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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

Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.

 

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

 

 

                                         

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 cellslow grade cytology but with comedonecrosis #1#2post-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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