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Presented by Pedram Argani, M.D. and prepared by Maryam Farinola M.D.
Case 4: A 55-year-old female with a 7 cm breast mass.
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1. Question
Week 165: Case 4
A 55-year-old female with a 7 cm breast mass./images/DCISmed.jpg
/images/tubularadenosismed.jpg
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/images/tubularadenosishigh.jpg
/images/tubularadenosisSMMHC.jpgCorrect
Answer: Ductal carcinoma in situ involving tubular adenosis
Histology: This is a high-grade ductal carcinoma in situ (DCIS) characterized by pleomorphic tumor cells with abundant pink cytoplasm and large areas of central (comedo) necrosis, along with periductal fibrosis. The background breast contains extensive tubular and sclerosing adenosis. Colonization of this adenosis by DCIS yields a pseudo-infiltrative pattern. However, in contrast to true invasion, the smaller glands have a rounded contour. The absence of invasion is confirmed by immunostains from myoepithelial markers (p63, smooth muscle myosin-heavy chain, smooth muscle actin, calponin). While it is difficult to exclude microinvasion in this sort of case, there is no specific evidence of microinvasion in the images shown. Tubular carcinoma is excluded by the presence of high-grade nuclei within this lesion.
Discussion: DCIS colonizing tubular adenosis is a well-known mimic of invasive ductal carcinoma, just as lobular carcinoma in situ colonizing sclerosing adenosis is a mimic of infiltrating lobular carcinoma.
Incorrect
Answer: Ductal carcinoma in situ involving tubular adenosis
Histology: This is a high-grade ductal carcinoma in situ (DCIS) characterized by pleomorphic tumor cells with abundant pink cytoplasm and large areas of central (comedo) necrosis, along with periductal fibrosis. The background breast contains extensive tubular and sclerosing adenosis. Colonization of this adenosis by DCIS yields a pseudo-infiltrative pattern. However, in contrast to true invasion, the smaller glands have a rounded contour. The absence of invasion is confirmed by immunostains from myoepithelial markers (p63, smooth muscle myosin-heavy chain, smooth muscle actin, calponin). While it is difficult to exclude microinvasion in this sort of case, there is no specific evidence of microinvasion in the images shown. Tubular carcinoma is excluded by the presence of high-grade nuclei within this lesion.
Discussion: DCIS colonizing tubular adenosis is a well-known mimic of invasive ductal carcinoma, just as lobular carcinoma in situ colonizing sclerosing adenosis is a mimic of infiltrating lobular carcinoma.
