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Presented by Peter Illei, M.D. and prepared by Shien Micchelli, M.D.
Case 5: 38 years old woman with intermediate grade DCIS on core biopsy.
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1. Question
Week 304: Case 5
38 years old woman with intermediate grade DCIS on core biopsy. The patient underwent experimental intraductal chemotherapy and ductography prior to the simple mastectomy./images/3_12_07_6a.jpg
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Answer: Intraductal chemotherapy effects
Histology: The parenchyma of the upper outer and focally of the upper inner quadrant shows marked lymphocytic mastitis with edema, focal intraductal deposits of small amorphous black foreign material, and marked reactive epithelial atypia in the lobules. These changes are consistent with the clinical history of ductography and intraductal injection of anti neoplastic agents. The above changes were not seen in the area of biopsy site and in the residual focus of DCIS. The cytologic atypia seen in the lobules is reactive in nature with normal N/C ratio and is seen in association with marked lymphocytic lobulitis and edema. The lobules are enlarged due to edema, but the acini are not distended, which is helpful for excluding lobular involvement by DCIS. The scattered intraductal dark pigment deposits are most consistent with residual dye from the ductography that was performed before and after the intraductal chemotherapy.
Discussion: These changes are consistent with the clinical history of ductography and intraductal injection of anti neoplastic agents. The above changes were not seen in the area of biopsy site and in the residual focus of DCIS. The cytologic atypia seen in the lobules is reactive in nature with normal N/C ratio and is seen in association with marked lymphocytic lobulitis and edema. The lobules are enlarged due to edema, but the acini are not distended, which is helpful for excluding lobular involvement by DCIS. The scattered intraductal dark pigment deposits are most consistent with residual dye from the ductography that was performed before and after the intraductal chemotherapy.
Incorrect
Answer: Intraductal chemotherapy effects
Histology: The parenchyma of the upper outer and focally of the upper inner quadrant shows marked lymphocytic mastitis with edema, focal intraductal deposits of small amorphous black foreign material, and marked reactive epithelial atypia in the lobules. These changes are consistent with the clinical history of ductography and intraductal injection of anti neoplastic agents. The above changes were not seen in the area of biopsy site and in the residual focus of DCIS. The cytologic atypia seen in the lobules is reactive in nature with normal N/C ratio and is seen in association with marked lymphocytic lobulitis and edema. The lobules are enlarged due to edema, but the acini are not distended, which is helpful for excluding lobular involvement by DCIS. The scattered intraductal dark pigment deposits are most consistent with residual dye from the ductography that was performed before and after the intraductal chemotherapy.
Discussion: These changes are consistent with the clinical history of ductography and intraductal injection of anti neoplastic agents. The above changes were not seen in the area of biopsy site and in the residual focus of DCIS. The cytologic atypia seen in the lobules is reactive in nature with normal N/C ratio and is seen in association with marked lymphocytic lobulitis and edema. The lobules are enlarged due to edema, but the acini are not distended, which is helpful for excluding lobular involvement by DCIS. The scattered intraductal dark pigment deposits are most consistent with residual dye from the ductography that was performed before and after the intraductal chemotherapy.
