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Presented by Pedram Argani, M.D. and prepared by Matthew Olson, M.D.
Case 3: This is a 55 year old female with calcifications noted on mammogram.
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1. Question
Week 480: Case 3
This is a 55 year old female with calcifications noted on mammogram.images/1Alex/05022011_3_1.jpg
images/1Alex/05022011_3_2.jpg
images/1Alex/05022011_3_3.jpgCorrect
Answer: Lobular carcinoma in situ with necrosis
Histology: The ducts are fully distended by monotonous cells which have increased nucleus cytoplasm ratio and are associated with central necrosis that is calcified focally. The lesional cells demonstrate only moderate nuclear atypia. Focally, one can appreciate signet ring cell morphology. The lesion cells are non immunoreactive for E-cadherin, supporting the diagnosis of lobular carcinoma in situ with necrosis.
Discussion: Ductal carcinoma in situ would generally feature neoplastic cells forming glandular structures, and should have intact E-cadherin. Atypical ductal hyperplasia is a lesion that has some of the cytologic features of low grade ductal carcinoma in situ, but is confined to a limited area (less than 2mm). Usual ductal usually hyperplasia features a mixed population of cells having hyperchromatic nuclei and a syncytial growth pattern.
Lobular carcinoma in situ with necrosis (florid lobular carcinoma in situ) is generally treated like DCIS when it is at a margin, in that it should be excised to obtain margins free of carcinoma in situ with necrosis.
Incorrect
Answer: Lobular carcinoma in situ with necrosis
Histology: The ducts are fully distended by monotonous cells which have increased nucleus cytoplasm ratio and are associated with central necrosis that is calcified focally. The lesional cells demonstrate only moderate nuclear atypia. Focally, one can appreciate signet ring cell morphology. The lesion cells are non immunoreactive for E-cadherin, supporting the diagnosis of lobular carcinoma in situ with necrosis.
Discussion: Ductal carcinoma in situ would generally feature neoplastic cells forming glandular structures, and should have intact E-cadherin. Atypical ductal hyperplasia is a lesion that has some of the cytologic features of low grade ductal carcinoma in situ, but is confined to a limited area (less than 2mm). Usual ductal usually hyperplasia features a mixed population of cells having hyperchromatic nuclei and a syncytial growth pattern.
Lobular carcinoma in situ with necrosis (florid lobular carcinoma in situ) is generally treated like DCIS when it is at a margin, in that it should be excised to obtain margins free of carcinoma in situ with necrosis.
