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WHO Classification of Tumours
Ductal carcinoma in situ, NOS
Breast


Definition

Ductal carcinoma in situ (DCIS) is an intraductal neoplasm that typically originates in the terminal duct-lobular unit (TDLU) and remains confined to the epithelium of mammary ducts. It is characterized by increased epithelial proliferation, subtle to pronounced cellular atypia and a tendency for progression to invasive breast cancer. Depending on the degree of nuclear atypia, necrosis and, to a lesser extent, on mitotic activity and calcification, DCIS is divided into low grade, intermediate grade, and high grade lesions. Areas of different histological grades within the same tumour are not uncommon
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Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003



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> Low grade DCIS is characterized by small, monomorphic cells forming arcades,
micropapillae, cribriform or solid patterns. Nuclei are round, have uniform sizes and a regular chromatin pattern with inconspicuous nucleoli. Mitoses are rare. Microcalcifications usually appear laminated and crystalline and resemble psammoma bodies. Necrosis and comedo histology are absent.

> Intermediate grade DCIS is distinguished from low grade lesions by the presence of intraluminal necrosis, nuclei of intermediate grade, or areas of amorphous microcalcification.

> High grade DCIS is characterized by highly atypical cells forming one-layered micropapillae, cribriform or solid patterns. Nuclei have an irregular contour, are markedly pleomorphic and contain clumped chromatin and prominent nucleoli. Mitoses are common (but not required for classification). Microcalcifications are almost exclusively amorphous and develop in necrotic tumour areas. Characteristic is comedo necrosis with abundant necrotic debris in duct lumina surrounded by a usually solid proliferation of large pleomorphic tumour cells.

Ductal carcinoma in situ accounts for >14% of breast carcinomas

Click to access Pubmed
Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R (2000)
Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program.
Arch Intern Med 160: 953-8



. It occurs in all age groups but is extremely rare before puberty; the mean age is around 55 years. Male patients are exceptional. >85% of DCIS are detected by imaging; clinical symptoms are rather uncommon (they may include palpable abnormalities, pathological nipple discharge, or nipple alterations associated with Paget disease). The relative risk for the development of invasive breast cancer is 8-11 for DCIS patients
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Fitzgibbons PL, Henson DE, Hutter RV (1998)
Benign breast changes and the risk for subsequent breast cancer: an update of the 1985 consensus statement. Cancer Committee of the College of American Pathologists.
Arch Pathol Lab Med 122: 1053-5



. About 22% of patients with unilateral DCIS develop DCIS or invasive carcinoma in the other breast
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Ward BA, McKhann CF, Ravikumar TS (1992)
Ten-year follow-up of breast carcinoma in situ in Connecticut.
Arch Surg 127: 1392-5



. Follow-up data suggest that DCIS per se is not life threatening. Deaths are related to an undetected invasive carcinoma, progression to invasive carcinoma after incomplete excision of DCIS, or development of a de novo invasive carcinoma
Click to access Pubmed
Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R (2000)
Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program.
Arch Intern Med 160: 953-8



. Important factors for the choice of therapy are size, grade and clearance margins of the lesion. Traditionally, DCIS has been treated by mastectomy, but there is evidence that complete local eradication is adequate and usually curative for small, low grade lesions
Click for details
Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003



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