372
Chapter 11
Ta b l e 1 1 . 3
Lagios’ Nuclear Grading System
Nuclear Features
Low Grade
Intermediate Grade
High Grade
Grade 1
Grade 2
Grade 3
Diameter
<2 × rbc
2–2.5 × rbc
>2.5 rbc
Pleomorphism
Absent
More uniform
Prominent
Chromatin
Diffuse
Coarse
Vesicular
Nucleoli
Absent
Inconspicuous
Prominent
a
Mitoses
Frequent
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).
