Invasive breast carcinoma of no special type
ductal NOS

Topic Completed: 1 September 2009

Minor changes: 21 June 2020

Copyright: 2002-2019,, Inc.

PubMed Search: Ductal carcinoma [title] breast (Review[ptyp] "loattrfree full text"[sb])

Monika Roychowdhury, M.D.
Page views in 2019: 26,172
Page views in 2020 to date: 20,924
Cite this page: Roychowdhury M. ductal NOS. website. Accessed August 6th, 2020.
Definition / general
  • Most common type of invasive breast carcinoma (75 - 80%)
  • Lacks features of any other subtypes (i.e. is a diagnosis of exclusion)
  • Arises from terminal duct lobular unit (as does lobular carcinoma), not ductal epithelium, so nomenclature is not actually accurate
  • Also called invasive ductal carcinoma, no special / specific type (NST)
Clinical features
Case reports
  • 50 year old woman with diffuse neuroendocrine differentiation in a morphologically composite mammary infiltrating ductal carcinoma (Arch Pathol Lab Med 2003;127:e131)
  • 71 year old woman with poorly differentiated tumor containing central necrosis, and resembling comedo DCIS (Case of the Week #236)
Clinical images

Contributed by Mark R. Wick, M.D.



Fungating, breast skin

Spot film

Gross description
  • Firm, poorly circumscribed, contracts from surrounding tissue, hard cartilaginous consistency, grating sound when scraped, streaks of chalky white elastotic stroma penetrating surrounding stroma ("crab like"), calcification
  • Large tumors have hemorrhage, necrosis and cystic degeneration
  • May be fixed to chest wall and cause skin dimpling or nipple retraction
Gross images

Contributed by Mark R. Wick, M.D.

Various images


Ductal carcinoma

Images hosted on other servers:

Irregular borders, infiltrating into adjacent tissue

Central necrosis and hemorrhage

Microscopic (histologic) description
  • Sheets, nests, cords or individual cells
  • Tubular formations are prominent in well differentiated tumors but absent in poorly differentiated tumors
  • Tumor cells are more pleomorphic than lobular carcinoma
  • Stroma usually desmoplastic and may obscure tumor cells
  • Calcification in 60% of cases, variable necrosis
  • Elastosis involves wall of vessels and ducts and causes grossly noted chalky streaks
  • Often DCIS (up to 80%), perineural invasion (28%)
  • Mitotic figures are often prominent
  • Mast cells are associated with low grade tumors
  • Uncommon features: eosinophils (BMC Cancer 2007;7:165), intraluminal crystalloids (Arch Pathol Lab Med 1997;121:593)
  • No myoepithelial cell lining (as seen in DCIS or benign lesions)
  • Angiolymphatic invasion:
    • In 35% - differs from tissue retraction because:
      • Occurs outside margin of carcinoma
      • Does not conform precisely to space it is in
      • Endothelial lining is present and is CD31+, Factor VIII+
      • Blood vessels are in vicinity
Microscopic (histologic) images

Scroll to see all images:

Contributed by Mark R. Wick, M.D.

Cancerization of lobules

Ductal NOS

Involving skin

Pseduo DCIS



Estrogen receptor





Progesteron receptor

Angiolymphatic invasion

Various images



Grade I

Low grade, mixed

Grade II

Grade III

High grade


Common histologic features

Occult invasive carcinoma and DCIS (arrows)

Perineural invasion


Primary tumor, lymphocytic
infiltration and fibrous stromal
reaction, contains invasive
carcinoma around duct with DCIS

Angiolymphatic invasion

Arrow: possible blood vessel invaded by carcinoma

Elastic stain accentuates
venous elastica involved
by carcinoma and artery


Not angiolymphatic invasion, shrinkage artifact
with partly necrotic tumor in space created by
shrinkage, no endothelial cells are present,
elastic stain highlights elastic tissue in walls
of vessels; marked lymphoplasmacytic infiltrate

Images hosted on other servers:

Common histologic features

Infiltration of fibroadipose

With cribriform DCIS

Desmoplastic stroma

Resembling comedo DCIS but negative for myoepithelial markers (cocktail)

Multinucleated giant cells (fig 3c, arrows)

Minimal tumor in core biopsy (fig 3a and 3b)

Angiolymphatic invasion

Vein invaded by tumor cells

Not angiolymphatic invasion


Low grade

High grade


Mast cells (stained with tryptase)


Calponin negative (normal ducts are positive)

Common histologic features

Perineural invasion


HER2 (3+)


Cytology description
  • Can use cellular pleomorphism, nuclear size, nuclear margin, nucleoli, naked tumor nuclei and mitoses to assess cytologic tumor grade, which correlates with histologic grade (Diagn Cytopathol 2003;29:185)
Cytology images

Contributed by Mark R. Wick, M.D.

Needle biopsy


Diff quik

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Ductal carcinoma, Figure A

Poorly differentiated ductal carcinoma

47 year old woman with 3 x 2 cm painless retroareolar mass and ipsilateral axillary lymphadenopathy, courtesy of Dr. Abdulaziz Mohamed

Virtual slides

Images hosted on other servers:

With cancerization of lobules

Positive stains
Negative stains
Molecular / cytogenetics images

Contributed by Mark R. Wick, M.D.


Images hosted on other servers:

no gene amplification,
courtesy of Dr. Semir Vranic

Electron microscopy description
  • Glandular differentiation (microvilli and terminal bars on luminal side)

Differential diagnosis
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