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Breast-malignant, males, children
Morphologic variants of DCIS
Comedo DCIS / comedocarcinoma
Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.
Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)
Revised: 15 August 2009
Last major update: August 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● High nuclear grade lesion with wide spread comedonecrosis (central necrosis within involved ducts)
● Necrosis is due to apoptosis and oncosis (passive cell death) (Ultrastruct Pathol 2000;24:135)
Epidemiology
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● Has similar hormonal and reproductive risk factors as invasive ductal carcinoma, unlike non-comedo DCIS (Cancer Epidemiol Biomarkers Prev 2009;18:1507)
Clinical
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● 1/3 appear multicentric, but many are actually continuous in 3 dimensions, as demonstrated by serial section mapping studies
● 10% are bilateral
● 1-3% of patients have axillary nodal metastases, even without evidence of invasive carcinoma
● Lesions may be extensive (>5 cm); must examine carefully for invasive carcinoma
X-ray
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● Mammography usually shows linear and branching microcalcifications due to calcification of necrotic material, more often central than other tumors
● Occasionally lacks calcifications
X-ray images
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Linear and branching microcalcifications
Gross description
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● Cheesy appearance (resembling comedones) due to plugging of thick walled ducts with necrotic material
Microscopic description
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● Solid growth of large, pleomorphic, high grade cells with central necrosis (either a central focus or individual cells)
● Frequent mitotic figures
● Usually minimal stroma within the duct and minimal/no myoepithelial cells
● Coarse microcalcifications are common
● Periductal fibrosis and inflammation are common
● Often cancerization of lobules
● May have pseudocribriform architecture (but with high grade cells)
Micro images
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Central necrosis with dystrophic Classic features
calcifications (AFIP)
Classic features
Large pleomorphic tumor cells Periductal fibrosis
with prominent nucleoli and mitotic activity
Involving lobules Cancerization of lobules
HER2+
Androgen receptor+
Other images: central necrosis #1; #2
Cytology images
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Pleomorphic cells with large High power Irregular calcium particles
large nucleoli and irregular
chromatin
Other images: low power; atypical cells with large nuclei #1; #2; #3
Virtual slides
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DCIS and LCIS Calponin
Positive stains
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● HER2 amplification (Cancer 2000;89:2153), p53 (Lab Invest 1994;71:67)
● Also P-cadherin (Virchows Arch 2007;450:73)
Negative stains
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● ER, PR (Br J Surg 2005;92:429)
Molecular / cytogenetics
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● Aneuploid
● Multicentric tumors were monoclonal in one study (Hum Path 2003;34:1163)
Molecular / cytogenetics images
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Tetraploid DNA Aneuploid DNA
Differential diagnosis
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● Invasive ductal carcinoma with central necrosis (J Med Case Reports 2007;1:83)
● Intraductal papilloma with comedo-like necrosis (Ann Diagn Pathol 2004;8:276)
Additional references
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End of Breast – Malignant, Males, Children > Comedo DCIS / comedocarcinoma
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