Ductal Carcinoma
In Situ
363
FIG. 11.40.
DCIS in sclerosing adenosis with invasion.
A:
DCIS (
above
) in SA.
B:
Area of sclerosis involved by DCIS.
C:
Invasive cribriform carcinoma originating in SA.
FIG. 11.41.
Invasive carcinoma arising in sclerosing ad-
enosis.
DCIS in SA is shown on the
right
in this section
prepared with the immunostain for SMM-HC. Invasive car-
cinoma in the stroma to the
left
of the SA is not encased
in actin-positive myoepithelial cells.
were neither palpable nor grossly evident, and were gener-
ally of smaller extent with variable histologic type (including
cribriform, micropapillary, and papillary) and comprised
cells with lower grade nuclei and exhibited no necrosis.
Then, as now, a proportion of comedo and noncomedo
types of DCIS comprised combinations of growth patterns
and nuclear grade.
Comedocarcinoma is “high” grade by definition. Poorly
differentiated nuclei, usually accompanied by necrosis, are
also infrequently encountered in papillary, micropapillary,
and cribriform DCIS
149
(Figs. 11.19, 11.25, and 11.51). DCIS
is in the intermediate-grade category when it has a cribri-
form, solid, or papillary pattern with necrosis but lacks the
nuclear anaplasia of comedocarcinoma, or if one of these
growth patterns is composed of high-grade carcinoma cells
in the absence of necrosis (Figs. 11.9, 11.11, 11.21, and 11.26).
Any pattern of DCIS composed of uniform cells without
atypia or necrosis is classified as low grade (Figs. 11.2, 11.4,
11.7, 11.15, 11.21, 11.43, and 11.52). A case is usually clas-
sified on the basis of the highest grade present.
151
Rarely,
