Difference between revisions of "Non-invasive breast carcinoma"

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Non-invasive breast carcinoma (view source)

Revision as of 00:16, 29 November 2010

275 bytes removed ,  00:16, 29 November 2010
re-arr. rm text duplicated in tabular form
(→‎Ductal neoplasia: change hierarchy)
(re-arr. rm text duplicated in tabular form)
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=Ductal neoplasia=
=Ductal neoplasia=
==Overview==
This category includes:
This category includes:
#Atypical ductal hyperplasia (ADH).
#Atypical ductal hyperplasia (ADH).
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#The degree of '''nuclear atypia'''; high grade is DCIS.
#The degree of '''nuclear atypia'''; high grade is DCIS.
#The '''extent'''; small lesions are ADH, large lesions (low-grade) DCIS.
#The '''extent'''; small lesions are ADH, large lesions (low-grade) DCIS.
==Is it ductal neoplasia?==
===FEHUT versus ADH versus DCIS===
*Breast duct lumen with too many cells; this is common problem is breast pathology.<ref name=Ref_BP167-8>{{Ref BP|167-8}}</ref> 
**The general DDx for this scenario is: ''EHUT'' versus ''ADH'' versus ''DCIS''.
Notes:
*EHUT = epithelial hyperplasia of the usual type, [[AKA]] ''florid epithelial hyperplasia of the usual type'' (FEHUT).
*ADH = atypical ductal hyperplasia.
*DCIS = ductal carcinoma in situ.
====Tabular comparison====
Comparison of EHUT, ADH and DCIS (memory device: ''CLEAN'' = cell uniformity, luminal spaces, extent/size, arch., nuclei):
{| class="wikitable"
| || '''EHUT''' || '''ADH''' || '''DCIS'''
|-
| '''Cellular composition''' || varied || focal uniformity || uniform
|-
| '''Lumina''' || slits/irregular spaces; <br>cells haphazardly <br>arranged around lumen || irregular spaces, no slits || circular "punched-out"; <br>cells size-by-size + <br>equally spaced @ interface
|-
| '''Extent''' || usually lobulocentric || limited extent || extensive
|-
| '''Architecture''' || irregular/swirling || DCIS-like || DCIS architecture (solid, <br>cribriform, papillary, micropapillary)
|-
| '''Nuclei (intranuclear<br>spacing)''' || variable || hyperchromatic<br>& uniform || evenly spaced
|-
|}
Treatment - implications:
*EHUT - nothing; EHUT is benign.
*ADH - simple excision, i.e. lumpectomy.
*DCIS - excision (lumpectomy) + radiation.
*Invasive ductal carcinoma - excision with sentinel lymph node disection<ref>Sentinel Lymph Node Biopsy: What Breast Cancer Patients Need to Know. cancernews.com. URL: [http://www.cancernews.com/data/Article/202.asp http://www.cancernews.com/data/Article/202.asp]. Accessed on: 9 October 2009.</ref> and radiation.


==Ductal carcinoma in situ==
==Ductal carcinoma in situ==
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*If no RBCs are present to compare with compare the nuclei to one another.  
*If no RBCs are present to compare with compare the nuclei to one another.  
*If you see nuclei >3x larger than their neigbour you're ready to call DCIS Grade 3.
*If you see nuclei >3x larger than their neigbour you're ready to call DCIS Grade 3.
==FEHUT vs ADH vs DCIS==
*Breast duct lumen with too many cells.
*This is common problem is breast pathology.<ref name=Ref_BP167-8>{{Ref BP|167-8}}</ref>
Definitions:
*EHUT = epithelial hyperplasia of the usual type, aka ''florid epithelial hyperplasia of the usual type'' (FEHUT).
*ADH = atypical ductal hyperplasia.
*DCIS = ductal carcinoma in situ.
*Mnemonic ''CLEAN'' = cell uniformity, luminal spaces, extent/size, arch., nuclei.
**Cellular composition:
***EHUT = varied.
***ADH = focal uniformity.
***DCIS = uniform.
**Lumina:
***EHUT = slits/irregular spaces.
***ADH = irregular spaces, no slits.
***DCIS = circular "punched-out".
**Extent:
***EHUT = usually lobulocentric.
***ADH = limited extent.
***DCIS = extensive.
**Architecture:
***EHUT = irregular/swirling.
***ADH = DCIS-like.
***DCIS = DCIS architecture (solid, cribriform, comedo, papillary, micropapillary).
**Nuclei:
***EHUT = variable.
***ADH = hyperchromatic + uniform.
***DCIS = evenly spaced.
===Tabular comparison===
Comparison of EHUT, ADH and DCIS:
{| class="wikitable"
| || '''EHUT''' || '''ADH''' || '''DCIS'''
|-
| '''Cellular composition''' || varied || focal uniformity || uniform
|-
| '''Lumina''' || slits/irregular spaces || irregular spaces, no slits || circular "punched-out"
|-
| '''Extent''' || usually lobulocentric || limited extent || extensive
|-
| '''Architecture''' || irregular/swirling || DCIS-like || DCIS architecture (solid, <br>cribriform, papillary, micropapillary)
|-
| '''Nuclei''' || variable || hyperchromatic<br>& uniform || evenly spaced
|-
|}
Treatment - implications:
*EHUT - nothing; EHUT is benign.
*ADH - simple excision, i.e. lumpectomy.
*DCIS - excision (lumpectomy) + radiation.
*Invasive ductal carcinoma - excision with sentinel lymph node disection<ref>Sentinel Lymph Node Biopsy: What Breast Cancer Patients Need to Know. cancernews.com. URL: [http://www.cancernews.com/data/Article/202.asp http://www.cancernews.com/data/Article/202.asp]. Accessed on: 9 October 2009.</ref> and radiation.


=Lobular neoplasia=
=Lobular neoplasia=
Michael
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