Rosen's Breast Pathology, 4e

355

Ductal Carcinoma In Situ

FIG. 11.28.  DCIS, “comedo,” with periductal fibrosis. A: Solid DCIS with central necrosis and con- centric periductal fibrosis. B: Prominent periductal neovascularity forms a distinct zone between the comedoDCIS and peripheral concentric fibrosis. C,D: Aremarkably thick, reduplicated basementmem- brane forms a broad collar around these ducts between the DCIS and a zone of neovascularization.

an excessive diameter are deprived of one or more essential metabolites, such as oxygen, as a result of limited diffusion in the nonvascularized intraductal neoplastic epithelium. It has been theorized that the presence of a hypoxic compartment in

DCIS with comedonecrosis renders this type of DCIS relatively ­radioresistant and contributes to a high risk of local recurrence after breast conservation and radiotherapy for carcinomas with this feature. 125

FIG. 11.29.  DCIS, “comedo” type. A,B: Periductal lymphocytic reaction is concentrated at a site of possible microinvasion at the upper border of this duct.