Table of Contents
Definition / general | Epidemiology | Clinical features | Radiology description | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Cytology images | Positive stains | Negative stains | Molecular / cytogenetics description | Molecular / cytogenetics images | Differential diagnosis | Additional referencesCite this page: Comedo DCIS / comedocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantcomedoDCIS.html. Accessed April 26th, 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
Positive stains
- HER2 amplification (Cancer 2000;89:2153), p53 (Lab Invest 1994;71:67)
- Also p-cadherin (Virchows Arch 2007;450:73)
Negative stains
Molecular / cytogenetics description
- Aneuploid
- Multicentric tumors were monoclonal in one study (Hum Pathol 2003;34:1163)
Differential diagnosis
- Invasive ductal carcinoma with central necrosis (J Med Case Rep 2007;1:83)
- Intraductal papilloma with comedo like necrosis (Ann Diagn Pathol 2004;8:276)
Additional references