• This is a medium power view of ductal carcinoma in situ (DCIS).
• The black arrows point to the intact basement membrane surrounding the ducts and confining the neoplastic cells to the duct.
• The blue arrows point to the profound nuclear atypia which can even be spotted from this power.
• In this type of DCIS the duct is not filled with neoplastic cells but close attention to the cytologic detail of the lining cells reveals their abnormality.
|Ductal Carcinoma in Situ|
• Some evidence that BRCA1 abnormalities already present in in situ disease
• See discussion of infilatrating duct carcinoma for more details.
• Increasing age
• More frequent in women of low parity with first child after 30
• Increased in obesity
• Increased in women with history of atypical hyperplasia
• Increased in women with history of breast carcinoma
• Increased in women with mother or sibling with breast cancer
• Increased relative risk of breast cancer 10 fold
• Lesions are generally extirpated surgically with clear margins, followed by radiation therapy, or by mastectomy
• For more information on prognosis and treatment, consult NCI web site.
|General Gross Description|
• May be associated with microcalcifications within the lumens
• Gross findings may be of fibrocystic change
• May form mass
• In comedo variant cysts (dilated ducts) are filled with granular, yellow white material
• May be associated with invasive carcinoma
|General Micro Description|
• There are several varieties including papillary (delicate fibrovascular cores covered with atypical cells), cribriform (multiple lumens within a single duct), solid, micropapillary (tiny epithelial papillae), comedo (around necrotic center) and clinging in which only one to two abnormal cell layers "cling" to the basement membrane.
• All show loss of typical bilayered epithelium
• All show enlarged round to oval nuclei with nucleoli; comedo variety typically shows nuclear pleomorphism, hyperchromasia, large nucleoli and mitotic activity
• All show loss of polarity towards lumen
• All types may show intraluminal microcalcifications
|Robbins and Cotran: Pathologic Basis of Disease, 7th ed., 2005, pp. 1139-41.|