scholarly journals Estrogen Receptor and Cytokeratin 5 Are Reliable Markers to Separate Usual Ductal Hyperplasia From Atypical Ductal Hyperplasia and Low-Grade Ductal Carcinoma In Situ

2016 ◽  
Vol 140 (7) ◽  
pp. 686-689 ◽  
Author(s):  
Anthony P. Martinez ◽  
Cynthia Cohen ◽  
Krisztina Z. Hanley ◽  
Xiaoxian (Bill) Li
Keyword(s):  
Estrogen Receptor ◽  
Progesterone Receptor ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Low Grade ◽  
Usual Ductal Hyperplasia ◽  
Ductal Hyperplasia ◽  
Cytokeratin 5

Context.—High–molecular weight cytokeratins, such as cytokeratin 5 (CK5), are helpful to distinguish usual ductal hyperplasia (UDH) from atypical ductal hyperplasia (ADH) or low-grade ductal carcinoma in situ (DCIS). Few studies have looked at combining CK5 with estrogen receptor (ER) to differentiate UDH from ADH. Objective.—To evaluate the expression pattern of CK5 and ER as single or combined markers to separate UDH from ADH and low-grade DCIS. Design.—A total of 23 ADH, 10 low-grade DCIS, and 32 UDH whole-tissue slides were stained for ER, CK5, progesterone receptor (PR), and Bcl-2. Nuclear staining of ER and PR was scored as diffuse (>80%), focal (10%–80%), or negative (<10%). Cytoplasmic staining of CK5 and Bcl-2 was scored as diffuse (>60%), focal (10%–60%), or negative (<10%). Differences in staining patterns were evaluated. Results.—For ER staining: 94% of ADH/DCIS cases showed a diffuse staining pattern, whereas none of the 32 UDH cases showed diffuse staining. For CK5 staining: 96% of ADH/DCIS cases were negative or focally positive, whereas all 32 UDH cases had diffuse staining. The combination of ER and CK5 increased the sensitivity (94% to 97%). For PR staining: 11 of 23 ADH cases (48%), 6 of 10 DCIS cases (60%), and 4 of 32 UDH cases (13%) showed diffuse staining. Bcl-2 staining showed no statistical significance (P = .73). Conclusions.—Although morphology remains the gold standard, ER and CK5 are useful makers to differentiate UDH from ADH. Progesterone receptor staining may have limited value, and Bcl-2 staining is not useful.

Acidophilic Nuclear Inclusions Are Specific for Florid Ductal Hyperplasia Among Proliferative Breast Lesions

2011 ◽  
Vol 135 (6) ◽  
pp. 766-769
Author(s):  
Scott Lauer ◽  
Gabriela Oprea-Ilies ◽  
Cynthia Cohen ◽  
Volkan Adsay ◽  
Amy L. Adams
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Low Grade ◽  
Intranuclear Inclusions ◽  
Ductal Hyperplasia ◽  
Mammary Hyperplasia ◽  
Insight Into

Abstract Context.—Recently we have observed distinctive acidophilic intranuclear inclusions in cases of usual intraductal hyperplasia of the breast. Similar inclusions were described almost 20 years ago in cases of mammary hyperplasia. These correlated ultrastructurally with so-called helioid inclusions. However, there since has been little discussion of these inclusions in the literature. Objective.—To examine the incidence and specificity of these inclusions in proliferative lesions of the breast. Design.—Forty cases of usual intraductal hyperplasia, 15 cases of atypical ductal hyperplasia, and 34 cases of low-grade ductal carcinoma in situ were examined for the presence of acidophilic intranuclear inclusions. Results.—Acidophilic intranuclear inclusions were present in 50% of cases of usual intraductal hyperplasia (20 of 40) but were not identified in any cases of atypical ductal hyperplasia (0 of 15) or low-grade ductal carcinoma in situ (0 of 34). Conclusions.—Acidophilic intranuclear inclusions appear to be a common, specific feature found in usual intraductal hyperplasia and may be helpful in distinguishing it from atypical ductal hyperplasia and low-grade ductal carcinoma in situ in some cases. Elucidating the nature of these inclusions may provide insight into the pathogenesis of usual intraductal hyperplasia.

Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma on Excision: A Clinicopathologic Study of 143 Cases

2021 ◽  
pp. 106689692110109
Author(s):  
Cunxian Zhang ◽  
Edmond Y. Wang ◽  
Fang Liu ◽  
M. Ruhul Quddus ◽  
C. James Sung
Keyword(s):  
Breast Carcinoma ◽  
Invasive Ductal Carcinoma ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Low Grade ◽  
Type B ◽  
Ductal Hyperplasia

The literature shows a wide range in the frequencies of finding breast carcinoma in the excised specimens following a biopsy diagnosis of atypical ductal hyperplasia (ADH), likely due to a poor diagnostic reproducibility among different pathologists as well as an inherent heterogeneity in ADH. We evaluated whether histologic subtyping of ADH would help predict the risk of breast carcinoma. Our study consisted of 143 cases of ADH diagnosed by core needle biopsy and followed by excision. Of these, 54 cases (37.8%) showed carcinoma in the excised specimens (47 cases of ductal carcinoma in situ alone, 3 cases of invasive ductal carcinoma alone, and 4 cases of mixed invasive ductal carcinoma and ductal carcinoma in situ). We arbitrarily divided ADH into two subtypes: type A was considered when one or more ducts were completely replaced by low-grade ductal carcinoma in situ type cells but the lesion was <2 mm and type B was considered when one or more ducts were partially involved by low-grade ductal carcinoma in situ type cells regardless of lesion size. Type A was associated with a significantly higher frequency of breast carcinoma (63.6%) than type B (30.0%). ADH containing punctate necrosis showed a higher association of carcinoma (66.7%) compared to those without necrosis (35.1%). Within type B ADH, involvement of 3 or more foci had a higher frequency of carcinoma (50.0%) than involvement of fewer foci (26.6%). These histologic features of ADH may prove useful in predicting the likelihood of breast carcinoma and provide helpful information for patient's management.

Reflex Estrogen Receptor (ER) and Progesterone Receptor (PR) Analysis of Ductal Carcinoma In Situ (DCIS) in Breast Needle Core Biopsy Specimens

2016 ◽  
Vol 40 (8) ◽  
pp. 1090-1099 ◽  
Author(s):  
Christopher J. VandenBussche ◽  
Ashley Cimino-Mathews ◽  
Ben Ho Park ◽  
Leisha A. Emens ◽  
Theodore N. Tsangaris ◽  
...  
Keyword(s):  
Estrogen Receptor ◽  
Progesterone Receptor ◽  
Ductal Carcinoma In Situ ◽  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Needle Core Biopsy ◽  
Biopsy Specimens

Minimal (≤0.1 cm) Invasive Carcinoma in Breast Core Needle Biopsies

2004 ◽  
Vol 128 (9) ◽  
pp. 996-999
Author(s):  
Andrew A. Renshaw
Keyword(s):  
Minimally Invasive ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Ductal Carcinomas ◽  
Invasive Carcinomas

Abstract Context.—Although minimally invasive (microinvasive) carcinoma (≤0.1 cm) of the breast is a well-known and well-characterized entity in excision specimens, the significance of small foci of invasion in breast core needle biopsies has not been well described. Objective.—To define the significance of minimally invasive carcinoma in breast core needle biopsies. Design.—Review of a large series of core needle biopsies for invasive carcinomas measuring 0.1 cm or less and correlation of the results with those of subsequent excision. Setting.—Large community hospital. Results.—From approximately 8500 biopsies, a total of 18 cases of minimally invasive carcinoma from 16 women aged 42 to 80 years were identified. All were present on only 1 of 8 slides made from the block. Overall, the incidence was approximately 0.1% of all biopsies and 1% of all invasive carcinomas. Six cases were invasive lobular carcinomas, 1 was tubulolobular carcinoma, 3 were tubular carcinomas, and the remaining 8 were ductal carcinomas. Eight cases were associated with high-grade comedo ductal carcinomas, 2 with low-grade ductal carcinoma in situ, 3 with atypical ductal hyperplasia, 3 with atypical ductal hyperplasia and lobular carcinoma in situ, and 2 with no other lesion. From a total of 8 sections done entirely through the block, the lesion was present on the first level in 4 cases and the fifth level in 5 cases. No cases were identified in the last 3 levels. Subsequent pathology was available for 16 of the 18 cases. Invasive carcinomas measuring more than 1 cm were present in 9 cases (64%; along with 2 positive lymph nodes), invasive carcinomas less than 1 cm in 2 cases (14%), ductal carcinoma alone in 4 cases (29%), and no carcinoma in 1 case (7%). No pathologic or radiologic features were associated with the finding of invasive carcinoma at excision. Conclusion.—Invasive carcinoma measuring 0.1 cm or less is a rare finding in breast core needle biopsies, is commonly associated with in situ carcinomas and atypical hyperplasias, and is often associated with larger invasive foci at excision. However, invasive carcinomas smaller than 0.1 cm can occur without any other significant findings and may require relatively extensive sampling to identify.

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