Breast, Chemotherapy related changes and residual carcinoma in situ [LMP34781]
Keywords
chemotherapy, DCIS
Clinical History
42 year-old female, history of right breast ductal carcinoma in situ (DCIS) status post lumpectomy with multiple margins less than 1 mm from DCIS. Because she also had contralateral (left breast) invasive ductal carcinoma with nodal involvement she underwent lumpectomy, sentinel lymph node biopsy, and chemotherapy. This specimen is from a re-excision of the right breast DCIS margins.
Clinical Discussion
Chemotherapy related changes can be detected in neoplastic as well as non-neoplastic tissue. Following chemotherapy, there is some evidence that suggests that in situ carcinoma is relatively more resistant to chemotherapy compared to invasive carcinoma.
This was a challenging case where the differences between chemotherapy related changes and residual ductal carcinoma in situ (DCIS) were not entirely clear. This case was reviewed at interdepartemental consensus rounds and was the subject of extended discussion. Ultimately, the consensus was that there was likely some residual DCIS within the lumpectomy specimen > 1 mm from all resection margins. It was determined that the groups of ducts/lobules < 1 mm from the margins represented chemotherapy related changes, and not DCIS.
Shown in this slide, the background breast parenchyma demonstrates several ducts and lobules lined by scattered cells with enlarged hyperchromatic and irregularly shaped nuclei with prominent nucleoli, however the nuclear-cytoplasmic ratio is preserved and there are no evident mitotic figures. The patient's previous lumpectomy was pulled for comparison (see Related Content), which can often be very helpful in a case such as this one.
This was a challenging case where the differences between chemotherapy related changes and residual ductal carcinoma in situ (DCIS) were not entirely clear. This case was reviewed at interdepartemental consensus rounds and was the subject of extended discussion. Ultimately, the consensus was that there was likely some residual DCIS within the lumpectomy specimen > 1 mm from all resection margins. It was determined that the groups of ducts/lobules < 1 mm from the margins represented chemotherapy related changes, and not DCIS.
Shown in this slide, the background breast parenchyma demonstrates several ducts and lobules lined by scattered cells with enlarged hyperchromatic and irregularly shaped nuclei with prominent nucleoli, however the nuclear-cytoplasmic ratio is preserved and there are no evident mitotic figures. The patient's previous lumpectomy was pulled for comparison (see Related Content), which can often be very helpful in a case such as this one.
Related Content
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