乳腺纤维上皮性病变伴广泛的软骨样间质讨论2017.6.21【中美加乳腺病理交流群病例106】

小王

孔祥田
Another case I got today. 60s F left breast 9mm lesion core bx. She had right breast IDC in 1995 with left iliac bone mets in 2012. Chemotherapy received. The following pictures from left breast bx. How far you go?I ordered breast triple, ck5/6, p63 and p40. Will update when I get the stains. Thanks

刘梅301医院
@孔祥田(Max)*Sacramento*CA] 好奇ERPR会不会阳

孔祥田
I did not order yet.If I call it ca, I will order ER, PR and Her2. The results will be signed out by our regional HP pathologists @刘梅301医院

刘梅301医院
@孔祥田(Max)*Sacramento*CA] 等待结果学习，只是想到与多形腺瘤鉴别

孔祥田
Update my case with IHC















P63 IHC pattern is similar to breast triple. P40 is focally positive in myoepithelial cells. How do you call it?

车拴龙
硬化性腺病

杨鹏
腺肌上皮瘤？

刘梅301医院
@孔祥田(Max)*Sacramento*CA] 高倍pattern看不清，目前倾向多形腺瘤，有的粉染的上皮团周围无P63？

孔祥田
@刘梅301医院 p63 is patchy, loss in some areas
@车拴龙 吉林 sclerosing adenosis is a part of the lesion. What is the other part of the lesion with chondroid stroma?

刘梅301医院
软骨样区就是考虑多形性腺瘤，@孔祥田(Max)*Sacramento*CA] 我会考虑补ERPR再看看

孔祥田
@刘梅301医院 what info can we get from ER and PR in this situation?

刘梅301医院
有文献报道多形腺瘤会有ER的阳性，因为这例主要与化生癌鉴别，我只遇到过1例典型的腺瘤，是别的医院的医生转给我的会诊病例，病例实在太少，文献图片形态各种各样，感觉乳腺专家们的意见还未统一

孔祥田
@刘梅301医院 yes. Metaplastic carcinoma is in the ddx. But overall feeling it's benign. Pleomorphic adenoma is a rare entity in breast.

刘梅301医院
是

孔祥田
@刘梅301医院 thanks for your comments. Here is the report after discussion with my colleagues 。

孔祥田
Final Dx: - FIBROEPITHELIAL LESION WITH EXTENSIVE CHONDROID STROMA. SEE DIAGNOSIS COMMENT.
- SLCEROSING ADENOSIS

Sections show a well demarcated fibroepithelial lesion with adjacent sclerosing adenosis. The fibroepithelial lesion shows tubular and islands architecture with extensive chondroid stroma. By immunohistochemistry, myoepithelial cells are present, even patchy or loss in some areas which are highlighted by Breast triple (p63, calponin, CAM5.2), p63, p40, s100 and CK5/6. The lesion most likely represents fibroadenoma with chondroid metaplasia. However, given the extensive chondroid stroma, pleomorphic adenoma is also a diagnostic consideration. Metaplastic carcinoma is also considered in the differential diagnosis; however the well- circumscribed nature, lack of significant atypia and presence of myoepithelial cells are all in favor of a benign process. Complete excision of the lesion is recommended. We did not do ER and PR! We don't think it is DCIS either

刘梅301医院
这个病例的意义在于不是所有间质的软骨样改变都是化生癌

孔祥田
@刘梅301医院 同意

Andy K
@孔祥田(Max)*Sacramento*CA] 你那个病例的软骨区内上皮细胞团的免疫组化染色如何？这种情况我大概会做ER, PR, Her2。如果是三阴的话，就不能排除化生癌。

孔祥田
@Andy K 等切下来再说吧! 整个病变只有0.9 厘米，境界清楚，很难push to metaplastic carcinoma

xiaofeng

谢谢分享