[醫如往常] Senior Clerkship Day 107-108: Pathology: Breast

Morning Meeting
LAM; Lymphangioleiomyomatosis
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Paraganglioma
GATA 3 +
S100 +
Ck -
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Breast
Diabetes mastopathy
Lymphocyte infiltration
Big fibroblast
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Parotids sebaceous lymphadenoma
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Skin hyperpigmentation
Fine chromatin
Tdt trace
CD3 -, 79a -
CD123, 56, 4 +
Blast
Plasmacytoid dendritic cell neoplasm
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Haematoma
Cartilage 旁邊有東西
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連醫師
Breast cancer
MRM
Simple
Partial/ BCT, lumpectomy
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Facial margin
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Serial slicing
Med. to lat.
3-5mm
May skip
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RCC Stage 1<7cm
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Breast Mass 10cm, may be DCIS
Clinical, pathology discrepancy


外面醫院考慮成本 只能切五片
NTUH切四十片
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Random for multifocal
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ALND
至少要10顆
小於十顆會被核刪
Multislice 2mm
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美國病理最便宜的180美金
台灣從一千到五千點
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2003開始sentinel lymph node. 通常2,3顆， 最多做過10顆
Blue cassette
500 um


可能false negative tumor塞滿


IHC 染ck


Isolated tumor cell clusters <200 cells, <0.2mm
pN0 i+
ITCs
可是NEJM2009 還是有差異
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Van Nuys Prognostic classification
RT for DCIS
Age
Grade
Margin
Size
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ER, PR
Her2
Ki67 proliferation
14% low
20% high
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FISH 可以與二十年前蠟塊
PCR
Microarray fresh tissue RNA
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UCLA Jews Her2 tyrosine kinase
Amplification, overexpression
Chromosome 17
Her2/centromere>2.0
Counts 20 cells
一萬元


IHC 2+ 做FISH
3+ 直接用Herceptin 80萬
(Protein unstable)


Doxorubicin(Adriamycin)
Herceptin Trastuzumab
都有cardiotoxicity


Heart development Her2
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Imatinib (Glivec) CML


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Colon
EGFR 60%
Ras 40%
Raf


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Lung
EGFR exon 18,19,20,21
19 5 deletion
21 1 deletion l858r


T790m
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Quality control sensitivity
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Ewing sarcoma
T 22, 11
PCR
FISH
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Day 108
Morning Meeting
Breast cancer with SPC; Solitary papillary carcinoma


Increased, in situ, borderline, invasive
• CAIX
• MCT4
Decreased


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Invasive tumor with SPC >
Pure in situ Spc with conventional DCIS


• Mucinous type
• WT1, Muc2


CA9 loss of basement membrane (type iv collagen)
• Old
• Spindled tumor
• ER, PR,chromogranino


• Smaller size <20mm
• Lower grade grade 1
• Older age
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Type B neuroendocrine
• Synaptophysin
• Chromogranin A
• CD56
• NSE
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No significant difference between
Invasive carcinoma with SPC and without SPC
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Prostate幾乎都有neuroendocrine change
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