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Difference between revisions of "Non-invasive breast carcinoma"
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Non-invasive breast carcinoma (view source)
Revision as of 16:25, 4 August 2011
, 16:25, 4 August 2011→Microscopic
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Cells cohesive. | *Cells cohesive. | ||
**No spaces in between. | **No spaces in between. | ||
* | *Cells spaced equally - "cookie cutter" look. | ||
*Cells line-up along lumen/glandular spaces - form "Roman briges". | |||
*Nuclear changes: | |||
**Nuclear enlargement - at least 2-3x size of RBC - '''key feature'''. | |||
* | ***Compared to RBCs to grade DCIS - see ''[[Grading DCIS]]''. | ||
** | ****Compare sizes of nuclei if you cannot find RBCs. | ||
**Nuclear pleomorphism - important feature. | |||
*+/-Mitoses. | |||
Note: | |||
* | *Apocrine changes of cytoplasm -- nuclei should be ~4x RBC for low grade, 5x RBC for high grade.<ref>URL: [http://surgpathcriteria.stanford.edu/breast/dcis/apocrinedcis.html http://surgpathcriteria.stanford.edu/breast/dcis/apocrinedcis.html]. Accessed on: 4 August 2011.</ref> | ||
====Grading DCIS==== | ====Grading DCIS==== | ||
Graded 1-3 (low-high)<ref>[http://surgpathcriteria.stanford.edu/breast/dcis/ http://surgpathcriteria.stanford.edu/breast/dcis/]</ref> - compare lesional nuclei to one another. | Graded 1-3 (low-high)<ref>URL: [http://surgpathcriteria.stanford.edu/breast/dcis/ http://surgpathcriteria.stanford.edu/breast/dcis/]</ref> - compare lesional nuclei to one another. | ||
*Grade 1 | *Grade 1: | ||
**Nuclei 2-3x size of RBC. | **Nuclei 2-3x size of RBC. | ||
**NO necrosis. | **NO necrosis. | ||
*Grade 2 | *Grade 2: | ||
**Nuclei 2-3x size of RBC. | **Nuclei 2-3x size of RBC. | ||
**+/-Necrosis. | **+/-Necrosis. | ||
*Grade 3 | *Grade 3: | ||
**Nuclei >3x size of RBC. | **Nuclei >3x size of RBC. | ||
**Necrosis usually present. | **Necrosis usually present. | ||
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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. | ||
====Size criteria for low-grade DCIS==== | |||
DCIS must meet the following size criteria:<ref name=Ref_BP168>{{Ref BP|168}}</ref> | |||
*Two membrane-bound spaces - ''OR'' - 2 mm. | |||
**If it isn't (low-grade) DCIS... it's atypical ductal hyperplasia (ADH). | |||
The treatment is similar; ADH and DCIS are both excised. | |||
The differences are: | |||
*DCIS is cancer, i.e. this has life insurance implications. | |||
*Radiation treatment - DCIS is irradiated; ADH does ''not'' get radiation. | |||
=Lobular neoplasia= | =Lobular neoplasia= | ||