Shadowing Practice: Breast Pathology Cases 5 through 7 - Learn English Speaking with Video
בחר מצב תרגול
כל מצב פותח חדר תרגול במסך מלא.
137 משפטים
אם המשפטים קצרים או ארוכים מדי, לחץ על ערוך כדי להתאים אותם.
1
This is breast pathology cases 5, 6, and 7.
2
Cases 5, 6, and 7 are related so we will go through these together.
3
This is case number 5.
4
This is an older slide and somewhat faded but you can still make out the pathology.
5
So let's see what we have here.
6
We have a terminal duct lobular unit here and a part of one here.
7
here, but let's focus on this particular terminal duct lobular unit.
8
First of all, is this terminal duct lobular unit normal or abnormal?
9
Well it's abnormal.
10
Why is it abnormal?
11
It's abnormal because it has expansion of these acini, these acinar structures, which would normally just have a single layer of epithelium and a lumen, and instead what we have is filling in of the acini within a terminal duct lobular unit.
12
Overall, I would say the degree of expansion is somewhat mild, although obviously that can be subjective.
13
But let's look at the cytology of the cells.
14
You can see that they're relatively uniform, so the nuclear size and shape throughout most of these expanded acini look relatively uniform.
15
They have ovoid nuclei, relatively abundant cytoplasm.
16
You can make out these clear cells on the periphery of the acini.
17
These are the myoepithelial cells.
18
And notice in particular that you see a lot of white space in between the individual epithelial cells.
19
That is a feature that points towards discohesion or dis-heasion, however you want to say it.
20
So there is a lack of adhesion between many of these cells.
21
Upon closer inspection we can make out some of the nuclear details.
22
You can see that they have somewhat granular chromatin.
23
We do have conspicuous nucleoli.
24
They've got relatively abundant cytoplasm.
25
Again, unlike the previous cases that we saw, you can't really make out the cell membranes and the adhesion between the epithelial cells.
26
Also notice a clue here.
27
There is a vacuole within the cytoplasm of some of these epithelial cells.
28
Here's another magnified view you can see this little mucin vacuole within the epithelial cell that is compressing the nucleus.
29
Here is an immunohistochemical stain that was performed on this particular focus.
30
There are some folds so ignore those.
31
This is E-cadherin.
32
So you can see that most of these cells that are filling in the lumen within these expanded acini are negative for E-cadherin.
33
It's not uncommon to have scattered staining but for the most part they're negative.
34
So the diagnosis for this case is atypical lobular hyperplasia, and it's somewhat subjective.
35
Some may call this lobular carcinoma in situ.
36
We'll talk more about criteria in a bit.
37
This is the next case.
38
This is case number six.
39
And this case will actually show you how subjective this can be.
40
So what we have here, although less discrete than we saw in the previous biopsy, we have a terminal duct lobular unit that has expanded asini.
41
Upon closer inspection, similar to what we saw in the previous case, you can actually make out some vacuoles at this lower magnification.
42
And you can make out the relative lack of cohesion among the cells so you can see some spaces in between the epithelial cells.
43
Higher power magnification shows somewhat uniformity among the nuclei, but we do have a typical We have hyperchromasia, we have some pseudo-inclusions, we have some programmed cell death.
44
At this power you can make out more clearly the vacuoles within some of these epithelial cells causing compression of the nucleus.
45
You can also make out a distinct layer of cells that looks different than the the cells that are filling in the lumen.
46
These are likely myoepithelial cells.
47
Here is another E-cadherin stain, so this is negative.
48
And the diagnosis for this biopsy was lobular carcinoma in situ.
49
Now to my eye, the difference between the two cases is not that great.
50
I think either one could have been called atypical lobular hyperplasia or lobular carcinoma in situ.
51
This is case 7, and in this case you once again make out a terminal duct lobular unit, although this is less clearly defined to my eye compared to the previous cases.
52
But it's still an expansion of asinine that are relatively close to one another that you might consider to be a part of a single terminal duct lobular unit.
53
These are much more expanded than our previous cases, and there's variability to the extent of expansion.
54
On higher magnification you can see there is a greater degree of nuclear pleomorphism than we saw in our previous case.
55
Some of the nuclei are much larger than the others, so we have at least a several fold variation in nuclear size.
56
We also have prominent nucleoli throughout most of these cells.
57
They've got relatively abundant cytoplasm.
58
You can make out vacuoles, similar to our two previous cases within the cytoplasm, and evidence of discohesion among the cells.
59
Here is a higher power view, making out here the vacuoles within the cytoplasm.
60
Another view here showing the coarseness of the chromatin, the prominent nucleoli, and the variability in nuclear size and shape.
61
Again, see how the cells are pulling apart.
62
So there is a problem with cellular cohesion within this type of lesion.
63
And here is a focus of comedonecrosis.
64
E-cadherin was performed in this case, showing complete negative staining within the lesion.
65
So the diagnosis for this case, case 7, is pleomorphic lobular carcinoma in situ.
66
Lobular carcinoma in situ is a proliferation of small and generally loosely cohesive neoplastic epithelial cells within the terminal duct lobular units.
67
The difference between lobular carcinoma in situ and atypical lobular hyperplasia is basically the extent or the degree of involvement of the terminal duct lobular units.
68
Generally, LCIS and ALH are considered as generalized risk markers, and that's bilateral risk, and they are not generally considered to be direct invasive breast cancer precursors.
69
This is an example of lobular carcinoma in situ.
70
Essentially what you have is enlarged terminal duct lobular units that have expanded acini.
71
The page criteria for lobular carcinoma in situ is that at least 50% of the acini within these terminal duct lobular units is expanded by the atypical cells.
72
If it's less than 50% using the Page criteria, then you're best to classify it as atypical lobular hyperplasia.
73
Here is a closer view showing the asini that's expanded by the loosely cohesive population of cells.
74
And by that, what we refer to are these spaces that you can see in between the cells, unlike what we saw with ductal carcinoma in situ where you could see the cell membranes and there was cohesion between the cells.
75
Here it's more of a discohesive pattern.
76
The cells are atypical.
77
They're generally uniform, small round nuclei with hyperchromasia.
78
Here's another example.
79
Again, this is a terminal duct lobular unit.
80
These are acini, and greater than 50% of these acini are expanded by these atypical cells, qualifying this as lobular carcinoma in situ.
81
Lobular carcinoma in situ can be composed of two different cell types, so-called type A and type B cells.
82
This is an example here of type B cells, and they essentially consist of slightly more atypical epithelioid cells than you usually see with LCIS.
83
And they can be confused because of their atypical features and conspicuous nucleoli with pleomorphic LCIS.
84
But as we saw in the previous case, pleomorphic LCIS has a much greater degree of nuclear polyomorphism, with generally a two to three fold variation in nuclear size.
85
So although these look atypical with nucleoli, they lack that two to three fold variation.
86
These are type B cells.
87
This example shows the smaller central type A cells in comparison to the larger type B cells on the periphery.
88
Another consistent feature seen in both atypical lobular hyperplasia and lobular carcinoma in situ are these small cytoplasmic vacuoles within the cytoplasm of the atypical epithelial cells.
89
Pleomorphic lobular carcinoma in situ basically represents the high-grade form of lobular carcinoma in situ.
90
It is actually not very common, and when you see it, you're more likely to confuse it with ductal carcinoma in situ.
91
It retains this discohesive nature that you see within these lobular lesions, and what What makes it unique is the high-grade nuclei and the two- to three-fold nuclear variability.
92
Again, you'll also see prominent nuclei.
93
This is an example of pleomorphic lobular carcinoma in situ with comedonecrosis, calcifications, high-grade cells.
94
They easily can be confused with ductal carcinoma in situ, and in this case also a high mitotic rate.
95
Question, which of the following results is the most likely for classic lobular carcinoma in situ.
96
Is it going to be ER negative, PR positive, HER2 positive, ER positive, PR positive, HER2 negative, triple negative, or positive for all three?
97
Classic lobular carcinoma in situ is going to co-express ER and PR and will be negative for HER2.
98
The exception to the rule is pleomorphic lobular carcinoma in situ, which can be negative for ER and PR and can be positive for HER2.
99
Question, what protein generally shows absence of expression in atypical lobular hyperplasia and lobular carcinoma in situ?
100
Answer, E-cadherin.
101
Next question, what is the chromosomal location of the E-cadherin gene?
102
chromosome 6q22.1 and losses at 16q are a feature of LCIS.
103
16q loss may also be seen with flat epithelial atypia, atypical ductal hyperplasia, and DCIS.
104
Here's an example of E-cadherin immunohistochemistry here on the left, negative in LCIS, and then positive in the normal underlying ductal structures.
105
Question, you make a diagnosis of LCIS on a needle core biopsy.
106
What is the patient's risk of developing invasive carcinoma?
107
Answer, 8 to 10 fold increase in risk, which is similar to what we saw with low grade DCIS.
108
The next question is, which breast is at risk?
109
Is it the ipsilateral, contralateral, or bilateral breasts?
110
The answer is bilateral.
111
Some studies found that the ipsilateral breast may have slightly more risk in the first 5-10 years after diagnosis, but generally for the board examinations when you're dealing with LCIS lesions, the risk is considered to be bilateral.
112
Question.
113
The majority of invasive breast cancers that develop in women with LCIS are of what type?
114
Watch out for trick questions like this because the answer is invasive ductal carcinoma.
115
Classic LCIS is not generally considered to be a precursor to invasive carcinoma, but is rather a marker of risk, and again that risk is for the bilateral breasts.
116
These patients can develop invasive ductal carcinoma or invasive lobular carcinoma, but invasive ductal carcinoma is the most common.
117
The most appropriate management of these patients with classical LCIS is close observation with or without ER modulators such as tamoxifen.
118
Question true or false, assessment of margins is important for the management of patients with LCIS?
119
The answer, false.
120
See the previous comments.
121
Again, this is a marker of risk and not a direct precursor of invasive carcinoma.
122
True or false, pleomorphic LCIS may behave more like DCIS?
123
are true, these lesions should be excised with negative margins in a manner similar to DCIS.
124
And the same is also suggested for cases of LCIS with comedonecrosis.
125
So essentially you treat these as if they're DCIS.
126
You found this on a breast biopsy.
127
Your immunohistochemistry lab is on strike, so what is the diagnosis?
128
Here's a closer view.
129
So you have expansion of a terminal duct lobular unit as well as the acini and greater than 50% of the acini within the terminal duct lobular unit.
130
On close examination, you do have some of these cribriform-like structures.
131
Notice what's missing.
132
You're missing that discohesive pattern and you're also missing those cytoplasmic vacuoles.
133
So the diagnosis is DCIS involving terminal duct lobular units.
134
Polarization of these cells at the periphery is a feature of DCIS, so that was one clue.
135
And microasini, or these cribriform-like structures, is also another feature of DCIS.
136
And again, in terms of pertinent negatives, the lack of discohesive properties and the lack of setoplasmic vacuoles all point towards ductal carcinoma in situ.
137
So this completes cases 5 through 7.
הורד אפליקציה
כל מה שאתה צריך כדי לדבר בשטף
הגיית AIציון לכל משפט
תרגול IPAשלוט בכל צליל
אוצר מיליםבנה את מאגר המילים שלך
משחק אוצר מיליםלמד תוך כדי משחק
אותו ערוץ
FOR YOU
המלץ על סרטון
C23
32 משפטים
Intestinal Villi
University StudentsWorking Adults
C24
186 משפטים
Embolization of AV Malformations: Tips and Tricks
Business EnglishUniversity StudentsWorking Adults
C11
380 משפטים
A man hiked in the woods. Every brain cell got cooked.
Daily ConversationUniversity StudentsWorking Adults
C11
91 משפטים
How To: Ultrasound for Pneumothorax Case Study Video
Daily ConversationUniversity StudentsWorking Adults
C13
7 משפטים
Clinical Cuts: B-Cell Activation, Differentiation, & Contraction
IELTS PrepTOEFL PrepCambridge Exam Prep
C23
29 משפטים
Introduction to focused ion beam scanning electron microscopy (FIB-SEM)
University StudentsWorking Adults
C12
442 משפטים
Allergy Assessment for Nurses: True Allergy vs Sensitivity, and Safer Care with Dr. Sophia Thomas
Daily ConversationUniversity StudentsWorking Adults
C11
423 משפטים
Free CCNA | VLANs (Part 2) | Day 17 | CCNA 200-301 Complete Course
Daily ConversationUniversity StudentsWorking Adults
C12
47 משפטים
The Pelvic Floor Muscles, Explained | Corporis
University StudentsWorking Adults
C11
4 משפטים
Ambr®️ 250 High Throughput Perfusion Product Tutorial - Learn with Sartorius
Business EnglishUniversity StudentsWorking Adults
אוצר מילים והערות הגייה לשיעור הזה
שיעור הדיבור הזה ברמה C2 מבוסס על הסרטון “Breast Pathology Cases 5 through 7”. המילים שחוזרות הכי הרבה: lobular, cell, carcinoma, situ, duct. בסרטון הזה יש 137 משפטים ו-2015 מילים לתרגול Shadowing. הדיבור נמשך 14:56. הדובר שומר על קצב יציב של כ-135 מילים בדקה, קצב נוח לתרגול Shadowing. רק 73% מהמילים נמצאות בין 3,000 המילים הנפוצות ביותר באנגלית, כך שאוצר המילים מאתגר.
אוצר מילים מרכזי בסרטון הזה
15 המילים המתקדמות ביותר בסרטון, עם ההגייה והמשמעות שלהן:
| מילה | הגייה | משמעות |
|---|---|---|
| carcinoma שם עצם | /ˌkɑɹsɪˈnoʊmə/ | קרצינומה |
| duct שם עצם | /dʌkt/ | צִנּוֹר, תְּעָלָה |
| vacuole שם עצם | /ˈvækjʊˌəʊl/ | חלולית |
| nucleus שם עצם | /ˈnuː.kli.əs/ | גַּרְעִין, ליבה \ לִבָּה |
| biopsy שם עצם | /ˈbaɪɑpsi/ | בִּיּוֹפְּסְיָה |
| criterion שם עצם | /kɹaɪˈtɪɹ.i.ən/ | קרִיטֶרִיוֹן |
| lumen שם עצם | /ˈlumən/ | נהור |
| conspicuous שם תואר | /kənˈspɪk.ju.əs/ | בולט |
| pathology שם עצם | /pəˈθɒləd͡ʒi/ | פתולוגיה |
| chromosome שם עצם | /ˈkɹoʊməˌsoʊm/ | כְרוֹמוֹזוֹם |
| enlarge פועל | /ɪnˈlɑɹd͡ʒ/ | הִגְדִּיל |
| epithelium שם עצם | /ˌɛpɪˈθiːlɪəm/ | אפיתל |
| confuse פועל | /kənˈfjuːz/ | בלבל |
| cellular שם תואר | /ˈsɛl.ju.lə/ | תָּאִי |
| needle שם עצם | /ˈniː.dəl/ | מַחַט |
משפטים שכדאי לחזור עליהם
משפטים קצרים ושלמים מהסרטון שאפשר להשתמש בהם בשיחה יומיומית:
- We'll talk more about criteria in a bit.
- What is the patient's risk of developing invasive carcinoma?
- Your immunohistochemistry lab is on strike, so what is the diagnosis?
דקדוק בסרטון הזה
המבנים שהדובר משתמש בהם הכי הרבה, עם המילים המדויקות מהסרטון:
| מבנה | בסרטון |
|---|---|
| סביל (Passive voice) be + past participle — הדגש הוא על מה שקורה, לא על מי שעושה את הפעולה | was performed · have been called · are considered |
| הווה מושלם (Present perfect) have/has + past participle — פעולה שקרתה בעבר ועדיין יש לה חשיבות או השפעה עכשיו | has expanded · have expanded |
| משפטי זיקה (Relative clauses) who / which + clause — מידע נוסף על אדם או דבר | situ, which can · risk, which is |
הגייה ששווה לשים לב אליה
הדובר משתמש ב-14 קיצורים וצורות מקוצרות, כמו you're, they're, they've. אמרו אותם בצורה הקצרה, כפי שאתם שומעים אותם.
- הצלילים של “th”: pathology /pəˈθɒləd͡ʒi/, epithelium /ˌɛpɪˈθiːlɪəm/
- הצלילים של “sh” ו-“zh”: hyperplasia /ˌhaɪ.pɚˈpleɪ.ʒə/, lesion /ˈliːʒən/, cohesion /kəʊˈhiː.ʒən/, magnification /ˌmæɡnɪfɪˈkeɪʃən/, variation /ˌvɛəɹiˈeɪʃn̩/
- מילים ארוכות — שימו לב להטעמה: carcinoma /ˌkɑɹsɪˈnoʊmə/, atypical /eɪˈtɪp.ɪ.kəl/, cytoplasm /ˈsaɪtəʊˌplæzəm/, hyperplasia /ˌhaɪ.pɚˈpleɪ.ʒə/, bilateral /baɪˈlætəɹəl/
צלילים שדוברי עברית מתקשים בהם:
- /æ/ — פתוח יותר מה-“אֶ” העברית, לא כמו “a” ב-“cup”: acinus /ˈæsɪnəs/, vacuole /ˈvækjʊˌəʊl/, cadherin /kædˈhɪəɹɪn/, cytoplasm /ˈsaɪtəʊˌplæzəm/, bilateral /baɪˈlætəɹəl/
- /r/ — הלשון לא נוגעת בשום מקום, לא ה-“ר” הגרונית: carcinoma /ˌkɑɹsɪˈnoʊmə/, cadherin /kædˈhɪəɹɪn/, bilateral /baɪˈlætəɹəl/, abnormal /ˌæbˈnɔɹ.ml̩/, criterion /kɹaɪˈtɪɹ.i.ən/
- עיצור קולי בסוף מילה — /b/, /d/, /g/, /z/, /v/ בלי להפוך אותם לאטומים: invasive /ɪnˈveɪsɪv/, fold /ˈfəʊld/, subjective /səbˈd͡ʒɛktɪv/, cohesive /kəʊˈhiː.sɪv/, compose /kəmˈpəʊz/
איך לתרגל עם הסרטון הזה
- הקשיבו לכל הסרטון פעם אחת בלי לדבר, ורשמו את המילים שאתם לא מכירים.
- תרגלו Shadowing משפט אחר משפט במהירות רגילה, וחזרו על כל משפט עד שהקצב שלכם תואם את הדובר.
- הקליטו את עצמכם והשוו למקור, תוך תשומת לב למילים כמו carcinoma, duct, vacuole.
מהי טכניקת השאדואינג?
שאדואינג היא טכניקת למידת שפה מבוססת מדע שפותחה במקור להכשרת מתורגמנים מקצועיים ופופולרית על ידי הפוליגלוט ד"ר אלכסנדר ארגואלס. השיטה פשוטה אך עוצמתית: אתה מקשיב לאודיו באנגלית ילידית וחוזר עליו בקול רם מיד — כמו צל העוקב אחרי הדובר עם עיכוב של 1–2 שניות בלבד. בניגוד להאזנה פסיבית או תרגילי דקדוק, שאדואינג מכריח את המוח והשרירים בפה לעבד ולשחזר דפוסי דיבור אמיתיים בו זמנית. מחקרים מראים שזה משפר משמעותית את דיוק ההגייה, האינטונציה, הקצב, הדיבור המחובר, הבנת השמיעה ושטף הדיבור — מה שהופך אותו לאחת השיטות היעילות ביותר להכנה לIELTS Speaking ולתקשורת באנגלית בעולם האמיתי.