Comedo carcinoma of the breast

Comedo carcinoma of the breast is actually a type of ductal carcinoma in situ. It is considered to be an early stage of breast cancer, and it is characterized by the presence of central necrosis, or evidence of cell death and decay. A diagnosis of this particular kind of breast cancer is somewhat fortuitous as it is confined to the breast ducts and usually does not spread beyond. However, in terms of the various kinds of DCIS, comedo carcinoma is considered to be of a higher grade and a little more aggressive than the others, and may be treated a little more aggressively.

This page is still has some very helpful information, but check out our new and improved up-to-date page on Comedo Carcinoma.

Ductal carcinoma in situ may be classified by many ‘subtypes’

Breast DCIS is really not considered a single disease, but rather a ‘heterogenous‘ collection of diseases. The different types and grades of ductal carcinoma in situ have different tendencies regarding their potential to become invasive breast cancer. There are various factors that influence the type of grade associated with DCIS, but generally speaking it is determined by the nuclear grade of the tumor cells and the presence or absence of intraductal comedo-type necrosis.

Comedo DCIS usually shows small groups of ‘dead cells’

What typically happens in a breast comedo carcinoma is that some of the cells die off and form small groups. (These small groups of dead cells are termed ‘comedo necrosis‘). It is a fast growing type of breast cancer with some risk of future invasive cancer status, but most of the time comedo breast carcinoma is considered to be ‘intraductal‘, meaning, that it will be confined to the breast ducts. DCIS-comedo is generally diagnosed when at least one duct in the breast is filled and expanded by large, markedly atypical cells, and which also has abundant central luminal necrosis.

Necrosis and calcification are common

When a sample of the comedo carcinoma lesion is removed for biopsy study, one will find it has a characteristic necrotic tissue with calcification, that almost feels ‘cord-like‘. If the breast duct is physically ‘squeezed‘, a material will be expressed which might be described as ‘cheesy-like‘, almost like toothpaste. That ‘paste‘ is caused by the degeneration of the central cells of the early-stage tumor, and it is quite easily expressed from the rest of the tumor.

What is the difference between normal DCIS and comedo DCIS?

There are some biological differences between conventional DCIS and comedo breast carcinoma in situ. For one thing, comedo carcinomas have a different expression pattern of tenascin, which is a large extra cellular matrix protein. Cytologically, comedo breast carcinoma in situ will typically have an altered basal lamina, and also a looser and more disorganized collagenous matrix. In general, one finds an increase in stromal cellularity in breast comedo carcinomas, including the presence of fibroblasts, lymphocytes, histiocytes and small blood vessels. The lateral intercellular spaces between large myoepithelial cells that border the basal lamina are often expanded in comedo breast carcinoma in situ, when compared to those of non-comedo DCIS. Some of these features may play a role in a perceived ‘greater infiltrative potential‘ for comedo DCIS when compared to non-comedo DCIS.

 
 

Additional histological characteristics of breast comedo carcinoma

There is some histological evidence to support the observation that breast comedo carcinomas in situ are usually estrogen receptor negative. As a result, there would generally be little benefit to treated comedo breast carcinoma with anti-estrogen chemotherapy (such as tamoxifen). Chemical therapy for DCIS is a controversial area anyways, but is almost certainly not advised for breast comedo DCIS. Comedo breast carcinoma in situ is also frequently associated with a higher HER2/neu (c-erbB2) gene amplification or protein over expression, and a higher proliferation rate. Researchers suggest that ‘apoptosis‘, which means ‘programmed cell death‘ is one reason for the clinically more aggressive behavior of comedo breast carcinoma in situ. It is suggested that the genetic control mechanisms which regulate proliferation and apoptosis have somehow been compromised in comedo DCIS.

Treatment and prognosis for breast comedo carcinoma DCIS

If comedo carcinoma is found in an in situ status in the breast ducts, it has been suggested that following surgical removal, the risk of local recurrence is slightly higher than for non-comedo DCIS. (Inability to obtain a ‘wide‘ surgical margin would be another increased rick factor for local recurrence.) This is one of the reasons that treated of comedo breast carcinoma often involves radiotherapy in addition to lumpectomy, whereas for most DCIS radiation therapy is not used. The risk for in-breast recurrence of comedo breast carcinoma in situ at 5 years after lumpectomy and radiotherapy is approximately 8%.

Comedo DCIS requires more aggressive treatment, but the outlook is just as positive

Ductal carcinoma in situ (DCIS) of the breast is generally believed to represent about 20%-30% of all breast cancers detected by clinical screening and mammography, and comedo breast carcinoma in situ would be a smaller subset of this group. But it has to be remembered that DCIS of all types have a cure rate of near 100%. Comedo carcinoma might make treatment a little more aggressive, but overall the outlook is almost always highly positive. Remember that the overall mortality from DCIS of any kind is extremely low, at around 2%.

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Everything you need to know about Comedo Carcinoma is all listed above. But here are just a couple other Q&A’s for you…

• What is NON-comedo ductal carcinoma in situ? This is a subgroup of DCIS. This group comprises of relatively less aggressive types with low nuclear grade. It also can have multiple patterns which often co-exist, these types include: cribriform, micropapillary, papillary, and solid.
• What are the treatment options? Breast-conserving surgery and radiation therapy with or without tamoxifen, total mastectomy with or without tamoxifen, or breast-conserving surgery without radiation therapy.

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References

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