356
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).
