Pathology of Ductal Carcinoma In Situ (DCIS)

  • DCIS is a proliferation of malignant cells that have not breached the ductal basement membrane:
    • They arise from ductal epithelium:
      • In the region of the terminal ductal–lobular unit (TDLU)
  • DCIS had previously been considered one stage in the continuum of histologic progression from ADH to invasive carcinoma:
    • But, in fact, DCIS comprises a heterogeneous group of lesions:
      • With variable histologic architecture, molecular and cellular characteristics, and clinical behavior
  • Malignant cells proliferate:
    • Until the ductal lumen is obliterated
    • There may be associated breakdown of the myoepithelial cell layer of the basement membrane surrounding the ductal lumen
  • DCIS has also been linked with changes in the surrounding stroma resulting in:
    • Fibroblast proliferation
    • Lymphocyte infiltration
    • Angiogenesis
  • Thus, although the process is poorly understood:
    • Most but not all invasive ductal carcinomas are believed to arise from DCIS:
      • Which is considered a nonobligate precursor of invasive breast carcinoma
Architectural heterogeneity is a common feature of DCIS. Even in the same lesion, DCIS may show different growth patterns. Image is showing a cribriform DICS
Micropapillary DCIS
Papillary DCIS
Solid DCIS

#Arrangoiz #CancerSurgeon #BreastSurgeon #SurgicalOncologist #BreastCancer #LCIS #DCIS #DuctalCarcinomaInsitu #LobularNeoplasia #LobularCarcinomaInsitu #Surgeon #Teacher #Miami #Mexico #MSMC #MountSinaiMedicalCenter

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