Invasive ductal carcinoma of the breast

From Libre Pathology
Jump to: navigation, search
Invasive ductal carcinoma of the breast
Diagnosis in short

Invasive ductal carcinoma. H&E stain.
LM DDx DCIS, invasive lobular carcinoma
EM usu. ER and PR +ve, usu. HER2 -ve, mammoglobin +ve, CK7 +ve, CK20 -ve
Grossing notes breast grossing
Staging breast cancer staging
Site breast

Signs +/-palpable breast mass
Prevalence common
Prognosis dependent on stage and grade, good to poor
Clin. DDx other breast tumours

Invasive ductal carcinoma of the breast, also breast invasive ductal carcinoma, is the most common form of invasive breast cancer. It arises from ductal carcinoma in situ.

It is also known as NST (No Specific Type). Generically, it may be referred to as invasive mammary carcinoma.

In the context of the breast, the meaning of invasive ductal carcinoma is clear; if the context is not the breast, it may refer to other (unrelated) cancers.

General

Gross

  • White, firm stellate lesion.

Microscopic

Features:

  • Atypical cells:
    • Usually >2x RBC diameter.
    • Nucleoli common.
    • Forming ducts or sheets.
    • +/-Mitoses.
    • +/-Necrosis.
  • Evidence of invasion:
    • Atypical nucleus adjacent to adipocyte - diagnostic.
    • "Infiltrative" pattern:
      • Small glands of variable size within desmoplastic stroma.
      • Glands lined by a single layer of cells.

DDx:

IHC

Myoepithelial markers - diagnostic for invasion:

  • SMMS -ve.
  • p63 -ve.

Prognostic markers - may be useful for metastates:

  • ER +ve (diffuse).
  • PR +ve (diffuse).
  • HER2 -ve.

Invasive lobular carcinoma versus invasive ductal carcinoma:[1]

  • E-cadherin -ve (includes incomplete membrane staining).

Images

See also

References

  1. de Deus Moura, R.; Wludarski, SC.; Carvalho, FM.; Bacchi, CE. (Jan 2013). "Immunohistochemistry applied to the differential diagnosis between ductal and lobular carcinoma of the breast.". Appl Immunohistochem Mol Morphol 21 (1): 1-12. doi:10.1097/PAI.0b013e318255bafa. PMID 22595945.