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I just want to let you know that I have created a newer version of this page with more up-to-date information on Ductal Carcinoma In Situ.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.
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.
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‘.
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.
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.
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