DUCTAL versus LOBULAR CARCINOMA of the BREAST (DCIS v. LCIS) CARCINOMA in SITU of the BREAST with Indeterminate Features (CIS-IF)

Konference: 2006 11. ročník odborného sympózia na téma Onkologie v gynekologii a mammologii

Kategorie: Zhoubné nádory prsu

Téma: Kontraverze v diagnostice a léčbě časného karcinomu prsu, standardní postupy vs. nestandardní. I.Blok: Diagnostika

Číslo abstraktu: 008

Autoři: Ladislav A. Sokol

most CIS easily categorized DCIS or LCIS
in some CIS the cytologic and/or architectural features deviate
extremely difficult if not impossible
to determinate
thenature and/orcategory of CIS

how best to classify indeterminate CIS ?
combined or mixed ductal and lobular category ?
categorization as ductal type ?
categorization as lobular type ?

The distinction LCIS v. DCIS I M P O R T A N T (!)
careful observation
addition of tamoxifen
clinically margins status not important

The distinction LCIS v. DCIS I M P O R T A N T (!) therapeutic implications
wide local
excision excision and radiation therapy
clinically margins status important

LCIS classified not in DCIS
lobules distended, solidified
uniform, dyshesive, small cells
small, uniform round-to oval nuclei
+ homogenous chrom.,+/- nucleoli
nn. eccentric, cyto. pale lightly eos.
cyto. vacuoles-signet ring cell „A“
cyto. more, nn. variation, + nucleoli „B“

DCIS classified not in LCIS
nuclear grade (low, intermediate, high)
architecture predominant
comedo, cribriform, papillary
micropapillary, solid, spindle, streaming...
presence /type of necrosis

E-cadherin (E-c) transmembranous glycoprotein participates in molecule of calcium dependent intercellular adhesion
E-c function in mantaining/ in consonance with epithelial integrity/cell adhesion

Abnormal E-c function attributable to a mutation of the E-c gene (predominantly in the part that encodes the extracellular domain) facilitates abnormal loss of E-c expression signalizes detachment process leading to metastasis

E-c tumor/invasion suppressor gene is to be mutated in human lobular carcinoma with corresponding l o s s of E-c expression

E-c tumor/invasion suppressor gene is not to be mutated in human ductal carcinoma with corresponding p r e s e r v a t i o n of E-c expression

E-c gene is to be mutated in LCIS
E-c gene is not to be mutated in DCIS

L o s s of E-c expression reflects an abnormal E-c function demonstrates germline mutation in the gene encoding E-c in a patient with lobular carcinoma corresponding with l o s s of E-c expression

consistently E-c negative
false positivity
usually in an abnormal
cytoplasmic staining o n l y

DCIS/DIC consistently E-c positive
cell membrane staining
including Paget disease
(intensity „sometimes“ varying
with high grade DCIS)

CIS-IF with histogically ambiguous/indeterminate features varies
E-c negative akin to LC
E-c negative akin to DC
E-c mixture of positive/negative neoplastic cells
truly MIXED lesions should be considered
combined/MIXED LC andDC

expression in cases of solid mammary CIS-IF valuable adjunct in defining
n a t u r e and c a t e g o r i z a t i o n of CIS/IC

This publication has depended on the inevitable technical and designing assistance of both departments.
Autor is greatly indebted and especially grateful to Dr. Jozef Bodnar, NZZ Košice – Sever.

Datum přednesení příspěvku: 6. 1. 2006