Comedo DCIS / comedocarcinoma

Breast malignant, males, children
In situ carcinoma
Comedo DCIS / comedocarcinoma

Author: Dina Kandil, M.D. (see Authors page)

Revised: 18 October 2016, last major update January 2012

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Comedocarcinoma [title] breast

Table of Contents

Cite this page: Comedo DCIS / comedocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantcomedoDCIS.html. Accessed April 22nd, 2018.

Definition / general

High grade DCIS with central expansile comedonecrosis (central necrosis within involved ducts)
Necrosis is due to apoptosis and oncosis (passive cell death, Ultrastruct Pathol 2000;24:135)

Epidemiology

Has similar hormonal and reproductive risk factors as invasive ductal carcinoma, unlike non-comedo DCIS (Cancer Epidemiol Biomarkers Prev 2009;18:1507)

Clinical features

1/3 appear multicentric, but many are actually continuous in 3 dimensions, as demonstrated by serial section mapping studies
10% are bilateral
1 - 3% of patients have axillary nodal metastases, even without evidence of invasive carcinoma
Lesions may be extensive (> 5 cm); must examine carefully for invasive carcinoma

Radiology description

Mammography usually shows linear and branching microcalcifications due to calcification of necrotic material, more often central than other tumors
Occasionally lacks calcifications

Gross description

Cheesy appearance (resembling comedones) due to plugging of thick walled ducts with necrotic material

Microscopic (histologic) description

Solid growth of large, pleomorphic, high grade cells with central expansile necrosis
Frequent mitotic figures
Myoepithelial cell layer may be attenuated
Coarse microcalcifications are common
Periductal fibrosis and inflammation are common
Often cancerization of lobules
May have branching and budding

Microscopic (histologic) images

Images hosted on PathOut server: