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Extensive, pure micropapillary Ductal Carcinoma in Situ (Download PDF Version) David L. Page, M.D.
Of the candidate special types of ductal carcinoma in situ which
have special or possibly special clinical implications, of pure
micropapillary ductal carcinoma in situ is certainly the most ready for
general acceptance. Thus, as we structure the categories of invasive
mammary carcinoma, with ductal carcinoma in situ there is a general type
which is graded usefully, and some special types. The general or no special
type DCIS is graded into low, intermediate and high grade with the nucler
grade as the major basis. Special types of DCIS are not generally accepted,
but are useful in the manner of special invasive types by recognizing
clustering of anatomic features that are useful either to indicate special
clinical features, or to aid in diagnosis when usual features of the common
DCIS patterns are lacking.
We believe that micropapillary type of ductal carcinoma in situ only
has special implications when it is present in pure form. It has long been
known that micropapillae can coexist with the cribriform pattern of ductal
carcinoma in situ, and the usually somewhat circumscribed ( especially in
smaller examples) pattern of DCIS is usually seen with those cases
evidencing mixed pattern, low grade DCIS.
There are few formal studies in the world,s literature where the
extensiveness of the pure micropapillary ductal carcinoma in situ is
implicated. The first of these was published by Patchefsky, et al. in
which these authors demonstrated from mastectomy specimens removed for DCIS
that lesions were very much larger when purely micropapillary as opposed to
comedo, cribriform or solid. This specific evaluation was also clearly
stated in a study by Bellamy, et al. from Edinburgh, Scotland. The purely
micropapillary cases were often filling one quadrant and present in a
adjacent quadrant of the breast. In our own experience, this is often the
case. Obviously, in an individual case, the actual extent of the lesion
needs to be ascertained.
In this particular case the original biopsy of approximately 2 cm.
had extensive micropapillary ductal carcinoma in situ. This point was made
clear and after another biopsy indicated presence in another quadrant, a
mastectomy was done from which the current material is available. The
lesion was present in at least two and probably three quadrants of the
breast. Note that micropapillomas are also present.
The second reason for accepting pure micropapillary DCIS as a useful
clinical entity is that the extensiveness is present independent of
cytologic grade, and attempts at grading are difficult because of
variability of nuclear grade in many of these cases (Scott et al., 1997)
Bellamy, C., McDonald, C., Salter, D.M., Chetty, U. and Anderson, T.J.,
Noninvasive ductal carcinoma of the breast: the relevance of histologic
categorization. Hum Pathol, 24: 16-23,1993.
Patchefsky, A.S., Schwartz, G.F., Finkelstein, S.D., Prestipino, A., Sohn,
S.E., Singer, J.S. and Feig, S.A., Heterogeneity of intraductal carcinoma of
the breast. Cancer, 63: 731-741,1989.
Scott, M.A., Lagios, M.D., Axelsson, K., Rogers, L.W., Anderson, T.J. and
Page, D.L., Ductal carcinoma in situ of the breast: Reproducibility of
histological subtype analysis. Hum Pathol, 28: 967-973,1997.
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