Mammary Intraductal Carcinoma: Issues of Interdisciplinary Concern

Abstract

hile information regarding many aspects of in-W traductal carcinoma (IDCA) continues to be accumulated, there are several issues that particularly require combined attention and effort by clinicians and pathologists for their optimal resolution. The following outline presents the issues of concern, current approaches, and future considerations. 1.The optimal configuration (shape), method of orientation, and processing of the biopsy specimen.Currently, the excised specimen is generally an irregularly shaped mass that is removed in a manner to contain the mammographic lesion (calcification, density, etc.). When sutures are placed by surgeons for orientation, they are placed to identify the superior, inferior, lateral, and medial margins, with rare if any reference to the nipple margin. In processing the specimen, serial sections are made in a majority of cases, but these sections are cut perpendicular to the longitudinal axis of the specimen; therefore, the specimen may be serially sectioned from superior to inferior, lateral to medial, or anterior to the posterior margin.It has been shown that IDCA predominantly originates in the terminal duct-lobular units (1) and migrates or extends toward the nipple generally within a single segment, but it may cross over to other segments through anastomosing ducts (2, 3 ) . Therefore, any attempts at determination of the extent of IDCA and preThe opinions and assertions contained herein are the viewpoints of the author and do not reflect the official views of the Department of the Army or Defense.diction of possible residual disease requires assessment of the route of extension toward the nipple. Optimal resection should consider the segmental nature of the duct system and its branching pattern as it moves away from the nipple; this would result in a conical specimen with the tip of the cone toward the nipple. Attempts should be made to remove any suspicious lesions along their possible route of extension toward the nipple. The resected specimen should have sutures identifying the direction of the nipple, overlying skin, deep and lateral margins. Regardless of their ultimate shape, these samples should be serially sectioned toward the direction of the nipple margin. Since currently a vast majority of specimens are neither optimally excised, nor so oriented or cut, it is difficult to determine the extent of lateral or central (toward the nipple) spread of the lesion. 2.Specification of the morphologic subtype and grade of IDCA.At present, a diagnosis of intraductal carcinoma is generally, but not invariably, followed by a designation of its subtype (comedo, papillary, cribriform, and micropapillary) and far less frequently by a grade assignment (4-12). Though various methods have been proposed (8, lo), there is no standardized approach to grading IDCA. Since a proportion of IDCA do not fit any of the classic subtypes, the grade of the IDCA may be more important as a possible predictor of the aggressive potential of the lesion. The significance of identifying the subtype and gr...

Neoplastic and Malignant Lesions Involving or Arising in a Radial Scar: A Clinicopathologic Analysis of 17 Cases

“…In grade 3 LN, there is either pronounced distention of the acini with almost complete loss of interacinar stroma but without confluence, or there may not be significant distention, but the prolifer-ating cells are of the signet ring cell type or highly atypical and pleomorphic as in the pleomorphic variant of infiltrating lobular carcinoma. The in situ ductal carcinomas were graded using a three-tiered grading system proposed in 1992 (11,12). The criteria formulated by Fisher et al (4) and Linell et al (8) were employed for interpretation of the radial scars; no sclerosing papillary lesions were included in our study.…”

Cytologic features of ductal carcinoma in situ

“…Recently, additional histologic subtypes have been described including a peripheral papillary, apocrine, clear cell, clinging, signet ring, and combined subtypes. 6 There has also been an attempt to grade these lesions into low, moderate, and high grades on the basis of architectural and cytologic criteria with or without necrosis.…”