Rosen's Breast Pathology, 4e

353

Ductal Carcinoma In Situ

FIG. 11.24.  DCIS, cribriform. A: Apocrine features. B,C: Low to intermediate nuclear grade with necrosis .

producing a distinct ring between the neoplastic epithelial cells and the basement membrane. This configuration is often accompanied by accentuation of the basement mem- brane itself, as well as a circumferential periductal collar of desmoplastic stroma. A “cocktail” of antibodies to smooth muscle myosin-heavy chain (SMM-HC) and p63 is especially sensitive for detecting myoepithelium in high-grade DCIS. 120 Elastosis occurs around some ducts with this periductal reac- tion. Rarely pronounced neovascularity is represented by a

partial or complete ring of capillaries external to the base- ment membrane 101 (Fig. 11.28). A variable inflammatory in- filtrate is present in the periductal stroma. In some instances, this consists of lymphocytes and histiocytes in amounts ranging from sparse to very abundant. A more conspicu- ous granulomatous inflammatory reaction may be elicited in foci where the duct wall is partially disrupted, and it appears that necrotic contents of the duct have been discharged or microinvasion is suspected (Fig. 11.29). Calcification can be

A

B

FIG. 11.25.  DCIS, cribriform. A,B : The affected ducts show central necrosis, high nuclear grade, and irregularly shaped microlumina.