Rosen's Breast Pathology, 4e

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Chapter 11

FIG. 11.22.  (Continued)

Comedo DCIS is described classically as a solid growth of large carcinoma cells with poorly differentiated nuclei, cen- tral necrosis, calcification, and, in some but not all cases, a high mitotic rate (Fig. 11.27). The myoepithelial cell layer is variably affected and sometimes completely eliminated by the carcinomatous proliferation. In some instances, the myo- epithelial cells are hyperplastic with hyperchromatic nuclei,

invasive cribriform carcinoma, collagenous spherulosis, and atypical ductal hyperplasia (ADH). Applying the “ADH-5” cocktail (a combination of CKs 5/14, 7/18, and p63) in the differential diagnosis of ADH and DCIS has shown promise for improving interobserver and intraobserver agreement; however, the usefulness of this immunostain in a controlled ­prospective setting remains to be determined. 119

FIG. 11.23.  DCIS, cribriform. A,B: Microlumina with various shapes. C: A circumscribed lobulated focus of cribriform DCIS with calcifications.