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Presented by Pedram Argani, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 5: Forty-one year old female with a breast mass.
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1. Question
Week 201: Case 5
Forty-one year old female with a breast mass.images/PA 9 27 04 case 5 1.jpg
images/PA 9 27 04 case 5 2.jpg
images/PA 9 27 04 case 5 3.jpg
images/PA 9 27 04 case 5 4.jpg
images/PA 9 27 04 case 5 5.jpgCorrect
Answer: Ductal carcinoma in-situ colonizing tubular adenosis
Histology: The lesion has a somewhat irregular border to it, and is composed of monotonous epithelial cells forming a cribriform pattern. However, on close inspection of the surrounding breast, one sees the classic features of tubular adenosis, with streaming, branching, elongated glands present in a non-desmoplastic stroma. The lesion represents tubular adenosis colonized by low-grade cribriform ductal carcinoma in situ, therefore expanding the compressed adenotic glands and simulating an invasive duct carcinoma. The in situ nature of the lesion is demonstrated by myoepithelial markers p63 and smooth muscle myosin heavy chain, which completely envelop all the small acini within this lesion.
Discussion: The presence of invasive carcinoma is excluded by the intact myoepithelial marker staining.
Low grade ductal carcinoma in situ colonizing tubular adenosis has been well described (Am J Surg Pathol 1996;20:46-54). This, and sclerosing papillary lesions, are common causes of overdiagnosis of invasive ductal carcinoma.
Incorrect
Answer: Ductal carcinoma in-situ colonizing tubular adenosis
Histology: The lesion has a somewhat irregular border to it, and is composed of monotonous epithelial cells forming a cribriform pattern. However, on close inspection of the surrounding breast, one sees the classic features of tubular adenosis, with streaming, branching, elongated glands present in a non-desmoplastic stroma. The lesion represents tubular adenosis colonized by low-grade cribriform ductal carcinoma in situ, therefore expanding the compressed adenotic glands and simulating an invasive duct carcinoma. The in situ nature of the lesion is demonstrated by myoepithelial markers p63 and smooth muscle myosin heavy chain, which completely envelop all the small acini within this lesion.
Discussion: The presence of invasive carcinoma is excluded by the intact myoepithelial marker staining.
Low grade ductal carcinoma in situ colonizing tubular adenosis has been well described (Am J Surg Pathol 1996;20:46-54). This, and sclerosing papillary lesions, are common causes of overdiagnosis of invasive ductal carcinoma.
