乳腺SPC伴浸润讨论2017.6.5【中美加乳腺病理交流群病例102】

小王

孔祥田
有个case想听听大家的意见。50s F left breast lumpectomy with sentinel lymph node biopsy. Biopsy was called at least DCIS. The entire lesion is 11 mm. 1 sentinel node is negative for carcinoma.

孔祥田
Patchy myoepithelial cells seen in small areas between the black dots on picture 7 and 9. Other areas lost the myoepithelial cells. There is myxoid stromal background. This is the only focus with lesion and bx clip. Small nests seen in pictures 1, 4 and 11. Those nests seem in the bx track. I personally feel the entire lesion is solid papillary carcinoma associated with adjacent DCIS. The nests in needle tract are artifact to me, not real invasion. Any objection or suggestions? Thanks

Andy K
@孔祥田(Max)*Sacramento*CA] This is an interesting case. I think the whole thing is invasive cancer, likely composite or collision tumor. You may have to run neuroendocrine makers to prove SPC. There is mucinous carcinoma as well, easily confirmed by mucicarmine. I think there's secretory component as well. You may do S100 to confirm it.

Wei Shi-UAB
@孔祥田(Max)*Sacramento*CA] @Andy K I would call it mucinous ca + spc, unless you prove that's not mucin. SPCs don't have to express neuroendocrine markers, although they often do.

李国霞
学习中：黏液背景中漂浮的那些巢，周围还有肌上皮吗？孔老师?如果那些巢周围没有肌上皮，考虑浸润性癌，看看细胞异型性和核级，核级低的，可以考虑黏液癌，核级高一点的，可以考虑浸润性导管癌伴黏液分泌。那些大巢好像SPC，神经内分泌标记阳性更好，阴性也不影响诊断SPC吧

赵澄泉



同意大家分析。这图左上细胞团一定是侵润癌。本例可能原来是SPC，进展成浸润。SPC与分泌粘液的癌常併生。神经内分泌染色无意义。此例最难的和可有争议的是如何测量浸润癌大小，以决定分期的问题。如有明显多处明显浸润，在实际工作中我可䏻按整个病变做为癌大小，1.1 cm. 诊断：浸润性导管癌伴局粘液，组织学2级（T-3; N-2, M-1; 总分6/9），癌大小为1.1 cm; SPC. 备注分析浸润癌起源于SPC.

孔祥田
@Andy K @春天潍坊郝丽娜 @Wei Shi-UAB @石丽华吉林德惠市医院群管 谢谢大家的意见！@李国霞上海 no myoepithelial cells in those small nests. this is mucin for sure. I usually don't do neuroendocrine markers for SPC since I will call it anyway even with negative NE markers.

Andy K



@孔祥田(Max)*Sacramento*CA] make sure this is not secretory component.

孔祥田
@Andy K I can add s100
孔祥田
Here are the pictures from deeper sections and p63 IHC.













We can see the clip space and misplaced epithelium which are negative for p63. The case was finalized as SPC, pTis. Just want to update it. Nobody wants to call it invasive during our department consensus conference .S100 was negative @Andy K 

赵澄泉
@孔祥田(Max)*Sacramento*CA] thank for sharing the updated results.It is difficult case, especially in reviewing on cell phone

Andy K 
@孔祥田(Max)*Sacramento*CA] thank for sharing the updated results

孔祥田
@赵澄泉UPMC @石丽华吉林德惠市医院群管 @Andy K Yes, it's very difficult case even I looked at my scope for multiple times and showed in consensus twice. And I finally asked my colleague to look at the case in her scope by herself and she co-signed the case with me. We don't want the patient to be over treated.

刘梅301医院
@孔祥田(Max)*Sacramento*CA] 黏液围绕在巢团周围，不算浸润？还是周围白色区是纤维组织

孔祥田
Misplaced cancer epithelium due to needle bx. There is inflammation, fibrosis. The epithelium is disrupted. @刘梅301医院 

刘梅301医院
@孔祥田(Max)*Sacramento*CA] 看了记录，只是针的直径很粗吧，可以造成那么多的黏液？我们自己会倾向浸润，但会跟临床沟通不建议过治疗，但不除外转移的可能。

孔祥田
这边都是粗针穿刺 然后在放clip@刘梅301医院

Bill, Emory 
@孔祥田(Max)*Sacramento*CA] @刘梅301医院 第一，4张和最后一张我也倾向invasive mucinous ca.

刘梅301医院
我们见过很多黏液外渗的SPC，我们会告知浸润和极低的转移风险，但结合Ki67不建议化疗。clip处只有黏液没有瘢痕，有疑问真是穿刺造成的？

孔祥田
@Bill, Emory 你是只第一和第五张吧？
@刘梅301医院 谢谢！they will follow her anyway. This is a lumpectomy. All margins are widely clear



@吴焕文北京协和医院 just like this