Rosen's Breast Pathology, 4e

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Chapter 11

Apoptosis , genetically programmed cell death, also ap- pears to contribute to necrosis in comedo and other types of DCIS. Evidence of apoptosis in DCIS is derived from mor- phologic observations supported by terminal deoxynucleo- tidyl transferase dUTP nick-end labeling (TUNEL) staining to demonstrate nuclear fragmentation. Morphologic crite- ria of apoptosis include nuclear shrinkage, condensation of chromatin, nuclear fragmentation, the formation of apop- totic bodies, and the absence of inflammation. Bodis et al. 126 reported that TUNEL-positive staining was present in foci of necrosis with the features of apoptotic cell death in 19 exam- ples of DCIS. No TUNEL staining was found in low-grade DCIS without necrosis. Nuclear immunoreactivity for p53 did not correlate significantly with apoptosis or necrosis. Harn et al. 127 studied the distribution of apoptosis in intraductal, invasive, and metastatic ductal carcinomas. The apoptosis labeling index determined by the TUNEL method was significantly higher in DCIS than in invasive or metastatic carcinoma. There was also a significant positive

FIG. 11.30.  DCIS, “comedo” type. Note concentric peri- ductal fibrosis, lymphocytic reaction ( left ), and the eo- sinophilic band at the perimeter of the duct formed by the thickened basement membrane.

FIG. 11.31.  DCIS with crystalloids. A: Small crystalloids are being formed ( upper left ) in the necrotic debris in this duct. B: Numerous crystalloids are present in another part of the specimen shown in (A) . C,D: Cribriform and micropapillary DCIS with crystalloids in another case. E: The needle-shaped crystalloids appear transparent in this preparation in which the epithelium and intraductal cellular debris are immunoreactive for epithelial membrane antigen (EMA).