Breast malignant, males, children
Carcinoma subtypes
Ductal carcinoma, NOS - general

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 28 October 2016, last major update September 2009

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Ductal carcinoma [title] breast

Cite this page: Ductal carcinoma, NOS - general. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastmalignantductalNOS.html. Accessed December 4th, 2016.
Definition / General
  • Most common type of invasive breast carcinoma (75 - 80%)
  • Lacks features of any other subtypes (i.e. is a diagnosis of exclusion)
  • Arises from terminal duct lobular unit (as does lobular carcinoma), not ductal epithelium, so nomenclature is not actually accurate
Terminology
  • Also called invasive ductal carcinoma, no special / specific type (NST)
Clinical Features
Case Reports
  • 50 year old woman with diffuse neuroendocrine differentiation in a morphologically composite mammary infiltrating ductal carcinoma (Arch Pathol Lab Med 2003;127:e131)
  • 71 year old woman with poorly differentiated tumor containing central necrosis, and resembling comedo DCIS (Case of the Week #236)
Clinical Images

Images hosted on PathOut server:
Images courtesy of Mark R. Wick, M.D.

Invasive

Mammogram

Fungating, breast skin



Spot film

Gross Description
  • Firm, poorly circumscribed, contracts from surrounding tissue, hard cartilaginous consistency, grating sound when scraped, streaks of chalky white elastotic stroma penetrating surrounding stroma ("crab like"), calcification
  • Large tumors have hemorrhage, necrosis and cystic degeneration
  • May be fixed to chest wall and cause skin dimpling or nipple retraction
Gross Images

Images hosted on PathOut server:

Courtesy of Mark R. Wick, M.D.

AFIP image



Images hosted on other servers:

Irregular borders, infiltrating into adjacent tissue

Central necrosis and hemorrhage

Micro Description
  • Sheets, nests, cords or individual cells
  • Tubular formations are prominent in well differentiated tumors but absent in poorly differentiated tumors
  • Tumor cells are more pleomorphic than lobular carcinoma
  • Stroma usually desmoplastic and may obscure tumor cells
  • Calcification in 60% of cases, variable necrosis
  • Elastosis involves wall of vessels and ducts and causes grossly noted chalky streaks
  • Often DCIS (up to 80%), perineural invasion (28%)
  • Mitotic figures are often prominent
  • Mast cells are associated with low grade tumors
  • Uncommon features: eosinophils (BMC Cancer 2007;7:165), intraluminal crystalloids (Arch Pathol Lab Med 1997;121:593)
  • No myoepithelial cell lining (as seen in DCIS or benign lesions)

  • Angiolymphatic invasion:
    • In 35% - differs from tissue retraction because:
      • Occurs outside margin of carcinoma
      • Does not conform precisely to space it is in
      • Endothelial lining is present and is CD31+, Factor VIII+
      • Blood vessels are in vicinity
      • See also Prognostic factors - Angiolymphatic invasion
Micro Images

Scroll to see all images:


Images hosted on PathOut server:
Images courtesy of Mark R. Wick, M.D.

Cancerization of lobules

Ductal NOS

Involving skin

Pseduo DCIS



Cadherin

Desmin

Estrogen receptor

HER2



Ki-67

p53

Popoplanin

Progesteron receptor



Common histologic features

Occult invasive carcinoma and DCIS (arrows) - AFIP

Perineural invasion

Primary tumor, lymphocytic
infiltration & fibrous stromal
reaction, contains invasive
carcinoma around duct with DCIS



Angiolymphatic invasion

Courtesy of Mark R. Wick, M.D.



Podoplanin, courtesy of Mark R. Wick, M.D.

Arrow: possible blood vessel invaded by carcinoma (AFIP)

Elastic stain accentuates venous elastica involved by carcinoma and artery below

Not angiolymphatic invasion, shrinkage artifact
with partly necrotic tumor in space created by
shrinkage, no endothelial cells are present, elastic
stain highlights elastic tissue in walls of vessels;
marked lymphoplasmacytic infiltrate



Grading

Grade I, courtesy of Mark R. Wick, M.D.

Low grade, mixed, courtesy of Mark R. Wick, M.D.



Grade II, courtesy of Mark R. Wick, M.D.



Grade III, courtesy of Mark R. Wick, M.D.

High grade, courtesy of Mark R. Wick, M.D.



Images hosted on Flickr:
Common histologic features

Perineural invasion



Stains

HER2 (3+)

Topo II IHC



Images hosted on other servers:
Common histologic features

Infiltration of fibroadipose

With cribriform DCIS

Desmoplastic stroma



Resembling comedo DCIS but negative for myoepithelial markers (cocktail)

Multinucleated giant cells (fig 3c, arrows)

Minimal tumor in core biopsy (fig 3a and 3b)



Angiolymphatic invasion

Vein invaded by tumor cells

Not angiolymphatic invasion



Grading

Low grade

High grade



Stains

Mast cells (stained with tryptase)

PR+

Calponin negative (normal ducts are positive)

Cytology Description
  • Can use cellular pleomorphism, nuclear size, nuclear margin, nucleoli, naked tumor nuclei and mitoses to assess cytologic tumor grade, which correlates with histologic grade (Diagn Cytopathol 2003;29:185)
Cytology Images

Images hosted on PathOut server:
Courtesy of Mark R. Wick, M.D.:

Needle biopsy

FNAB

Diff quik



Images hosted on Flickr:

47 year old woman with 3 x 2 cm painless retroareolar mass and ipsilateral axillary lymphadenopathy, courtesy of Dr. Abdulaziz Mohamed



Images hosted on other servers:

Ductal carcinoma, Figure A

Poorly differentiated ductal carcinoma

Virtual Slides

Images hosted on other servers:

Core biopsy

With cancerization of lobules

Positive Stains
Negative Stains
Molecular / Cytogenetics Images

Images hosted on PathOut server:

HER2 amp FISH, courtesy of Mark R. Wick, M.D.



Images hosted on Flickr:

TOP2A CEP17 FISH -
no gene amplification,
courtesy of Dr. Semir Vranic

Electron Microscopy Description
  • Glandular differentiation (microvilli and terminal bars on luminal side)
Videos



Differential Diagnosis