Carcinoma in situ

Breast carcinoma in situ
Updated: 12/11/2018
© Jun Wang, MD, PhD

General features
  • Neoplastic proliferation with malignant features
  • Confined within spaces bordered by myoepithelium and basement membrane
  • May progress to invasive carcinoma
Clinical presentations
  • Clinically occult
  • Ductal carcinoma in situ
    • Mammographic finding of microcalcifications, soft-tissue densities
  • Lobular carcinoma in situ: 
    • Usually incidental finding due to biopsy for other lesions, such as fibrocystic changes
    • Multifocal, bilateral
    • NOT associated with microcalcification or stromal density
Key morphological features
Comedo type: Markedly atypical ductal cells with central necrosis, may habor microinvasion, may be treated as invasive ductal carcinoma
Paget disease, ductal carcinoma in situ involving nipple skin
Cribriform: Round rigid spaces (Roman bridges)
Micropapillary: finger like projects of tumor cells without fibrovascular core
Papillary: finger like projects of tumor cells with fibrovascular core
Solid: Ducts filled with low to intermediated grade tumor cells, or high grade tumor cells without central necrosis
Loosely cohesive cells
Relatively monotonous
Negative for E-cadherine
Pleomorphic lobular carcinoma in situ: Lobular carcinoma in situ with moderate to severe cytological atypia
Marker
  • Ductal carcinoma in situ: Positive for E-cadherin
  • Lobular carcinoma in situ: Negative for E-cadherin
Treatment
  • Ductal carcinoma in situ: Surgery
  • Pleomorphic lobular carcinoma in situ: Surgery
  • Lobular carcinoma in situ: Observation



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