Group 1A: Example 2.2



10.1055/b-0034-80355

Group 1A: Example 2.2


A 70-year-old asymptomatic woman, screening examination. The faint cluster of crushed stone-like calcifications was not perceived. At her next screening examination 18 months later she was still asymptomatic and was called back for further assessment of the cluster of calcifications.

Ex. 2.2-1 & 2 Detail of the MLO projection in two consecutive screenings with an interval of 18 months. The barely perceptible cluster of discernible, crushed stone-like calcifications (within the circle) has evolved to a mixture of crushed stone-like and casting type calcifications, occupying a much larger volume.
Ex. 2.2-3 & 4 Stereoscopic images of one extremely distended TDLU (22 mm in diameter!). There are a few atrophic TDLUs in the surrounding tissue for comparison of size. The individual cancerous acini measure up to 2-3 mm in diameter, much larger than one entire normal sized TDLU. The central necrotic contents and the intraluminal calcification of some of the acini have fallen out during specimen preparation.
Ex. 2.2-5 & 6 Large-section histological images of the solitary TDLU at two different slice levels. The TDLU is extremely distended by in situ carcinoma, central necrosis, and amorphous calcifications.

Histological diagnosis: 18 mm ⊠ 11 mm ⊠ 8 mm Grade 3 in-situ carcinoma with solid and cribriform cell architecture, containing multiple foci of microinvasion.

Ex. 2.2-7 & 8 Intermediate magnification of the extremely distended acini containing solid cell proliferation, extensive central necrosis, and large intraluminal, amorphous calcifications.
Ex. 2.2-9 & 10 Stereoscopic images of atrophic breast tissue for comparison with the individual acini, which are greatly distended by in situ carcinoma.
Ex. 2.2-11 Medium-power histological image (H & E) of an acinus with solid cell proliferation, central necrosis, and amorphous calcification.
Ex. 2.2-12 & 13 Higher-magnification stereoscopic subgross, thick-section (3D) images of the acini that have been greatly distended by the in situ carcinoma, necrosis, and amorphous calcifications. Some of the acini measure 2-3 mm, which is two to three times larger than an entire normal TDLU.
Ex. 2.2-14 Medium-power histological image (illumination with polarized light) of one acinus distended by solid cell proliferation (1), central necrosis (2), and amorphous calcification (3).
Ex. 2.2-15 & 16 Stereoscopic image pair of the surrounding normal breast tissue with pleated ducts and atrophic TDLUs.

Treatment and follow-up: Sector resection was performed. No postoperative radiotherapy or other adjuvant treatment was given. The patient had no evidence of breast cancer at the most recent follow-up, 12 years after operation.



Comment


The large-section histological image and the subgross 3D images clearly show that the disease was limited to a single, extremely distended TDLU. The malignant cells were confined to I the acini of the lobule and no ductal involvement was found. These observations are at odds with the conventional term “ductal” carcinoma in situ. Sefton R. Wellings and his co-workers pointed out that pathologists, viewing traditional, small histological sections, might have mistaken the extremely distended acini for ducts.1 The fact that the disease is restricted to a single, isolated TDLU should be a justification for less radical treatment, such as surgical excision alone without adjunctive therapy.

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Aug 1, 2020 | Posted by in ONCOLOGY | Comments Off on Group 1A: Example 2.2
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