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Presented by Jonathan Epstein, M.D. and prepared by Orin Buetens, M.D.
Case 4: 44 year-old female with a breast mass.
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1. Question
Week 7: Case 4
44 year-old female with a breast mass.
Correct
Answer: Micropapillary ductal carcinoma in situ
Histology: There are numerous dilated ducts filled with necrotic debris. These ducts show a prominent proliferation of micropapillae projecting into the lumen. These papillae are notable for their lack of fibrovascular cores. The cells lining these dilated cystic structures and the micropapillae are pleomorphic with high nuclear-to-cytoplasmic ratios and prominent cytologic atypia.
Discussion: Intraductal papillomatosis lacks the cytologic atypia seen within the current case of micropapillary DCIS. Also, within intraductal papillomatosis, the papillae would demonstrate fibrovascular cores. Intraductal papillomatosis would also lack necrosis. Similarly, atypical duct hyperplasia would lack the prominent necrosis seen in the current case. Potentially, if there was a single duct which showed some of the features seen in the current case yet without the necrosis, one might call it ADH. There is no evidence of infiltrating duct carcinoma. All of the ducts are consistent with a proliferation of malignant cells within pre-existing dilated existing duct structures. The presence of fibrosis around some of the dilated ducts does not indicate invasion.
Incorrect
Answer: Micropapillary ductal carcinoma in situ
Histology: There are numerous dilated ducts filled with necrotic debris. These ducts show a prominent proliferation of micropapillae projecting into the lumen. These papillae are notable for their lack of fibrovascular cores. The cells lining these dilated cystic structures and the micropapillae are pleomorphic with high nuclear-to-cytoplasmic ratios and prominent cytologic atypia.
Discussion: Intraductal papillomatosis lacks the cytologic atypia seen within the current case of micropapillary DCIS. Also, within intraductal papillomatosis, the papillae would demonstrate fibrovascular cores. Intraductal papillomatosis would also lack necrosis. Similarly, atypical duct hyperplasia would lack the prominent necrosis seen in the current case. Potentially, if there was a single duct which showed some of the features seen in the current case yet without the necrosis, one might call it ADH. There is no evidence of infiltrating duct carcinoma. All of the ducts are consistent with a proliferation of malignant cells within pre-existing dilated existing duct structures. The presence of fibrosis around some of the dilated ducts does not indicate invasion.
