Predominant Intraductal Component Research Articles

Early HER2-positive breast cancer arising from a fibroadenoma: a case report

ABSTRACTBreast cancer arising from fibroadenoma (FA) is rare, in which almost all reported cases are human epidermal growth factor receptor 2 (HER2)-negative. This is the first report to describe a case of HER2-positive breast cancer arising from FA that was treated with chemotherapy plus anti-HER2 therapy. In this early case, upfront surgery outcomes guided the selection of appropriate systemic therapy. A 31-year-old woman previously diagnosed with FA experienced tumor growth. Core needle biopsy and imaging studies confirmed a diagnosis of stage IIA HER2-positive invasive ductal carcinoma (IDC) with no evidence of lymph node metastasis (cT2N0M0). Breast-conserving surgery was performed. Pathological diagnosis revealed stage IA IDC with a predominant intraductal component (pT1aN0M0), arising from FA. In conclusion, we encountered an extremely rare case of HER2-positive breast cancer arising from FA in which pathological infiltration was difficult to predict based on preoperative imaging.

Tumor thickness and histological features as predictors of invasive foci within preoperatively diagnosed ductal carcinoma in situ

Small invasion into ductal carcinoma in situ (DCIS) can easily be overlooked in resected breast specimens. To disclose useful markers predictive of invasive foci within preoperatively diagnosed DCIS lesions, a retrospective histopathological comparison was made between postoperatively diagnosed invasive ductal carcinoma with a predominant intraductal component (IDCPIC) (n=43) and pure DCIS (n=82). Through a multivariate logistic regression analysis model, 5 variables (DCIS grade, "tumor thickness," extent of retraction cleft, presence of lymph node metastasis, and HER2 score) were found to be significantly associated with the presence of invasive foci within DCIS; with a cutoff point of 0.315, sensitivity, specificity, positive predictive value, and negative predictive value were 0.93, 0.77, 0.68, and 0.95, respectively. No statistically significant difference was observed in recurrence-free survival between IDCPIC and pure DCIS, whereas the IDCPIC curve showed a slightly earlier decline than the DCIS one. In general, preoperative detection of lymph node metastasis in DCIS patients is elusive because of the extremely tiny metastatic size in most cases; thus, a 4-variable model, without lymph node metastasis, would be the actual working model. Furthermore, tumor "thickness" was found to be the most significant parameter predictive of invasive foci within DCIS. Although IDCPIC and pure DCIS showed similar recurrence-free survival curves, prediction of invasive foci within DCIS necessitates postoperative pathological analysis of surgically resected lesions.

Invasive ductal breast carcinoma with predominant intraductal component: Clinicopathological features and prognosis

PurposeInvasive ductal carcinoma with predominant intraductal component (IDCPIC) represents almost 5% of breast cancers. Nevertheless few data exist concerning their characteristics and prognostic behaviour. Our objective was to describe IDCPIC's clinicopathological and prognostic features and compare them to that of invasive ductal carcinoma without predominant intraductal component (IDC). MethodsRetrospective single centre study including all the localized invasive ductal carcinoma listed in our institutional database. Clinical, radiological and pathological criteria were collected as well as disease-free survival (DFS) data. ResultsFrom 1995 to 2008, 4109 invasive ductal breast cancers treated were included. Out of them 192 (4.7%) were IDCPIC. Most of IDCPIC (63%) were discovered by radiological screening whereas IDC suspicion was more often clinical (82.7% vs 49.5%, p < 0.001). Pathological lymph node involvement was less frequent in IDCPIC (35.8 vs 44.3%, p = 0.04). Invasive tumour median size was 2-fold smaller in IDCPIC (10 mm vs 20 mm, p<0.001). Hormone receptors expression was similar between both groups whereas HER2 overexpression was more frequent in IDCPIC (32% vs 14.3%, p<0.001). Mastectomy was more frequently performed for IDCPIC (67.7% vs 30.3%, p < 0.001) whereas chemotherapy and radiation therapy were less frequent (55.5% vs 68%, and 82.8% vs 95.5%, respectively, p < 0.001 for both). After matching for discriminant clinicopathological features (tumour size, lymph node involvement, vascular invasion, HER2), DFS was similar in both groups (5-year DFS of 87.4% vs 84.4%, p = 0.47). ConclusionIDCPIC and other IDC with invasive components showing similar clinicopathological features display a similar prognosis.

IHC-breast cancer subtypes of invasive ductal carcinoma with predominant intraductal component as an insignificant prognostic factor: A register-based study from Korea

Abstract Background Invasive ductal carcinoma with predominant intraductal component (DCIS-IDC) has a favorable survival outcome. However, whether subtypes of DCIS-IDC have prognostic significance remains unknown. We assessed the prognostic value of immunohistochemical subtypes in DCIS-IDC compared with DCIS or IDC without predominant intraductal component. Methods We retrospectively studied 37,049 early breast cancer patients enrolled in the Korean Breast Cancer Registry between January 1993 and February 2011. We categorized DCIS, DCIS-IDC and IDC by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) expressions, such as luminal A, B, HER2 and Triple negative breast cancer(TNBC). Multivariate Cox regression analysis was used to estimate associations between subtypes and survival. Results In total, 8346 patients (26.3%) had DCIS, 20,427 (64.4%) had IDC and 2938 (9.3%) had DCIS-IDC. Luminal A type was the most predominant type in all three groups (DCIS=66.5%, IDC=64.7%, DCIS-IDC=46.9%). HER2 subtype was more frequent in DCIS-IDC (27.0%) than in IDC (8.3%) and DCIS (13.3%) ( p p Conclusions Different distribution of subtypes and indistinct prognostic effects in DCIS-IDC indicates that DCIS-IDC is a distinct clinical and biological entity from pure IDC or pure DCIS. MicroAbstract Through a large-sized, registery-based study, we reported differences of IHC-breast cancer subtypes or outcomes in pure IDC, pure DCIS and mixed DCIS-IDC cases with a predominant DCIS component (more than 80% of tumor was DCIS). IHC-breast cancer subtypes of invasive ductal carcinoma with predominant intraductal component were not significant prognostic factor unlike either pure IDC or DCIS. Clinical Practice points We subdivide breast cancer into pure IDC (64%), pure DCIS (26%) and mixed DCIS-IDC cases (9%) with a predominant DCIS component (more than 80% of tumor was DCIS). Within IDC, they observed differences in outcome that correlated with phenotype, among approximately 37,000 cases entered into the Korean cancer registry. They did not observe statistical differences in outcome with phenotypes for the DCIS-IDC group. This study supports that there is a biologic difference between DCIS-IDC cases compared to pure DCIS or pure IDC.

Ductal carcinoma of the breast. An analysis of proportions of intraductal and invasive components.

One hundred and ninety patients with mammary ductal carcinoma were studied to evaluate the correlation of proportions of intraductal and invasive tumor growth to histologic and immunohistochemical features. Initially, attempts were made to divide the cases into 6 groups according to the proportion of extraductal invasive areas within the whole tumor. It has been found that ductal carcinoma could be divided, on this criterion, into 2 groups. One comprised tumors in which invasive areas made up less than 20% of the tumor, the other included those with invasive areas exceeding 20%. In the former, intraductal and invasive components exhibited a lower grade of nuclear and tumor component and a higher incidence of cells with CEA immune positivity. The latter manifested higher grades in both intraductal and invasive components and a lower incidence of CEA positive cells. Many of the latter tumors had a solid or comedo-like growing pattern of the intraductal component. There was a significant difference in the prognosis between the two categories. We conclude that like intraductal carcinomas, invasive ductal carcinomas with a predominant intraductal component should be considered a lower grade malignancy.

An uncommon case of T1b breast cancer with diabetic mastopathy in type II diabetes mellitus

A 64-year-old postmenopausal female had been treated with insulin therapy for type 2 diabetes mellitus for 18 years, but her diabetes mellitus was not well controlled and she developed retinopathy. Her screening mammography showed abnormal findings, and thus she consulted a hospital. A physical examination showed her mammary glands to be hard on both sides and no palpable mass was observed. Mammography revealed an amorphous calcification in the middle outer portion of the left breast. Ultrasonography showed an irregular hypoechoic mass measuring about 11 mm in size in the upper outer portion of the left breast. Although a core-needle biopsy specimen of the hypoechoic mass showed hyalinizing fibrosis without any evidence of malignancy, a stereotactic guided vacuum-assisted biopsy was performed because magnetic resonance imaging revealed an enhanced area in the region of the amorphous calcification that could not be distinguished from breast cancer. The histological findings indicated noninvasive ductal carcinoma, and therefore a quardrantectomy with a sentinel lymph node biopsy was performed. The pathological diagnosis was invasive ductal carcinoma (0.7 × 0.3 cm) with a predominant intraductal component accompanying diabetic mastopathy. The sentinel lymph nodes demonstrated no metastasis. The surgical margin was positive for carcinoma and the patient later underwent a mastectomy. No malignant cells were observed in the specimen. The patient has so far experienced no recurrence after surgery.

Diffusion-weighted Imaging of Breast Cancer with the Sensitivity Encoding Technique: Analysis of the Apparent Diffusion Coefficient Value

The usefulness of diffusion-weighted imaging (DWI) in the field of neuroradiology has been established. Despite its high contrast resolution, DWI has the disadvantages of susceptibility artifact and chemical shift artifact. We performed DWI of breast cancer with the sensitivity encoding (SENSE) technique. The subjects were 60 female patients with breast mass. All patients underwent MRI including SENSE-DWI and were diagnosed histologically. Of these patients, 55 were diagnosed with breast cancer and the remaining five were diagnosed with benign mass. The histological diagnoses of breast cancer were as follows: 39 cases of invasive ductal carcinoma (IDC); 11 cases of IDC with a predominant intraductal component and non IDC (pure or predominant NIDC); and five cases of special types of cancer. The MR system used was a Gyroscan Intera 1.5T (Philips Medical Systems). In addition to routine MRI for breast cancer, including contrast-enhanced dynamic, SENSE-DWI was obtained. The accuracy of the positional information of SENSE-DWI was visually compared with that of conventional images. The apparent diffusion coefficient (ADC) values of breast mass were analyzed with SENSE-DWI. The accuracy of positional information was adequate for diagnosing of all patients. The mean ADC value of breast cancer was 1.021x10(-3) mm2/s and that of benign mass was 1.488x10(-3) mm2/s (p=0.0002). The mean ADC value of IDC was 0.968x10(-3) mm2/s and that of pure or predominant NIDC was 1.218x10(-3) mm2/s (p=0.0011). SENSE-DWI was of sufficient quality to support diagnosis of breast mass. SENSE-DWI may permit the acquisition of more detailed information about lesions, including tumor cellularity, that is difficult to obtain with conventional techniques.

Expression of maspin is up-regulated during the progression of mammary ductal carcinoma.

The tumour suppressor gene maspin is reported to inhibit the motility, invasiveness and metastasis of breast cancer cells. Maspin is expressed in normal mammary myoepithelial cells but is down-regulated during the progression of ductal carcinoma. However, we recently reported that maspin expression was frequently observed in invasive ductal carcinoma (IDC) with an aggressive phenotype, and it was a strong indicator of a poor prognosis. To our knowledge, to date, there has been no report investigating maspin expression in a large series of ductal carcinoma in situ (DCIS). To clarify whether there is down-regulation during the progression of ductal carcinoma, we immunohistochemically investigated the expression of maspin in 145 DCIS, 92 invasive ductal carcinomas with a predominant intraductal component as well as 94 usual ductal hyperplasias and 27 atypical ductal hyperplasias. The expression of maspin in carcinoma cells was observed in 9.6% (14 of 145) of DCIS and 18.5% (17 of 92) of IDC with a predominant intraductal components. It significantly correlated with larger tumour size (P = 0.013; P = 0.042), higher histological grade (P = 0.015; P = 0.0003) and the presence of comedo-necrosis (P = 0.000005; P = 0.0074) in DCIS and IDC with a predominant intraductal components, respectively. In epithelial cells, the expression of maspin was observed in only one case of usual ductal hyperplasia, and all cases of atypical ductal hyperplasia were negative. These results and our previous investigation in which 27.4% of IDC were positive for maspin suggest that the expression of maspin in epithelial cells could be up-regulated during the progression of ductal carcinoma, and that it could be correlated with the acquisition of an aggressive phenotype.

Clinical Significance of Invasive Ductal Carcinoma with Predominant Intraductal Component in Breast Cancer -Comparison with T1 Invasive Ductal Carcinoma-

Clinical Significance of Invasive Ductal Carcinoma with Predominant Intraductal Component in Breast Cancer -Comparison with T1 Invasive Ductal Carcinoma-

Extensive intraductal component (EIC) and estrogen receptor (ER) status in breast cancer.

The extensive intraductal component (EIC) of primary breast carcinoma is a special spread pattern observed in the breast. Extensive intraductal component may extend diffusely over the entire breast. Therefore, EIC is considered to be an important risk factor for local recurrence in breast-conserving therapy. However, the pathogenesis of EIC remains uncertain. Whether or not the estrogen receptor (ER) has an influence on its biologic behavior has not been fully studied. A consecutive series of 142 breast carcinomas submitted to the pathology department were examined on step gross sections of 5.0 mm thick. Extensive intraductal component was determined and divided into three types. Estrogen receptor was examined using both immunohistochemistry (ER-IHC) and enzyme immunoassay (ER-EIA). Extensive intraductal component was found in 78 of 138 (56.52%) invasive carcinomas including invasive ductal carcinoma with a predominant intraductal component. Estrogen receptor-IHC positivity was 42.96% (61/142) in the invasive breast carcinoma. Estrogen receptor positivity showed no significant difference between EIC-positive and -negative cases, as well as between EIC and invasive main tumor in the EIC-positive cases. But within the EIC-positive group, ER positivity was found to be higher in the peripheral type of EIC-II and EIC-III than in the central type of EIC-I (P < 0.05). Although ER may not play an essential role in the pathogenesis of EIC, it has shown some significance in the development of peripheral type EIC because of its higher presence in the peripheral type of EIC-II and EIC-III than in the central type of EIC-I.

Diagnostic Value of Enhanced Computed Tomography in the Detection of the Widely Spreading Intraductal Component of Breast Cancer: Case Reports.

We report cases of breast cancer with extensive intraductal component (EIC), the extent of which could be detected only by contrast-enhanced computed tomography (CT) scan. One case was a 32-year-old woman who presented left nipple bloody discharge without breast mass palpation. Mammography (MMG), galactography and ultrasonography (US) showed no abnormalities. Contrast helical CT scan revealed numerous patchy enhancement in the upper-outer quadrant of the left breast. Histological examnation revealed invasive ductal carcinoma with a predominant intraductal component. The second case was a 36- year-old woman who had noticed a left breast mass 2.4 cm in diameter. MMG and US suggested a localized breast cancer. Contrast helical CT scan revealed numerous patchy enhancement throughout the mammary gland in addition to the index tumor near the nipple. Histopathological results indicated invasive ductal carcinoma with widely spread ELC. In these two cases, the extent of intraductal cancer also correlated well with the CT findings. Breast CT scan can be an effective tool for determining the extent of the intraductal component of breast cancer, which is an important factor when considering breast-conserving therapy.

A CASE OF APOCRINE CARCINOMA OF THE BREAST WITH A PREDOMINANT INTRADUCTAL COMPONENT

We experienced a case of apocrine carcinoma of the breast with a predominant intraductal component. The complaint patient was seen at the hospital because of nipple discharge. Cytology of the nipple discharge suggested ductal carcinoma of comedo type. The reddness, thickness, and irregularity of the ductal wall were observed by a duct endoscopy. Carcinoembryonic antigen (CEA) in the nipple discharge was 1000ng/ml. Immunohistochemical staining for CEA and anti-gross cystic disease fluid protein 15 (GCDFP-15) was positive. In a review of 75 cases of apocrine carcinoma of the breast previously reported in Japan, three cases had nipple discharge. Of four cases of apocrine carcinoma including ours, two cases had an invasive microcarcinoma and another two cases, non-invasive carcinoma, and all carcinomas mainly extended within the lactiferous duct. So long as endoscopic findings of the duct are concerned, this is the first report of apocrine carcinoma of the breast.

Invasive ductal carcinoma with a predominant intraductal component arising in a fibroadenoma of the breast

A rare case of invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma of the breast in a 42 year old Japanese female was investigated by light microscopy. The patient, who had a well-defined, rubbery breast tumor measuring 2.0 x 3.0 cm, had undergone a tumorectomy 21 months after she noticed the tumor. Histologically, the fundamental architecture of the tumor showed an intracanalicular-type of fibroadenoma, but extensive proliferation of atypical cells was noticed in the lumen of the ducts. Tumor cells in the canaliculi had characteristics of ductal carcinoma, such as solid, comedo and cribriform patterns. As most of the ducts were occupied by carcinoma cells with several foci of microinvasion in the stroma of the fibroadenoma, it was diagnosed as invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma. This coexistence of in situ proliferation and invasive lesions of carcinoma within a fibroadenoma suggest the origin of the carcinoma to have been in the epithelial component of the fibroadenoma. In addition, this study clarifies the fact that carcinoma cells may proliferate and spread along the lumen of pre-existing ducts of the fibroadenoma and speculates that the duct system of the fibroadenoma has complete continuity.

Histologic regression of breast cancer after primary (neoadjuvant) chemotherapy

Primary (neoadjuvant) chemotherapy of locally advanced breast carcinomas is performed to locally reduce the tumour mass and to improve the operability. Recently, the indication for primary chemotherapy has been extended for preoperative treatment in breast conserving surgery. In an ongoing clinical trial we examined the resection specimens of 51 mammary carcinomas after primary chemotherapy. These patients had received a neoadjuvant therapy with epirubicin/cyclophosphamide for size reduction of large (> 3 cm) but operable tumours (pretreatment median tumour size 4.5 cm by mammography). The tumour response was evaluated pathologically and compared with the clinical tumour regression that was observed in over two-thirds of all cases. We classified the regressive changes using a semiquantitative scoring system from 0 to 4 (0 = no effect, 1 = resorption and tumour sclerosis, 2 = minimal residual invasive tumour [< 0.5 cm], 3 = residual noninvasive tumour only, 4 = no tumour detectable). The aim of this study was to evaluate the improvement of operability objectively and to correlate the histology of the primary tumour with the response to treatment. With invasive lobular carcinomas, the tumour size after therapy was reduced less than average and irrespective of the amount of histological tumour cell reduction, largely due to the stromal content of these neoplasms. Invasive ductal carcinomas with extensive or predominant intraductal component also underwent only a slight decrease in tumour size; this was because of the lack of tumour response with the intraductal component. Well differentiated tubular carcinomas were particularly resistant to primary chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of p53 protein in benign epithelial hyperplasia, atypical ductal hyperplasia, non-invasive and invasive mammary carcinoma: an immunohistochemical study.

To clarify whether p53 protein expression is involved in multistep carcinogenesis or the progression of mammary ductal carcinoma, we investigated p53 protein expression in 83 invasive ductal carcinomas (IDC), 10 IDC with a predominant intraductal component, 13 non-invasive ductal carcinoma (NIDC), 16 atypical ductal hyperplasia (ADH) and 39 benign epithelial hyperplasia (EH), using immunohistochemistry. Expression of p53 protein was detected in 24 (28.9%) cases of IDC, 5 (50%) cases of IDC with a predominant intraductal component and 1 (7.6%) case of NIDC. No expression was observed in either ADH or EH. In IDC, including cases with a predominant intraductal component, p53 protein expression was associated with a higher histological grade (P < 0.0001) or mitotic index (P < 0.0005). Although overexpression of c-erbB-2 protein has also shown a similar association with these prognostic indicators, expression of p53 protein correlated regardless of the status of c-erbB-2 overexpression. Completely coordinated expression of p53 protein was seen in both intraductal and invasive components. The intraductal component in IDC including cases with a predominant intraductal component which expresses p53 protein had significantly higher histological grade (P < 0.0005) or more comedo-subtypes (P < 0.0001). These results suggested that p53 protein expression occurs at a stage of NIDC with high histological grade or in comedo-subtypes. Its expression is maintained throughout invasion.

Salivary duct carcinoma.

Salivary duct carcinoma (SDC) is a distinctive salivary gland neoplasm morphologically characterized by intraductal and infiltrating components. Most tumors occur in the major salivary glands and demonstrate a propensity for invasive growth with early regional and distant metastases. Therefore, SDC is regarded as a high-grade malignancy in the current classification of salivary gland neoplasms. In an effort to identify clinically relevant prognostic features, we studied the clinicopathologic and immunohistochemical findings in 15 SDC, with ultrastructural evaluation of three tumors. Thirteen SDC occurred in the parotid gland, one in the Stensens duct, and one in the palate. Twelve patients were men (ratio of men to women = 4:1). Patients ranged in age from 39 to 81 years (mean = 59 years). Tumor size varied from 1.2 to 6.5 cm (mean = 3.1 cm). An intraductal component was identified in 10 of 14 primary SDC that made up 10% to 95% of the tumor. In three SDC a preexisting pleomorphic adenoma was identified. Immunohistochemical and electron microscopic evaluation showed the SDC to be composed entirely of ductal cells, and one tumor exhibited features of striated duct differentiation. SDC show a broader clinicopathologic spectrum than previously described. The tumor may arise in a pleomorphic adenoma. The proportion of intraductal and extraductal growth is variable and of prognostic significance. Although the majority of SDC behave in a high-grade fashion, those with a predominant intraductal component of greater than 90% (PID-SDC) and minimally invasive (< 8 mm) SDC in pleomorphic adenoma appear to have a more favorable prognosis.

ULTRASONIC DIAGNOSIS AND TREATMENT OF NONINVASIVE CARCINOMA OF THE BREAST

Seven cases of noninvasive carcinoma of the breast and 8 cases of invasive ductal carcinoma with a predominant intraductal component were clinicopathologically studied to determine the possibility of ultrasonic diagnosis. Both patient groups showed similar clinical features. Palpation of noninvasive carcinomas resulted in benign diseases such as mastopathy and fibroadenoma, but that of intraductal-predominant carcinomas turned out malignant in half of them. Ultrasonic diagnosis indicated malignancy for only one case of noninvasive carcinoma (diagnosing rate of 25%), versus for 2 cases (40%) of in intraductal-predomi nant carcinoma. In both groups, tumors ranged from around 1cm to the maximum of nearly 10cm in size, were not associated with lymph node metastasis and were in Stage I according to tn(N)m classification. The longest survival period of 6 years was noted in both groups, and there have been no recurrence in all patients. Both groups revealed almost similar ultrasonic pictures which could not be differentiated from each other. These pictures were characterized by ill-defined, inner echos in variety, and relatively low echoic tumor with small ratio of the length-to-breadth. From these findings, all patients of both groups can be possible candidates for limited operation, however, some question would be still remained in terms of the necessity of limph node dissection and extent of resection in breast conservation procedure.

ASPIRATION BIOPSY CYTOLOGY FOR BREAST CANCER WITH SPECIAL REFERENCE TO FALSE NEGATIVE CASES

The results of aspiration biopsy cytology (ABC) for 295 women with breast cancer who visited the breast clinic of Nagano Cancer Center on an out-patient basis, during the past 7 years and 3 months, were analyzed retrospectively. The true positive rate (class V. IV) of ABC for 295 breast cancers was 86.1% (254) and the false negative rate (class II-I+insufficient materials) was 9.2% (27). The false negative rate of tumors under 2.0cm in diameter was higher than that over 2.1cm. Histologically, the false negative rate was the highest in noninvasive ductal carcinomas (30.8%), followed in invasive lobular carcinomas (21.1%) of all histological types. As to the gross appearance of cut surface of the tumors, the false negative rate of unclassified type (20.0%) was the highest, while that of infiltrated type (5.9%) was the lowest of all types. In terms of histological spreading grade of cancer-invasion, the false negative rate in g (17.9%) significantly higher than that in f (5.4%). The false negative rate gradually decreased with an advanced in cancer invasion into the vessel and lymph vessel, and the same tendency was observed in lymph node involvement. The factors caused false negative in order of frequency were noninvasive ductal carcinoma + invasive ductal carcinoma with predominant intraductal component, small size of tumor and invasive lobular carcinoma. The frequency of malignant diagnosis for invasive lobular carcinoma was higher by the feeling of needle insertion into tumorous tissues than by aspiration biopsy cytology. ABC is the useful method for the diagnosis of breast cancer, but false negative diagnosis can not be avoidable. Therefore, the disposal after diagnosis of ABC must be chosen carefully, in view of the feeling when an injection-needle is inserted into the tumor.

Invasive Ductal Carcinoma of the Breast with a Predominant Intraductal Component: Cooperative Clinicopathologic Study in Seven Japanese Centers

A nationwide multicenter joint study was undertaken to investigate the clinicopathologic characteristics of invasive ductal carcinoma of the breast with a predominant intraductal component, a diagnostic entity proposed in the histologic typing of breast tumors by the World Health Organization in 1981. A total of 368 tumors, of which 218 were studied pathologically between 1983 and 1987 and 150 between 1971 and 1977, were accumulated for the present study from seven medical institutes in Japan. The incidence of such types of tumor was higher in the latter period than in the former, as was that of pure intraductal carcinomas. Seventy of the 368 tumors displayed metastatic nodal involvement and nine tumor deaths were observed from 150 tumors followed up for over 10 years following radical mastectomy, the overall quantity of the extraductal stromal invasion clearly acting on lymph node metastases and patients' outcome. We consider a total stromal invasion of greater than 5 mm to be critical in the prognosis of patients with tumor of this type.

Ductal Carcinoma of the Breasts: An Analysis of Proportions of Intraductal and Invasive Components

One hundred and ninety patients with mammary ductal carcinoma were studied to evaluate the correlation of proportions of intraductal and invasive tumor growth to bistologic and immunohistochemical features. Initially, attempts were made to divide the cases into 6 groups according to the proportion of extraductal invasive areas within the whole tumor. It has been found that ductal carcinoma could be divided, on this criterion, into 2 groups. One comprised tumors in which invasive areas made up less than 20% of the tumor, the other included those with invasive areas exceeding 20%. In the former, intraductal and invasive components exhibited a lower grade of nuclear and tumor component and a higher incidence of cells with CEA immune positivity. The latter manifested higher grades in both intraductal and invasive components and a lower incidence of CEA positive cells. Many of the latter tumors had a solid or comedo-like growing pattern of the intraductal component. There was a significant difference in the prognosis between the two categories. We conclude that like intraductal carcinomas, invasive ductal carcinomas with a predominant intraductal component should be considered a lower grade malignancy.