Breast – Malignant, Males, Children

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Breast-malignant, males, children

Morphologic variants of DCIS

Cribriform DCIS

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

Microscopic description

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● Multiple secondary lumens having round, regular spaces with sharp borders that appear to be made from “cookie-cutters”, usually low grade (image)

● Also small, regular fenestrations (Latin, the arrangement of windows in a building), giving a sieve-like appearance

● Nuclei are small and uniform, equidistant from each other; usually no necrosis

● Associated with flat epithelial atypia (Mod Path 2007;20:1149)

● Trabecular bars: rigid rows of cells with long axes perpendicular or at least not parallel to long axis of the bar (not just partial detachments of duct lining)

● Roman bridges: curvilinear trabecular bars connecting two portions of the epithelial lining (image)

Micro images

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Uniform cells either haphazard or at right angles Prominent Roman bridge (AFIP)

to long axis of intraductal columns (AFIP)

Cribriform growth due to merging Regular punched out fenestrations

of intraductal epithelial bridges and distension of duct

Glandular spaces and monotonous epithelial cells Rigid microlumina

Glandular spaces and monotonous epithelial cells

Lumina have round, regular

spaces with sharp borders

Glandular spaces and Round fenestrations Fenestrations, Roman bridges

monotonous epithelial cells and trabecular bars

Prominent roman bridges

Classic area (fig c) and areas resembling

low grade clinging carcinoma (fig a) and ADH (fig b)

With microcalcifications

ER+

Factor VIII staining shows only rare vascular

proliferation (fig 2a); low MIB1 staining (fig 2b)

Other images: glandular spaces and monotonous epithelial cells; low grade cytology but with comedonecrosis #1; #2; post-chemotherapy

Cytology description

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● Three dimensional structures, occasionally with tumor cells bordering central lumina

● Few single tumor cells

● Clear or slightly hemorrhagic background without necrosis

● Tumor cells are uniform and oval, with round/oval nuclei, finely granular chromatin, indistinct nucleoli, slight nuclear membrane condensation (Acta Cytol 1992;36:48)

Cytology images

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Complex tissue fragment superficially resembles Three dimensional epithelial

branching papillae, but has intercepting arches cribriform aggregate

and lacks fibrovascular cores

Sieve-like pattern of cribriform DCIS Microcalcification

Virtual slides

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Cribriform and solid DCIS

Positive stains

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● ER and PR

Differential diagnosis

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● Atypical ductal hyperplasia - cells more variable than in DCIS

● Adenoid cystic carcinoma - two types of cavities and two types of cells: (1) true glandular lumina lined by ductal epithelium (EMA+, keratin+) and (2) eosinophilic “cylinders” with basement membrane material lined by basal / myoepithelial-type cells (vimentin+), usually ER- and PR-

End of Breast – Malignant, Males, Children > Cribriform DCIS

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