Breast Cancer - Moose and Doc

A breast cancer explanations website

 

By Dr. Halls

Cellular Characteristics and risk evaluations for Infiltrating Ductal Carcinoma

The goal of cancer screening is to spot any atypical cellular formation in the breast, as early as possible. Microcalcification is one indicator, but new cell growth or ‘hyperplasia‘ is another, more alarming finding. A pathologist will also be looking for any abnormal nuclei within the proliferating cells, and for any compromise in the stroma of surrounding tissues. In terms of seriousness and initial ‘staging‘ for breast cancer histological findings can be graded on an informal continuum from ductal hyperplasia without atypia, atypical ductal hyperplasia, ductal carcinoma in situ, and finally to infiltrating ductal carcinoma.

I just want to let you know that I have created a newer version of this page with more up-to-date information on Ductal Carcinoma In Situ. However, this page still has great, useful information!

Also there is this page with overview of atypical ductal hyperplasia, which is good too.

Image of ductal hyperplasia without atypia

The image below shows a lesion with layers of cells proliferating toward the lumen, which would be interpreted as ‘ductal hyperplasia without atypia‘. With normal ducts, there are only two to three layers of cells lining the duct wall, and all with regular nuclei. Also, in this image the basement membrane and myoepithelial layer are both normal. However the layers of purple colored cells, which represents the duct wall, are too thick because there are too many of them, which is abnormal. Ductal hyperplasia without atypia is essentially a benign intraductal epithelial proliferation which is often associated with apocrine cystic change.

ductal-hyperplasia-no-atypia

Atypical Hyperplasia

Normally there are only 2 to 3 layers of cells in the duct wall, but in the image below we see several areas with thick layers of cells. Additionally, many of the proliferating cells demonstrate atypical nuclei. There are also microcalcifications on the surface of the lesion. The most likely diagnosis would be ‘atypical hyperplasia‘. An Atypical ductal hyperplasia breast lesions has architectural and cytologic features which are basically the same as low-grade DCIS or ductal carcinoma in situ, but these features are admixed with usual ductal hyperplasia, or show only a partial involvement of the Terminal duct lobular units.

atypical-hyperplasia

Image of ductal carcinoma in situ

When the carcinoma begins to attack the outer lining of the lumen, the situation becomes more serious. The image below shows malignant cells proliferating throughout the lumen and beginning to obliterate the outer lining. Microcalcifications are clearly present on the surface. A likely diagnosis for this image is ‘ductal carcinoma in situ‘.

ductal-hyperplasia-in-situ

Infiltrating Ductal Carcinoma

When the carcinoma has penetrated beyond the duct walls into the surrounding breast tissue it is termed infiltrating ductal carcinoma. On the image below we note many ‘cribiform‘ like cancer cells within the duct wall, but also many tubule-shaped cancer cells spreading throughout the surrounding breast tissue. ‘Cribriform‘ means, “like fabric piling up“. So the somewhat organized, ‘ripples‘ in the image below are described as a cribriform pattern.

infiltrating-ductal-carcinoma

Histological risk evaluation also takes into account the size, shape, and position malignant cells relative to the surrounding cell tissues.

For further reading, I suggest you visit a few pages; Visit this page on DCIS, this page on a risk of recurrence of DCIS following surgical removal, go to this page to know about detecting DCIS and the importance of finding malignant microcalcifications, this page for the type and grade of DCIS, as well as this page on infiltrating ductal carcinoma.

References

  1. Tavassoli F.A, Pathology of the Breast, p 254-397, 1999.
  2. Boughey JC, Hartmann LC, Anderson SS, Degnim AC, Vierkant RA, Reynolds CA, Frost MH, Pankratz VS. Evaluation of the Tyrer-Cuzick (International Breast Cancer Intervention Study) model for breast cancer risk prediction in women with atypical hyperplasia. J Clin Oncol. (Aug. 2010) 2010 28(22):3591-6.
  3. Agoff SN, Lawton TJ. Papillary lesions of the breast with and without atypical ductal hyperplasia: can we accurately predict benign behavior from core needle biopsy? Am J Clin Pathol. (Spet. 2004) 122(3):440-3.
  4. Meyer JE, Christian RL, Lester SC, et al. Evaluation of nonpalpable solid breast masses with stereotaxic large-needle core biopsy using a dedicated unit. AJR Am J Roentgenol. (1996);167:179-182.
  5. Darling MLR, Smith DN, Lester SC, et al. Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol. (2000);175:1341-1346.
  6. Moulis, S., Sgroi, DC., Re-evaluating early breast neoplasia. Breast Cancer Research (2008), 10:302
  7. Bijker N, Peterse JL, Duchateau L, Robanus-Maandag EC, Bosch CA, Duval C, Pilotti S, van de Vijver MJ.Histological type and marker expression of the primary tumour compared with its local recurrence after breast-conserving therapy for ductal carcinoma in situ. Br J Cancer. (Feb.2001) 84(4):539-44.
  8. Lampejo OT, Barnes DM, Smith P, Millis RR. Evaluation of infiltrating ductal carcinomas with a DCIS component: correlation of the histologic type of the in situ component with grade of the infiltrating component. Semin Diagn Pathol. (Aug. 1994) Aug;11(3):215–222.
  9. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. (Nov. 1991) 19(5):403–410.
  10. Leong AS, Sormunen RT, Vinyuvat S, Hamdani RW, Suthipintawong C. Biologic markers in ductal carcinoma in situ and concurrent infiltrating carcinoma. A comparison of eight contemporary grading systems. Am J Clin Pathol. (May 2001) 115(5):709-18.
  11. Menes TS, Kerlikowske K, Jaffer S, Seger D, Miglioretti DL.Rates of atypical ductal hyperplasia have declined with less use of postmenopausal hormone treatment: findings from the Breast Cancer Surveillance Consortium. Cancer Epidemiol Biomarkers Prev. (Nov. 2009) 18(11):2822-8.
  12. Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia. Hum Pathol. (1992) ;23:1095–1097.
  13. Purcell CA, Norris HJ. Intraductal proliferations of the breast: a review of histologic criteria for atypical intraductal hyperplasia and ductal carcinoma in situ, including apocrine and papillary lesions. Ann Diagn Pathol. (1998);2:135–145.

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About Steven Halls

Dr Halls has 25 years experience as a radiologist. He worked for 13 years at Cross Cancer Institute in Edmonton, a world-class cancer treatment facility. He has had high-volume experience with cancer, interventional procedures, clinical trials and his own phase 1 and 2 research in MRI and breast cancer staging.