
１.主要表现是一种含有两种生长模式的肿瘤
２.更大的可能是癌，特别是腺癌
３.原发或是继发。倾向于原发：无其它部位的病变。通常先考虑常见的，当然大多数乳腺肿瘤都是原发的。然而这不是一类经典的乳腺肿瘤，这位病人有做过其它器官的Ｘ线检查吗？
４.如果此例是原发性的乳腺癌，那么接下来的问题就是它是属于哪一型的呢，导管来源或小叶来源？倾向于导管癌因为有腺腔形成并且E-cad表达阳性。
５.ER,PR染色：如果此肿瘤是来自于乳腺或女性生殖系统，那么ER,PR染色应当为阳性。
PR染色在少许细胞可见到弱阳性表达（不是很确定）
如果是看切片将会更容易些。
谢谢全子提供如此有挑战性的病例，希望更多的人和我们一起分享你们的意见，
我们仍然不知道最终结果。from cz
海棠依旧翻译
Thank 海棠's excellent translation. cz
GCDFP-15 stain may be of help to confirm a breast primary.
I noticed that the latter H&E photos showed more inflammatory cell infiltrate especially in the poorly differentiated areas.
I'm afraid the occasional positive PR staining cells are from residual normal breast acini. If this is correct, triple negative will put this case into a basal type carcinoma.
Since the morphology is atypical, it's better to exclude other possibilities before giving final decision.
Like abin suggested, further markers for basal type. I would suggest again to exclude neuroendocrine differentiation (Maybe you see better on glass slide than pictures). Markers indicating other primaries can also be tried, such as TTP1, Ck20, CK7, although clinically not indicated.
