A 50-year-old woman, gravida 0 para 0, comes to the office for a well visit. She has no family history of cancer. Breast examination is normal. The patient has a screening mammography that reveals microcalcifications. Due to this finding, she undergoes a breast biopsy. Histopathology reveals ducts distended by pleomorphic cells with prominent central necrosis. The lesion does not extend beyond the ductal basal membrane. Which of the following is most likely the origin of the lesion?

Question

A 50-year-old woman, gravida 0 para 0, comes to the office for a well visit.  She has no family history of cancer.  Breast examination is normal.  The patient has a screening mammography that reveals microcalcifications.  Due to this finding, she undergoes a breast biopsy.  Histopathology reveals ducts distended by pleomorphic cells with prominent central necrosis.  The lesion does not extend beyond the ductal basal membrane.  Which of the following is most likely the origin of the lesion?

Quizplus · Accepted Answer

11ec160b_391b_ff1f_9249_155261a4a65a_MD0001_00 The breast is composed of subcutaneous tissue and breast tissue, the latter of which includes stromal and epithelial elements. Stroma constitutes the majority of breast volume in nonlactating women and consists of fibrous connective tissue. The epithelial elements of breast tissue proliferate during lactation and include branching ducts, which connect the lobules to sinuses that drain to the nipple. As the name suggests, ductal carcinoma in situ (DCIS) arises from the breast ducts. It is a precursor to the most common type of breast cancer, invasive ductal carcinoma. Age and nulliparity are risk factors for breast cancer, and breastfeeding has a protective effect. DCIS is typically identified by biopsy after mammography screening shows microcalcifications in asymptomatic patients with normal breast examinations. Histopathology demonstrates ducts (black arrows) distended by pleomorphic cells with prominent central necrosis without extension beyond the ductal basement membrane. Spread of these malignant cells to the nipple through the duct system results in eczematous nipple changes and indicates Paget disease (Choice A). (Choice B) The sinuses serve as collecting reservoirs for milk during lactation. A blockage of this area can cause a galactocele and eventually lead to a breast abscess. (Choice D) Lobular breast tissue can give rise to lobular breast carcinoma that typically presents as palpable breast masses with orderly rows of cells organized in single file. (Choice E) Phyllodes tumors arise from the breast stroma and can progress to malignancy. Histology shows disorderly, diffusely hypercellular connective tissue with cellular atypia and leaf-like projections (black arrow). Educational objective: Ductal carcinoma in situ is characterized by ducts distended by pleomorphic cells with prominent central necrosis that do not penetrate the basement membrane. It is the precursor to invasive ductal carcinoma, the most common type of breast cancer. __________ References: Progression from ductal carcinoma in situ to invasive breast cancer: revisited. (http://www.ncbi.nlm.nih.gov/pubmed/23890733)

A 50-Year-Old Woman, Gravida 0 Para 0, Comes to the Office