Difference between revisions of "Ductal carcinoma in situ"
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− | File:Immunohistochemistry with calponin in ductal carcinoma in situ.jpg|Immunohistochemistry for calponin in ductal carcinoma in situ, highlighting myoepithelial cells around all tumor cells, thereby ruling out [[invasive ductal carcinoma]]. | + | File:Immunohistochemistry with calponin in ductal carcinoma in situ.jpg|Immunohistochemistry for calponin in '''ductal carcinoma in situ''', highlighting myoepithelial cells around all tumor cells, thereby ruling out [[invasive ductal carcinoma]]. |
+ | File:Invasive ductal carcinoma with tubular features - combined.jpg|'''Invasive ductal carcinoma with tubular features''' can look like benign tubules, but calponin and p63 shows no surrounding myoepithelial cells. | ||
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Revision as of 08:17, 8 September 2021
Author:
Mikael Häggström [note 1]
Ductal carcinoma in situ (DCIS):
Contents
Comprehensiveness
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
Gross examination
As per:
or mastectomy.
Microscopic evaluation
Malignant epithelial cells confined to the ductal system of the breast.[1] The cells are cohesive and have high grade atypia.[2]
Differential diagnoses
- Invasive ductal carcinoma
- Has invasion through the basement membrane.[1] In uncertain cases, use immunohistochemistry stain for calponin (has the highest sensitivity) and p63 (has the highest specificity).
Immunohistochemistry for calponin in ductal carcinoma in situ, highlighting myoepithelial cells around all tumor cells, thereby ruling out invasive ductal carcinoma.
There is no single definite cutoff, but the following are suggested cutoffs defining a ductal carcinoma in situ:[3]
- Size over 2 mm.
- Involving more than one duct.
- Lobular carcinoma in situ (LCIS)
Lobular carcinoma in situ (LCIS) displays discohesive cells, often a feathery clear space between cells, solid growth pattern, intracytoplasmic vacuoles, and lack of polarization around luminal spaces.[4]
LCIS typically fills smaller lobules rather than ducts, but DCIS can display lobular cancerization as shown at bottom of image.[image 1]
When unsure, perform immunohistochemistry for E-cadherin and p120. Both E-cadherin (left image below) and p120 (right) have a membranous staining pattern in ductal carcinoma in situ:
In contrast:
Grading
At least a low/intermediate/high grading (by Van Nuys criteria) as follows:[5]
- Low grade DCIS
- Nuclei 10-15 microns (2-3 times the size of a red blood cell)
- Nuclei oval, round, regular, evenly dispersed chromatin up to mildly irregular and minimally pleomorphic
- Nucleoi, if present, are small and indistinct
- Intermediate grade DCIS
- Same nuclear features as low grade
- Substantial tumor cell (comedo) necrosis is present
- High grade DCIS
- Nuclei >15 microns (over 3 times the size of a red blood cell)
- Nuclei are pleomorphic with clumped chromatin
- Nucleoli are prominent, enlarged
- Necrosis is almost universal and lumenal
(Numerical grading
Use the low/intermediate/high grade to give a numerical grading as follows:[6]
Feature | Points | ||
---|---|---|---|
1 | 2 | 3 | |
Nuclear grade | Low | Intermediate | High |
Glands/papillae | >75% | 10% - 75% | <10% |
Mitotic rate (per 10 HPF) | <1 | 1 - 2 | >2 |
Central necrosis | <10% | 10% - 50% | >50% |
The points for each feature are added together, giving the following result:[6]
- 4 - 7 points: Grade 1
- 8 - 9 points: Grade 2
- 10 - 12 points: Grade 3
)
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ 1.0 1.1 Siziopikou, Kalliopi P. (2013). "Ductal Carcinoma In Situ of the Breast: Current Concepts and Future Directions ". Archives of Pathology & Laboratory Medicine 137 (4): 462–466. doi: . ISSN 0003-9985.
- ↑ Sucheta Srivastava, M.D.. Breast - Noninvasive lobular neoplasia - LCIS classic (Differential diagnosis section). Topic Completed: 1 September 2017. Minor changes: 17 May 2021
- ↑ Tozbikian, Gary; Brogi, Edi; Vallejo, Christina E.; Giri, Dilip; Murray, Melissa; Catalano, Jeffrey; Olcese, Cristina; Van Zee, Kimberly J.; et al. (2016). "Atypical Ductal Hyperplasia Bordering on Ductal Carcinoma In Situ ". International Journal of Surgical Pathology 25 (2): 100–107. doi: . ISSN 1066-8969.
- ↑ Gary Tozbikian, M.D.. Breast - Ductal carcinoma in situ - DCIS. pathologyOutlines. Topic Completed: 20 May 2020. Minor changes: 6 May 2021
- ↑ . Ductal Carcinoma in Situ of the Breast. Stanford Medical School (2020-08-27).
- ↑ 6.0 6.1 Allred, D. C. (2010). "Ductal Carcinoma In Situ: Terminology, Classification, and Natural History ". JNCI Monographs 2010 (41): 134–138. doi: . ISSN 1052-6773.
Image sources
- ↑ Image(s) by: Mikael Häggström, M.D. Public Domain
- Author info
- Reusing images