Difference between revisions of "Non-invasive breast carcinoma"

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===Size criteria for DCIS===
===Size criteria for DCIS===
DCIS must meet the following size criteria:<ref>Breast Pathology P.168.</ref>
DCIS must meet the following size criteria:<ref name=Ref_BP168>{{Ref BP|168}}</ref>
*2 membrane bound spaces -- OR -- 2 mm.
*2 membrane bound spaces -- OR -- 2 mm.
*If it isn't DCIS... it's atypical ductal hyperplasia (ADH).  
*If it isn't DCIS... it's atypical ductal hyperplasia (ADH).  
Line 68: Line 68:
==FEHUT vs ADH vs DCIS==
==FEHUT vs ADH vs DCIS==
*Breast duct lumen with too many cells.
*Breast duct lumen with too many cells.
*This is common problem is breast pathology.<ref>Breast Pathology PP. 167-8.</ref>
*This is common problem is breast pathology.<ref name=Ref_BP167-8>{{Ref BP|167-8}}</ref>


Definitions:
Definitions:
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*Mnemonic ''CLEAN'' = cell uniformity, luminal spaces, extent/size, arch., nuclei.
*Mnemonic ''CLEAN'' = cell uniformity, luminal spaces, extent/size, arch., nuclei.
**CELLULAR COMPOSITION:  
**Cellular composition:  
***EHUT = varied,
***EHUT = varied.
***ADH = focal uniformity,
***ADH = focal uniformity.
***DCIS = uniform.
***DCIS = uniform.
**LUMINA:  
**Lumina:  
***EHUT = slits/irregular spaces,
***EHUT = slits/irregular spaces.
***ADH = irregular spaces, no slits,
***ADH = irregular spaces, no slits.
***DCIS = circular "punched-out".
***DCIS = circular "punched-out".
**EXTENT:  
**Extent:  
***EHUT = usually lobulocentric,
***EHUT = usually lobulocentric.
***ADH = limited extent.  
***ADH = limited extent.  
***DCIS = extensive.  
***DCIS = extensive.  
**ARCHITECTURE:  
**Architecture:  
***EHUT = irregular/swirling,
***EHUT = irregular/swirling.
***ADH = DCIS-like,
***ADH = DCIS-like.
***DCIS = DCIS architecture (solid, cribriform, comedo, papillary, micropapillary).  
***DCIS = DCIS architecture (solid, cribriform, comedo, papillary, micropapillary).  
**NUCLEI:  
**Nuclei:  
***EHUT = variable,
***EHUT = variable.
***ADH = hyperchromatic + uniform,
***ADH = hyperchromatic + uniform.
***DCIS = evenly spaced.
***DCIS = evenly spaced.


Revision as of 15:56, 15 July 2010

Non-invasive breast cancer is a common entity... since the introduction of radiologic breast screening.

It can neatly be divided into the discussion of two entities:

  • Ductal carcinoma in situ, and,
  • Lobular carcinoma in situ.

Invasive breast cancer is dealt with in the article invasive breast cancer.

Ductal carcinoma in situ

General

  • Abbreviated DCIS.
  • Diagnosis based on nuclear abnormalities and architecture.
  • It is typically picked-up during radiologic screening.

Subtypes

Subtypes are based on architecture:

  • Solid.
    • No spaces between cells.
  • Cribriform.
    • Honeycomb-like appearance: circular holes.
    • "Cookie cutter" appearance/"punched-out" appearance/"Roman bridges" -- cells surround the circular holes.
  • Papillary.
    • Papillae with fibrovascular cores.
  • Micropapillary.
    • Small papillae without fibrovascular cores.
    • Have "drum stick" shape.

NOTE: comedonecrosis - used to be considered a separate subtype -- essentially solid type DCIS with necrosis.

Histologic features

  • Nuclear pleomorphism -- most important feature.
  • Nuclear size - compared to RBCs to grade DCIS.
    • Compare sizes of nuclei if you cannot find RBCs.
  • +/-Mitoses.
  • Cells cohesive.
    • No spaces in between.
    • Nuclei spaced equally.

Size criteria for DCIS

DCIS must meet the following size criteria:[1]

  • 2 membrane bound spaces -- OR -- 2 mm.
  • If it isn't DCIS... it's atypical ductal hyperplasia (ADH).

The treatment is similar; ADH and DCIS are both excised.

The differences are:

  • DCIS is cancer, i.e. this has life insurance implications.
  • Radiation treatment - DCIS is irradiated; ADH does not get radiation.

Grading DCIS

Graded 1-3 (low-high)[2] - compare lesional nuclei to one another.

  • Grade 1
    • Nuclei 2-3x size of RBC.
    • NO necrosis.
  • Grade 2
    • Nuclei 2-3x size of RBC.
    • +/-Necrosis.
  • Grade 3
    • Nuclei >3x size of RBC.
    • Necrosis usually present.

Notes:

  • It is often hard to find RBCs when you want 'em. DCIS is pleomorphic.
  • If no RBCs are present to compare with compare the nuclei to one another.
  • If you see nuclei >3x larger than their neigbour you're ready to call DCIS Grade 3.

FEHUT vs ADH vs DCIS

  • Breast duct lumen with too many cells.
  • This is common problem is breast pathology.[3]

Definitions:

  • EHUT = epithelial hyperplasia of the usual type, aka florid epithelial hyperplasia of the usual type (FEHUT).
  • ADH = atypical ductal hyperplasia.
  • DCIS = ductal carcinoma in situ.
  • Mnemonic CLEAN = cell uniformity, luminal spaces, extent/size, arch., nuclei.
    • Cellular composition:
      • EHUT = varied.
      • ADH = focal uniformity.
      • DCIS = uniform.
    • Lumina:
      • EHUT = slits/irregular spaces.
      • ADH = irregular spaces, no slits.
      • DCIS = circular "punched-out".
    • Extent:
      • EHUT = usually lobulocentric.
      • ADH = limited extent.
      • DCIS = extensive.
    • Architecture:
      • EHUT = irregular/swirling.
      • ADH = DCIS-like.
      • DCIS = DCIS architecture (solid, cribriform, comedo, papillary, micropapillary).
    • Nuclei:
      • EHUT = variable.
      • ADH = hyperchromatic + uniform.
      • DCIS = evenly spaced.

Tabular comparison

Comparison of EHUT, ADH and DCIS:

EHUT ADH DCIS
Cellular composition varied focal uniformity uniform
Lumina slits/irregular spaces irregular spaces, no slits circular "punched-out"
Extent usually lobulocentric limited extent extensive
Architecture irregular/swirling DCIS-like DCIS architecture (solid,
cribriform, papillary, micropapillary)
Nuclei variable hyperchromatic
& uniform		 evenly spaced

Treatment - implications:

  • EHUT - nothing; EHUT is benign.
  • ADH - simple excision, i.e. lumpectomy.
  • DCIS - excision (lumpectomy) + radiation.
  • Invasive ductal carcinoma - excision with sentinel lymph node disection[4] and radiation.

Lobular carcinoma in situ

  • Abbreviated LCIS.
  • Management is currently some matter of debate.
  • Not detected radiologically - it is an incidental pathologic finding.

See also

References

  1. ↑ O'Malley, Frances P.; Pinder, Sarah E. (2006). Breast Pathology: A Volume in Foundations in Diagnostic Pathology series (1st ed.). Churchill Livingstone. pp. 168. ISBN 978-0443066801.
  2. ↑ http://surgpathcriteria.stanford.edu/breast/dcis/
  3. ↑ O'Malley, Frances P.; Pinder, Sarah E. (2006). Breast Pathology: A Volume in Foundations in Diagnostic Pathology series (1st ed.). Churchill Livingstone. pp. 167-8. ISBN 978-0443066801.
  4. ↑ Sentinel Lymph Node Biopsy: What Breast Cancer Patients Need to Know. cancernews.com. URL: http://www.cancernews.com/data/Article/202.asp. Accessed on: 9 October 2009.
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