Breast malignant, males, children - Comedo DCIS/Intraductal comedocarcinoma

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Breast malignant, males, children

In situ carcinoma

Comedo DCIS / comedocarcinoma

Reviewer: Dina Kandil, M.D. (see Reviewers page)
Revised: 10 January 2012, last major update January 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

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

Clinical
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● 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

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

X-ray images
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Linear and branching microcalcifications

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

Micro description
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● 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

Micro images
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Central necrosis with dystrophic calcifications (AFIP)

Classic features

Periductal fibrosis

Involving lobules

Cancerization of lobules

HER2+

Androgen receptor+

Other images: central necrosis #1, #2

Cytology images
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Other images: low power; atypical cells with large nuclei #1; #2; #3

Virtual slides
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DCIS and LCIS

Calponin

Positive stains
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● HER2 amplification (Cancer 2000;89:2153), p53 (Lab Invest 1994;71:67)
● Also P-cadherin (Virchows Arch 2007;450:73)

Negative stains
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● ER, PR (Br J Surg 2005;92:429)

Molecular/cytogenetics description
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● Aneuploid
● Multicentric tumors were monoclonal in one study (Hum Pathol 2003;34:1163)

Molecular/cytogenetics images
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Tetraploid DNA

Aneuploid DNA

Differential diagnosis
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● Invasive ductal carcinoma with central necrosis (J Med Case Reports 2007;1:83)
● Intraductal papilloma with comedo-like necrosis (Ann Diagn Pathol 2004;8:276)

Additional references
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● Arch Pathol Lab Med 1996;120:81

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

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