Cui Xiaoyan, Wei Shi
Department of Pathology, the University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Pathology, the University of Alabama at Birmingham, Birmingham, Alabama, USA
Ann Clin Lab Sci. 2017 Sep;47(5):529-534.
Ductal or lobular carcinoma in situ (DCIS/LCIS) can rarely arise from sclerosing adenosis (SA). The combination of cytologically malignant cells and the infiltrative growth pattern may make it challenging to distinguish it from an invasive carcinoma. The authors reviewed 50 consecutive cases of CIS involving SA to seek the salient histologic characteristics in order to prevent overdiagnosis. The features commonly seen with CIS were the lobular configuration at low magnification (94%), uninvolved SA in neighboring tissue (84%), at least focally identifiable myoepithelial cells on H&E-stained sections (76%), separate foci of unequivocal CIS (58%), associated microcalcifications (54%), and hyaline basement membrane surrounding tumor cell nests (48%). The group of DCIS with high nuclear grade showed a tendency to occupy the entire lobule of SA, whereas those with non-high grade were more often partially involving the affected lobule. The presence of adjacent separate foci of CIS was more closely related to the DCIS lesions when compared to those of LCIS. The finding of an SA lobule entirely involved by CIS was signifi-cantly correlated with the presence of an invasive carcinoma; this should thus strongly prompt the pathologist to search for other evidence of invasion. Awareness of these features is an additional, useful tool for reaching a proper diagnosis.
导管原位癌或小叶原位癌（DCIS/LCIS）很少起源于硬化性腺病（SA）。细胞学上的恶性细胞与浸润性生长模式相结合，可能使其难以与浸润性癌区分开来。作者回顾了50例连续的累及SA的原位癌病例，以寻找显著的组织学特征，以防止过度诊断。原位癌常见的特征包括低倍镜下的小叶结构（94%）、邻近组织中未受累的SA（84%）、苏木精-伊红（H&E）染色切片上至少局灶性可识别的肌上皮细胞（76%）、明确原位癌的分离灶（58%）、相关微钙化（54%）以及肿瘤细胞巢周围的透明基底膜（48%）。高核级DCIS组有占据SA整个小叶的倾向，而非高核级的DCIS更常部分累及受累小叶。与小叶原位癌相比，相邻的原位癌分离灶的存在与导管原位癌病变的关系更为密切。原位癌完全累及SA小叶的发现与浸润性癌密切相关；因此这应强烈促使病理学家寻找其他浸润证据。认识到这些特征是做出正确诊断的另一个有用工具。
