Talk:Non-invasive breast carcinoma

DCIS & invasive

Microscopic

The specimen consists of incisional biopsies (x2) of the right breast that was submitted in two cassettes.

A. The sections show an invasive mammary carcinoma - nests of atypical epithelial cells (with mild nuclear enlargement and pleomorphism, moderate pale-gray cytoplasm, and very rare mitotic activity) within the breast stroma without a surrounding myoepithelial component and a desmoplastic stromal response. The maximal extent of the invasive component is 0.45 cm. There is minimal tubule formation (Nottingham tubule score 2-3/3), scant mitotic activity (Nottingham mitotic score 1/3) and mild nuclear pleomorphism (Nottingham nuclear score 1/3).

There are abundant nests of low grade ductal carcinoma in situ with a solid and cribriform architecture. Hemosiderin-laden macrophages are present. No calcifications are identified in the tumour, DCIS or benign breast parenchyma.

B. The sections show atypical epithelial cells (with mild nuclear enlargement and pleomorphism, moderate pale-gray cytoplasm) that, focally, that appear to bud into the breast stroma without a surrounding myoepithelial component. There are abundant nests of low grade ductal carcinoma in situ with a solid and cribriform architecture - the nests of cells have sharply demarcated/punched-out tubular structures, focally, that have atypical cells arranged around them. No slit-like structures are present. The cells within the nests have streaming focally. Hemosiderin-laden macrophages are present. No calcifications are identified in the DCIS or benign breast parenchyma.

Comment: The relevant findings agree with those of the primary pathologist. The mammographic abnormality should be completely excised.

Part B is felt to be primarily ductal carcinoma in situ (DCIS), that focally has some features of epithelial hyperplasia of the usual type (EHUT); specifically, there is cellular streaming. Features that favour DCIS are: (1) the lack of slit-like spaces, (2) the punched-out circular spaces with palisaded epithelial cells (“Roman bridges” appearance), and (3) the (focal) equal spacing of epithelial cells (“cookie cutter” appearance).

Final diagnosis

DIAGNOSIS: A. Right breast, incisional biopsy:
Invasive mammary carcinoma, Nottingham grade 1-2/3.
Extent of invasion at least 0.45 cm.
No lymphovascular invasion identified.

Ductal carcinoma in situ (cribriform and solid pattern), Grade 1/3.
No necrosis identified.

B. Right breast, incisional biopsy:
Suspicious for microinvasive mammary carcinoma.

Ductal carcinoma in situ (cribriform and solid pattern), Grade 1/3.
No necrosis identified.