Ductal Carcinoma In Situ with Microinvasion

Ductal Carcinoma In Situ with Microinvasion

The dominant lesion in DCISM is in situ carcinoma image (typically high grade) associated with microscopic foci of cancer cells image invading beyond the basement membrane into the adjacent stroma.

Frequently, stromal inflammation image surrounds the DCIS and can obscure the tumor cells. IHC for cytokeratins help identify foci of early stromal invasion image and confirm the diagnosis of DCISM.



  • Ductal carcinoma in situ with microinvasion (DCISM)


  • Microinvasive ductal carcinoma in situ

  • Foci of “early stromal invasion”


  • DCIS with extension of cancer cells beyond basement membrane lining ducts and lobules

  • Largest area of invasion ≤ 1 mm in size

    • DCISM has been divided into 2 types

      • Type 1: Single cells

      • Type 2: Clusters of cells



  • Transition from DCIS to invasive cancer is poorly understood

    • No gene expression patterns specific to invasive carcinoma have been identified

    • Loss of normal luminal cell signaling may lead to dysfunction of myoepithelial and stromal cells maintaining basement membrane

      • Myoepithelial cells associated with DCIS show abnormal loss of myoepithelial cell markers

    • Thus invasion may be primarily initiated by loss of normal function of supporting cells rather than gain of function by carcinoma

  • Several studies have compared biologic properties between DCISM and DCIS

    • DCISM is characterized by higher proliferative rate and enhanced apoptosis

    • DCISM shows higher levels of expression for a number of matrix metalloproteases



  • Incidence

    • DCISM is an uncommon entity accounting for < 1% of all breast cancers

  • Age

    • Range: 32-78 years (mean: 56.4 years)


  • Up to 50% of cases present as palpable mass

    • Imaging findings may include abnormal density with or without associated microcalcifications

    • Up to 20% patients may also experience serosanguineous nipple discharge

    • Some patients present with Paget disease of nipple

  • Several studies have shown correlation between extent of DCIS and presence of microinvasion

    • High-grade DCIS with comedonecrosis is most common architectural pattern reported for DCISM

    • Presence of extensive high-grade DCIS correlates with presentation as palpable mass more commonly than DCIS without microinvasion


Jul 6, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Ductal Carcinoma In Situ with Microinvasion

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