CARCINOMA IN SITU BREAST
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The condition refers to a neoplastic proliferation that is limited to ducts and lobules by the basement membrane
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There are two main types of carcinoma insitu. They are
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Ductal carcinoma insitu
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Lobular carcinoma insitu
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Ductal carcinoma in situ (DCIS, Intraductal carcinoma)
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Malignant clonal proliferation of cells are confined to ducts by the basement membrane
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Myoepithelial cells are preserved but decreased in number
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Five architectural subtypes of DCIS are described:
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Comedocarcinoma – Solid sheets of pleomorphic cells with “high grade” hyperchromatic nuclei and areas of central necrosis
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Solid DCIS – Duct is completely filled with tumor cells
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Papillary DCIS – Finger like projections with fibrovascular core lined by tumor cells
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Micropapillary DCIS – Cells arranged as papillary protrusion without Fibrovascular core
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Cribriform DCIS- Tumor cells arranged with gaps in between them resembling holes in swiss cheese pattern
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Paget disease of nipple is often described to be associated with DCIS. Pagets cells spread from DCIS to the surface along the epithelium without causing disruption
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DCIS with microinvasion– Areas of invasion through the basement membrane into stroma measuring <0.1cm
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Lobular carcinoma in situ (LCIS)
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More common in young women, often bilateral
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The cells of LCIS and invasive lobular carcinoma have similar appearance.
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Tumor cells lack E-cadherin which is cell adhesion protein.
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Cell morphology- Dyscohesive cells with oval or round nuclei and small nucleoli or signet ring cell morphology with intracytoplasmic mucin
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Treatment and prognosis of carcinoma in situ:
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Mastectomy is curative in majority of patients
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The major risk factors for recurrence are
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Grade
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Size
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Margins
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Post operative radiation therapy and Tamoxifen reduce the risk of recurrence
References :
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Robbins and Cotrans: Pathologic basis of diseases.8th edition