The pathology report will include several significant terms in determining the possibility of recurrence and progression to invasive cancer, thus providing the basis for the type of treatment that should be used for DCIS and LCIS.
Non-cancerous changes were seen under the microscope that will not influence the prognosis
ductal hyperplasia |
adenosis |
radial scar |
sclerosing lesion |
papillomatosis |
papilloma |
apocrine metaplasia |
cysts |
columnar cell change |
collagenous spherules |
duct ectasia |
fibrocystic changes |
flat epithelial atypia |
columnar alteration (CAPSS) |
|
|
Breast changes that can indicate DCIS can return after treatment are as follows:
Cribriform – rare type – slow proliferation and low grade
Micropapillary – extensive involvement in the ducts – high risk for recurrence (Castellano et al., 2010)
Apocrine – not well defined in DCIS; relatively rare (D'Arcy & Quinn, 2019)
Comedo – aggressive lesions; high-grade DCIS (Pacifici & Rasuli, 2020)
Comedonecrosis – remnants of cells that have died; high-grade subtype of DCIS; most aggressive type
A papillary – fern-like pattern within the duct;
Solid – a solid pattern of cells that have filled the duct; High-grade DCIS
The above is used to describe how the DCIS looks under the microscope and is graded by chances of recurrence:
Additional treatment and more follow-up can be prescribed for patients with higher-grade DCIS.
Estrogen and progesterone receptors
According to the American Cancer Society, normal breast cells and some breast cancer cells have receptors that attach to estrogen and progesterone and need these hormones for the cells to proliferate. https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-hormone-receptor-status.html
Breast cancer cells may have one, both, or none of these receptors.
Keeping the hormones estrogen and progesterone from attaching to the receptors can help keep cancer cells from proliferating and metastizing. Some drugs, such as tamoxifen, can be used to do this.
Some cases of DCIS contain estrogen receptor and progesterone receptor-positive hormone receptors on their surfaces, but some are negative. Tamoxifen is the medication traditionally used to treat these hormone receptors positive DCIS. However, patients with estrogen and progesterone receptor-negative DCIS will not need Tamoxifen or other hormone-blocking drugs. https://breast360.org/topic/2016/09/30/ductal-carcinoma-in-situ-overview/
Types of cells associated with Lobular Carcinoma in situ (LCIS)
Compared with women without LCIS or DCIS, women with LCIS have a 7 to 12 times higher risk of developing invasive cancer in either breast. The history and optimal treatment of PLCIS and FLCIS types are still being investigated. These are generally accepted descriptions of the different kinds of LCIS:
Pleomorphic cells called PLCIS occur in 2.7 to 4.4% of lobular neoplasia. They occur more frequently in the following situations:
Prognostic factors
Florid (FLCIS) is relatively rare. In a study by Bagaria et al. (2011) of 210 women with LCIS, 81% had nonflorid type, with 39% having F-LCIS. The florid LCIS had the following patterns:
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References:
Bagaria SP, Shamonki J, Kinnaird M, Ray PS, Giuliano AE. (2011). The florid subtype of lobular carcinoma in situ: marker or precursor for invasive lobular carcinoma? Ann Surg Oncol. 18(7), 1845-51.
Castellano, I., Marchiò, C., Tomatis, M. et al. (2010). Micropapillary ductal carcinoma in situ of the breast: an inter-institutional study. Mod Pathol 23, 260–269.
D'Arcy, C. & Quinn, C. (2019). Apocrine lesions of the breast: part 1 of a two-part review: benign, atypical and in situ apocrine proliferations of the breast Journal of Clinical Pathology.72, 1-6.
Pacifici, S., Rasuli, B. (2020). Comedo type ductal carcinoma in situ. Reference article,
Radiopaedia.org. (accessed on April 28 2022) https://doi.org/10.53347/rID-15335
Srivastava, S. (2022). LCIS pleomorphic. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/breastmalignantpleolcis.html. Accessed April 28, 2022.