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Chapter 11

Ta b l e 1 1 . 3  Lagios’ Nuclear Grading System

Low Grade

Intermediate Grade

High Grade

Nuclear Features

Grade 1 <2 × rbc Absent Diffuse Absent Frequent

Grade 2

Grade 3 >2.5 rbc

Diameter

2–2.5 × rbc

Pleomorphism

More uniform

Prominent Vesicular Prominent a

Chromatin

Coarse

Nucleoli Mitoses

Inconspicuous

Infrequent

Rare

a Nucleoli not required for grade 3 if pleomorphism and mitoses are prominent. Modified from Lagios MD. Duct carcinoma in situ: pathology and treatment. Surg Clin North Am 1990;70:853–871.

from women older than 55 years than in those from younger patients. A more detailed analysis of ER IHC was provided by Bur et al. 179 in 1992. They classified 80% of DCIS as ER positive, with a significantly higher frequency of receptor positivity in noncomedo (91%) than in comedo (57%) lesions. The frequencies of ER positivity among variants of noncomedo DCIS did not differ significantly (cribriform, 89%; solid,

94%; micropapillary–papillary, 100%). Cellular features as- sociated with the absence of ER were large cell size, nuclear pleomorphism, and necrosis. These authors also confirmed the observation of Barnes and Masood that ER immunore- activity was almost always the same in the intraductal and invasive portions of a lesion. Holland et al. 180 studied the response of DCIS to estrogens in human breast tissue in vivo using nude mouse xenografts.

FIG. 11.54.  DCIS, angiogenesis. A,B: DCIS, solid type with low nuclear grade is partially encircled by capillaries in these immunostained sections. C: Capillaries are present in the stroma, but they are not concentrated around this normal duct (CD34).