Michael: /* See also */

2016-05-12T21:40:13Z

Michael: /* See also */

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2016-05-01T04:01:36Z

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	#~~redirect~~ [[Non-~~invasive_breast_carcinoma#Ductal_carcinoma_in_situ~~]]		'''Ductal carcinoma in situ''', abbreviated '''DCIS''', in a common type of [[non-invasive breast carcinoma]].

			==General==
			*Diagnosis based on nuclear abnormalities ''and/or'' architecture.
			**Low-grade DCIS does '''not''' have a malignant cytology.
			*It is typically picked-up during radiologic screening.

			==Microscopic==
			Features:
			*Architectural changes:
			**Equal spacing of cells - "cookie cutter" look.
			**Cells line-up along lumen/glandular spaces - form "Roman briges".
			**Architecture suggestive of DCIS - see ''[[Subtypes of DCIS]]''.
			*Nuclear changes:
			**Nuclear enlargement - at least 2-3x size of [[RBC]] - '''key feature'''.
			***Compared to RBCs to grade DCIS - see ''[[Grading DCIS]]''.
			****Compare sizes of nuclei if you cannot find RBCs.
			**Nuclear pleomorphism - important feature.
			*+/-Mitoses.

			Note:
			*Apocrine changes of cytoplasm -- several sets of criteria exist -- any of the following:
			*#Nuclei should be ~4x RBC for low grade, 5x RBC for high grade.<ref>URL: [http://surgpathcriteria.stanford.edu/breast/dcis/apocrinedcis.html http://surgpathcriteria.stanford.edu/breast/dcis/apocrinedcis.html]. Accessed on: 4 August 2011.</ref>
			*#Nuclear enlargement of 3x +/- nucleolar enlargement.<ref name=pmid18171412/>
			*#Multiple nucleoli + nuclear size variation.<ref name=pmid18171412>{{Cite journal \| last1 = O'Malley \| first1 = FP. \| last2 = Bane \| first2 = A. \| title = An update on apocrine lesions of the breast. \| journal = Histopathology \| volume = 52 \| issue = 1 \| pages = 3-10 \| month = Jan \| year = 2008 \| doi = 10.1111/j.1365-2559.2007.02888.x \| PMID = 18171412 }}</ref>

			===Subtypes of DCIS===
			The subtypes are based on architecture.

			Note:
			*''Comedonecrosis'' used to be considered a separate subtype. [[Necrosis]] is seen most often in the context of ''solid ductal carcinoma in situ''.
			====Solid ductal carcinoma in situ====
			Features:
			*Sheet of cells fills the duct
			*No spaces between cells.

			<gallery>
			Image:Breast DCIS Solid IntermediateGrade SNP.jpg\|Breast - Ductal carcinoma in situ - Solid variant- Intermediate grade - Medium power (SKB)
			Image:Breast DCIS Solid SNP.jpg\|Breast - Ductal carcinoma in situ - Solid variant- Intermediate grade - Low power (SKB)
			Image:Breast DCIS Solid PA.JPG\|Breast - Ductal carcinoma in situ - Solid variant - Medium power (SKB)
			Image:Breast DCIS Comedonecrotic 2 PA.JPG\|Breast - Ductal carcinoma in situ - Solid variant - Comedonecrosis (SKB)
			Image:Breast DCIS Comedonecrosis MP PA.JPG\|Breast - Ductal carcinoma in situ - Solid variant - Comedonecrosis (SKB)
			</gallery>

			DDx:
			*[[LCIS]].
			**May show dyscohesion
			**More monomorphic population of cells

			====Cribriform ductal carcinoma in situ====
			Features:
			*Honeycomb-like appearance: circular holes.
			*"Cookie cutter" appearance/"punched-out" appearance/"Roman bridges" -- cells surround the circular holes.

			<gallery>
			Image:Breast DCIS Cribriform MP CTR.jpg\|Breast - Ductal carcinoma in situ - cribriform varient - medium power (SKB)
			Image:Breast DCIS Cribriform PA.JPG\|Breast - Ductal carcinoma in situ - cribriform varient - medium power (SKB)
			</gallery>

			DDx:
			*[[Collagenous spherulosis]].
			*[[Adenoid cystic carcinoma of the breast]].
			*Invasive cribriform carcinoma of the breast

			====Papillary ductal carcinoma in situ====
			Features:
			*Papillae with fibrovascular cores.
			*Papillae lack a myoepithelial layer
			*Papillae are lined by atypical cells.
			*Papillae within a ductal space lined by myoepithelial cells.

			<gallery>
			Image:Breast DCIS PapillaryVariant LP PA.JPG\|Breast - Ductal carcinoma in situ - Papillary variant - low power (SKB)
			Image:Breast DCIS Papillary PA.JPG\|Breast - Ductal carcinoma in situ - Papillary variant - Medium power (SKB)
			</gallery>

			DDX:

			*[[Intraductal papilloma]]
			*Ductal carcinoma in situ arising within an intraductal papilloma
			*[[Intracystic papillary breast carcinoma]]
			*[[Invasive papillary breast carcinoma]]

			====Micropapillary ductal carcinoma in situ====
			Features:
			*Small papillae without fibrovascular cores.
			*Have "drum stick" shape.

			DDx:
			*[[Gynecomastoid hyperplasia]].

			<gallery>
			Image:Breast DCIS MicropapillaryType MP CTR.jpg\|Breast - Ductal carcinoma in situ - micropapillary variant - Medium power - (SKB)
			Image:Breast DCIS Micropapillary SNP.jpg\|Breast - Ductal carcinoma in situ - micropapillary variant - High power - (SKB)
			Image:Breast DCIS Apocrine PA.JPG\|Breast - Ductal carcinoma in situ - Micropapillary type with apocrine features - High power - (SKB)
			</gallery>

			===Grading DCIS===
			Graded 1-3 (low-high)<ref>URL: [http://surgpathcriteria.stanford.edu/breast/dcis/ http://surgpathcriteria.stanford.edu/breast/dcis/]. Accessed on: 4 August 2011.</ref> - compare lesional nuclei to one another.
			*Grade 1:
			**Nuclei 2-3x size of [[RBC]].
			**No necrosis.
			*Grade 2:
			**Nuclei 2-3x size of RBC.
			**+/-[[Necrosis]].
			*Grade 3:
			**Nuclei >3x size of RBC.
			**Necrosis usually present.

			Notes:
			*It is often hard to find RBCs when you want 'em. DCIS is pleomorphic.
			*If no RBCs are present to compare with compare the nuclei to one another.
			*If you see nuclei >3x larger than their neigbour you're ready to call DCIS Grade 3.

			===Size criteria for low-grade DCIS===
			ADH is diagnosed if the lesion is small - specifically:<ref name=Ref_BP168>{{Ref BP\|168}}</ref><ref>{{Ref DCHH\|258}}</ref>
			# < Two membrane-bound spaces.
			# < 2 mm extent. ‡

			The treatment is similar; ADH and DCIS are both excised.

			The differences are:
			*DCIS is cancer, i.e. this has life insurance implications.
			*Radiation treatment - DCIS is irradiated; ADH does ''not'' get radiation.

			Notes:
			* ‡ 3 mm is used in papillary lesions.{{fact}}

			===Micrometastasis in DCIS===
			Micrometastasis in DCIS - not significant.<ref name=pmid14601079>{{Cite journal \| last1 = Lara \| first1 = JF. \| last2 = Young \| first2 = SM. \| last3 = Velilla \| first3 = RE. \| last4 = Santoro \| first4 = EJ. \| last5 = Templeton \| first5 = SF. \| title = The relevance of occult axillary micrometastasis in ductal carcinoma in situ: a clinicopathologic study with long-term follow-up. \| journal = Cancer \| volume = 98 \| issue = 10 \| pages = 2105-13 \| month = Nov \| year = 2003 \| doi = 10.1002/cncr.11761 \| PMID = 14601079 }}</ref><ref name=pmid16569492>{{Cite journal \| last1 = Broekhuizen \| first1 = LN. \| last2 = Wijsman \| first2 = JH. \| last3 = Peterse \| first3 = JL. \| last4 = Rutgers \| first4 = EJ. \| title = The incidence and significance of micrometastases in lymph nodes of patients with ductal carcinoma in situ and T1a carcinoma of the breast. \| journal = Eur J Surg Oncol \| volume = 32 \| issue = 5 \| pages = 502-6 \| month = Jun \| year = 2006 \| doi = 10.1016/j.ejso.2006.02.006 \| PMID = 16569492 }}</ref>

			==See also==
			*[[Non-invasive breast carcinoma]].

			==References==
			{{Reflist\|1}}

	[[Category:Diagnosis]]		[[Category:Diagnosis]]
			[[Category:Breast pathology]]

Michael: +cat.

2011-12-10T06:27:02Z

+cat.

← Older revision		Revision as of 06:27, 10 December 2011
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	#redirect [[Non-invasive_breast_carcinoma#Ductal_carcinoma_in_situ]]		#redirect [[Non-invasive_breast_carcinoma#Ductal_carcinoma_in_situ]]

			[[Category:Diagnosis]]

Michael: redirect

2011-08-16T03:21:09Z

redirect

New page

#redirect [[Non-invasive_breast_carcinoma#Ductal_carcinoma_in_situ]]

← Older revision		Revision as of 21:40, 12 May 2016
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	==See also==		==See also==
	*[[Non-invasive breast carcinoma]].		*[[Non-invasive breast carcinoma]].
	*[[~~Extensive~~ intraductal ~~carcinoma~~]].		*[[Breast carcinoma with an extensive intraductal component]].

	==References==		==References==

← Older revision		Revision as of 21:38, 12 May 2016
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	==See also==		==See also==
	*[[Non-invasive breast carcinoma]].		*[[Non-invasive breast carcinoma]].
			*[[Extensive intraductal carcinoma]].

	==References==		==References==

Ductal carcinoma in situ - Revision history

Michael: /* See also */

Michael: /* See also */

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