Ductal carcinoma in situ: Difference between revisions
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;[[Invasive ductal carcinoma]]: Has invasion through the basement membrane.<ref name="Siziopikou2013"/> In uncertain cases, use immunohistochemistry stain for '''calponin''' (has the highest sensitivity) and '''p63''' (has the highest specificity). | ;[[Invasive ductal carcinoma]]: Has invasion through the basement membrane.<ref name="Siziopikou2013"/> In uncertain cases, use immunohistochemistry stain for '''calponin''' (has the highest sensitivity) and '''p63''' (has the highest specificity). | ||
<gallery mode=packed heights= | <gallery mode=packed heights=220> | ||
File:Immunohistochemistry with calponin in ductal carcinoma in situ.jpg|Immunohistochemistry for the myoepithelial marker{{Myoepithelial marker note}} 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 the myoepithelial marker{{Myoepithelial marker note}} 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. | 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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;[[Lobular carcinoma in situ]] (LCIS) | ;[[Lobular carcinoma in situ]] (LCIS) | ||
<gallery mode=packed heights= | <gallery mode=packed heights=220> | ||
File:Histopathology of lobular carcinoma in situ.jpg|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.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html|title=Breast - Ductal carcinoma in situ - DCIS|author=Gary Tozbikian, M.D.|website=pathologyOutlines}} Topic Completed: 20 May 2020. Minor changes: 6 May 2021</ref> | File:Histopathology of lobular carcinoma in situ.jpg|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.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html|title=Breast - Ductal carcinoma in situ - DCIS|author=Gary Tozbikian, M.D.|website=pathologyOutlines}} Topic Completed: 20 May 2020. Minor changes: 6 May 2021</ref> | ||
File:Histopathology of DCIS with lobular cancerization.jpg|LCIS typically fills smaller lobules rather than ducts, but '''DCIS can display lobular cancerization''' as shown at bottom of image.{{MH}} | File:Histopathology of DCIS with lobular cancerization.jpg|LCIS typically fills smaller lobules rather than ducts, but '''DCIS can display lobular cancerization''' as shown at bottom of image.{{MH}} | ||
</gallery> | </gallery> | ||
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: | 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: | ||
<gallery mode=packed> | <gallery mode=packed heights=200> | ||
Immunohistochemistry for E-cadherin in ductal carcinoma in situ.jpg | Immunohistochemistry for E-cadherin in ductal carcinoma in situ.jpg | ||
Immunohistochemistry for p120 in ductal carcinoma in situ.jpg | Immunohistochemistry for p120 in ductal carcinoma in situ.jpg | ||
</gallery> | </gallery> | ||
In contrast: | In contrast: | ||
<gallery mode=packed> | <gallery mode=packed heights=200>> | ||
File:Immunohistochemistry for E-cadherin in lobular carcinoma in situ.jpg|thumb|'''E-cadherin''' is '''negative''' in '''lobular''' carcinoma in situ. | File:Immunohistochemistry for E-cadherin in lobular carcinoma in situ.jpg|thumb|'''E-cadherin''' is '''negative''' in '''lobular''' carcinoma in situ. | ||
File:Immunohistochemistry for p120 in lobular carcinoma in situ.jpg|'''p120''' has a '''cytoplasmic''' staining in '''lobular''' carcinoma in situ. | File:Immunohistochemistry for p120 in lobular carcinoma in situ.jpg|'''p120''' has a '''cytoplasmic''' staining in '''lobular''' carcinoma in situ. | ||
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{{Moderate-end}} | {{Moderate-end}} | ||
===Estrogen and progesterone receptors=== | ===Estrogen and progesterone receptors=== | ||
[[File:Immunohistochemistry of ductal carcinoma in situ (DCIS) with necrosis.jpg|thumb|In DCIS with necrosis, only use the areas of viable DCIS for the calculation of hormone receptors on immunohistochemistry.]] | [[File:Immunohistochemistry of ductal carcinoma in situ (DCIS) with necrosis.jpg|thumb|200px|In DCIS with necrosis, only use the areas of viable DCIS for the calculation of hormone receptors on immunohistochemistry.]] | ||
Generally perform immunohistochemistry for estrogen and progesterone receptors and calculate the percentage of positive tumor cells. | Generally perform immunohistochemistry for estrogen and progesterone receptors and calculate the percentage of positive tumor cells. | ||
Revision as of 08:34, 2 May 2022
Author:
Mikael Häggström [note 1]
Ductal carcinoma in situ (DCIS):
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 the myoepithelial marker[note 2] calponin in ductal carcinoma in situ, highlighting myoepithelial cells around all tumor cells, thereby ruling out invasive ductal carcinoma.
-
Invasive ductal carcinoma with tubular features can look like benign tubules, but calponin and p63 shows no surrounding myoepithelial cells.
![Immunohistochemistry for the myoepithelial marker[note 2] calponin in ductal carcinoma in situ, highlighting myoepithelial cells around all tumor cells, thereby ruling out invasive ductal carcinoma.](/index.php?title=Special:Upload&wpDestFile=Immunohistochemistry_with_calponin_in_ductal_carcinoma_in_situ.jpg){kind=link}
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]
![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]](/index.php?title=Special:Upload&wpDestFile=Histopathology_of_lobular_carcinoma_in_situ.jpg){kind=link}
![LCIS typically fills smaller lobules rather than ducts, but DCIS can display lobular cancerization as shown at bottom of image.[image 1]](/index.php?title=Special:Upload&wpDestFile=Histopathology_of_DCIS_with_lobular_cancerization.jpg){kind=link}
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:
-
E-cadherin is negative in lobular carcinoma in situ.
-
p120 has a cytoplasmic staining in lobular carcinoma in situ.
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
)
Estrogen and progesterone receptors
_with_necrosis.jpg){kind=link}
Generally perform immunohistochemistry for estrogen and progesterone receptors and calculate the percentage of positive tumor cells.
Reporting
Example:
| Left breast mass, 2:00, 1 cm from nipple, ultrasound-guided vacuum assisted core needle biopsy: Ductal carcinoma in situ. Negative for invasive carcinoma. |
For cancers, generally include a synoptic report, such as per College of American Pathologists (CAP) protocols at cap.org/protocols-and-guidelines.
See also: General notes on reporting
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.
- ↑ For myoepithelial markers, a combination of p63 (higher specificity) with either SMM or calponin (both have higher sensitivity) is generally recommended for breast lesions. D2-40 is useful for highlighting lymphatics for invasion.
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