Comedocarcinoma

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Comedocarcinoma
Specialty Oncology

Comedocarcinoma is a kind of breast cancer that demonstrates comedonecrosis, which is the central necrosis [1] of cancer cells within involved ducts. Comedocarcinomas are usually non-infiltrating and intraductal tumors, characterized as a comedo-type, high-grade ductal carcinoma in situ (DCIS). However, there have been accounts of comedocarcinoma which has then diversified into other cell types and developed into infiltrating (invasive) ductal carcinoma. [2] Recurrence and survival rates differ for invasive breast cancer which has originated as comedocarcinoma compared with other types of cancer cells. [3]

Contents

Pathophysiology

Cancer cells within these tumors are highly proliferative. As such, this can result in a lack of sufficient nutrients to some cells; leading to their starvation. As these starved cells die off, a build up of dead cancer cells will begin to form inside the tumor. These groups of necrotic cells are often referred to as comedones, hence the classification of this type of high-grade DCIS as "comedo necrosis". [4]

As of yet, it is still unclear the mechanism by which DCIS of the breast develop into a comedo-type morphology. However, a strong correlation between Tenascin and DCIS nuclear grade has been shown. In a pathological analysis, tenascin was present in all excised tissue from carcinomas. It was found that there were variations in the expression patterns of tenascin in comedo DCIS (comedocarcinoma) versus non-comedo DCIS. Specifically, numerous and thick tenascin bands were found in the surrounding stroma of comedo DCIS whereas non-comedo DCIS had a single thin tenascin band surrounding them. The difference in these expression patterns implicates Tenascin as a possible factor in the development of the comedo-type morphology in carcinomas. [5]

Morphology

Cells

Comedocarcinomas are typically marked by the presence of large, abnormal cells within the breast. These cells are often pleomorphic and have irregular nuclei and prominent nucleoli. [1] The tumor cells are poorly differentiated and are therefore recognized as high-grade (i.e. grade 3).

Tissue

Affected ducts have characteristic necrotic tissue which is composed of multiple, well-defined firm masses of dead cells. In most cases of comedocarcinomas (approximately 78%), [6] mammograms will reveal micro-calcifications in the breast tissue due to the calcification of necrotic elements. Upon physical examination, the infected area can often be described as feeling hard and cord-like. Once excised, sustained pressure to the tumor will cause inspissated material—that is cheese-like in appearance (resembling comedones in acne) and similar in consistency to toothpaste—to ooze from the ducts. This cheesy appearance is as a direct result of the clogging of ducts with necrotic elements. [7]

Clinical Relevance

Pathology

Comedocarcinomas are known as the most aggressive form of intraductal carcinomas, although they are considered to be an early stage of breast cancer and are classified as noninvasive. [4]

Individuals diagnosed with comedo-type DCIS (comedocarcinoma) often have a higher chance of it developing into an invasive derivative—if left untreated, this chance is nearly 100%. These individuals are also at an increased risk of cancer recurrence, with this recurrence manifesting itself earlier than in other forms of DCIS. The prognosis for comedocarcinoma is usually favorable with treatment intervention (i.e. surgery, radiotherapy, or hormone therapy); leading to a lower risk of invasive carcinoma development. [8]

While it is uncommon for these tumors to evolve into invasive carcinomas, there have been a few reported incidents of such cases.[ citation needed ]

Diagnosis

Diagnosis of comedocarcinoma is typically done using a combination of methods. A physical examination of the breast tissue can often reveal lumps in comedocarcinomas, while palpable lumps are rare in non-comedo carcinomas. Usually, a mammogram or biopsy is often needed to fully diagnose comedocarcinomas. Because of its prevalence in DCIS, evidence of calcification within the breast tissue is often used as a diagnostic tool for identifying comedocarcinomas and other forms of DCIS. Biopsies are normally only performed following a suspicious mammogram (i.e. possible evidence of comedocarcinoma), and in such cases invasive biopsies are seldom necessary for diagnosing comedocarcinomas. Following the biopsy, a pathological examination is performed on the portion of excised breast tissue. If the results of the examination show the appearance of highly proliferative, abnormal cells that are confined within their place of origin, this is indicative of cancer and an in-situ carcinoma diagnosis is made. The presence of E-cadherin can also be used by pathologists to distinguish an in-situ carcinoma as lobular or ductal—where the loss of E-cadherin expression is indicative of lobular in-situ carcinoma. [8] [9] To then classify the DCIS as a comedo-type (comedocarcinoma), the cancer cells need to show evidence of comedonecrosis and poor differentiation. [4]

Related Research Articles

<span class="mw-page-title-main">Adenocarcinoma</span> Medical condition

Adenocarcinoma is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, or both. Adenocarcinomas are part of the larger grouping of carcinomas, but are also sometimes called by more precise terms omitting the word, where these exist. Thus invasive ductal carcinoma, the most common form of breast cancer, is adenocarcinoma but does not use the term in its name—however, esophageal adenocarcinoma does to distinguish it from the other common type of esophageal cancer, esophageal squamous cell carcinoma. Several of the most common forms of cancer are adenocarcinomas, and the various sorts of adenocarcinoma vary greatly in all their aspects, so that few useful generalizations can be made about them.

Carcinoma <i>in situ</i> Medical condition

Carcinoma in situ (CIS) is a group of abnormal cells. While they are a form of neoplasm, there is disagreement over whether CIS should be classified as cancer. This controversy also depends on the exact CIS in question. Some authors do not classify them as cancer, however, recognizing that they can potentially become cancer. Others classify certain types as a non-invasive form of cancer. The term "pre-cancer" has also been used.

<span class="mw-page-title-main">Lumpectomy</span> Limited surgical removal of breast tissue

Lumpectomy is a surgical removal of a discrete portion or "lump" of breast tissue, usually in the treatment of a malignant tumor or breast cancer. It is considered a viable breast conservation therapy, as the amount of tissue removed is limited compared to a full-breast mastectomy, and thus may have physical and emotional advantages over more disfiguring treatment. Sometimes a lumpectomy may be used to either confirm or rule out that cancer has actually been detected. A lumpectomy is usually recommended to patients whose cancer has been detected early and who do not have enlarged tumors. Although a lumpectomy is used to allow for most of the breast to remain intact, the procedure may result in adverse affects that can include sensitivity and result in scar tissue, pain, and possible disfiguration of the breast if the lump taken out is significant. According to National Comprehensive Cancer Network guidelines, lumpectomy may be performed for ductal carcinoma in situ (DCIS), invasive ductal carcinoma, or other conditions.

<span class="mw-page-title-main">Invasive carcinoma of no special type</span> Medical condition

Invasive carcinoma of no special type (NST) is also referred to as invasive ductal carcinoma or infiltrating ductal carcinoma(IDC) and invasive ductal carcinoma, not otherwise specified (NOS). Each of these terms represents to the same disease entity, but for international audiences this article will use invasive carcinoma NST because it is the preferred term of the World Health Organization (WHO).

The International Classification of Diseases for Oncology (ICD-O) is a domain-specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. This classification is widely used by cancer registries.

<span class="mw-page-title-main">Ductal carcinoma in situ</span> Medical condition

Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pre-cancerous or non-invasive cancerous lesion of the breast. DCIS is classified as Stage 0. It rarely produces symptoms or a breast lump one can feel, typically being detected through screening mammography. It has been diagnosed in a significant percentage of men.

Stereotactic biopsy, also known as stereotactic core biopsy, is a biopsy procedure that uses a computer and imaging performed in at least two planes to localize a target lesion in three-dimensional space and guide the removal of tissue for examination by a pathologist under a microscope. Stereotactic core biopsy makes use of the underlying principle of parallax to determine the depth or "Z-dimension" of the target lesion.

<span class="mw-page-title-main">Medullary breast carcinoma</span> Rare type of breast cancer

Medullary breast carcinoma is a rare type of breast cancer that is characterized as a relatively circumscribed tumor with pushing, rather than infiltrating, margins. It is histologically characterized as poorly differentiated cells with abundant cytoplasm and pleomorphic high grade vesicular nuclei. It involves lymphocytic infiltration in and around the tumor and can appear to be brown in appearance with necrosis and hemorrhage. Prognosis is measured through staging but can often be treated successfully and has a better prognosis than other infiltrating breast carcinomas.

<span class="mw-page-title-main">Lobular carcinoma in situ</span> Medical condition

Lobular carcinoma in situ (LCIS) is an incidental microscopic finding with characteristic cellular morphology and multifocal tissue patterns. The condition is a laboratory diagnosis and refers to unusual cells in the lobules of the breast. The lobules and acini of the terminal duct-lobular unit (TDLU), the basic functional unit of the breast, may become distorted and undergo expansion due to the abnormal proliferation of cells comprising the structure. These changes represent a spectrum of atypical epithelial lesions that are broadly referred to as lobular neoplasia (LN).

Breast cancer classification divides breast cancer into categories according to different schemes criteria and serving a different purpose. The major categories are the histopathological type, the grade of the tumor, the stage of the tumor, and the expression of proteins and genes. As knowledge of cancer cell biology develops these classifications are updated.

<span class="mw-page-title-main">Desmoplasia</span> Growth of fibrous or connective tissue

In medicine, desmoplasia is the growth of fibrous or connective tissue. It is also called a desmoplastic reaction to emphasize that it is secondary to an insult. Desmoplasia may occur around a neoplasm, causing dense fibrosis around the tumor, or scar tissue (adhesions) within the abdomen after abdominal surgery.

<span class="mw-page-title-main">Invasive lobular carcinoma</span> Medical condition

Invasive lobular carcinoma (ILC) is breast cancer arising from the lobules of the mammary glands. It accounts for 5–10% of invasive breast cancer. Rare cases of this carcinoma have been diagnosed in men.

<span class="mw-page-title-main">Atypical ductal hyperplasia</span> Medical condition

Atypical ductal hyperplasia (ADH) is the term used for a benign lesion of the breast that indicates an increased risk of breast cancer.

<span class="mw-page-title-main">Breast mass</span> Localized swellings that feel different from the surrounding tissue

A breast mass, also known as a breast lump, is a localized swelling that feels different from the surrounding tissue. Breast pain, nipple discharge, or skin changes may be present. Concerning findings include masses that are hard, do not move easily, are of an irregular shape, or are firmly attached to surrounding tissue.

<span class="mw-page-title-main">Nipple adenoma</span> Medical condition

A nipple adenoma is a rare benign tumour of the breast.

<span class="mw-page-title-main">Ductal cells</span>

Ductal cells refer to the epithelial cell lining of the pancreatic duct that deliver enzymes from the acinar cells to the duodenum. They have the essential function of producing bicarbonate-rich (HCO3-) secretion to neutralize stomach acidity. The hormone secretin stimulates ductal cells and is responsible for maintaining the duodenal pH and preventing duodenal injury from acidic chyme. Ductal cells mix their production with acinar cells to make up the pancreatic juice.

Papillomatosis of the breast (PB) is a rare, benign, epitheliosis-like lesion, i.e. an overgrowth of the cells lining the ducts of glands that resembles a papilla or nipple-like nodule/tumor. PB tumors develop in the apocrine glands of the breast. PB is also termed juvenile papillomatosis because of its frequent occurrence in younger women and Swiss cheese disease because of its microscopic appearance. Rarely, PB has also been diagnosed in very young, adolescent, and adult males.

Tubular carcinoma is a subtype of invasive ductal carcinoma of the breast. More rarely, tubular carcinomas may arise in the pancreas or kidney. Most tubular carcinomas begin in the milk duct of the breast and spread to healthy tissue around it.

Papillary carcinomas of the breast (PCB), also termed malignant papillary carcinomas of the breast, are rare forms of the breast cancers. The World Health Organization (2019) classified papillary neoplasms of the breast into 5 types: intraductal papilloma, papillary ductal carcinoma in situ (PDCIS), encapsulated papillary carcinoma (EPC), solid-papillary carcinoma (SPC), and invasive papillary carcinoma (IPC). The latter four carcinomas are considered here; intraductal papilloma is a benign neoplasm. The World Health Organization regarded solid papillary carcinoma as having two subtypes: in situ and invasive SPC.

<span class="mw-page-title-main">Pure apocrine carcinoma of the breast</span> Medical condition

Pure apocrine carcinoma of the breast (PACB) is a rare carcinoma derived from the epithelial cells in the lactiferous ducts of the mammary gland. The mammary gland is an apocrine gland. Its lactiferous ducts have two layers of epithelial cells, a luminal layer which faces the duct's lumen and a basal layer which lies beneath the luminal layer. There are at least 4 subtypes of epithelial cells in these ducts: luminal progenitor cells and luminal mature cells which reside in the luminal layer and mammary stem cells and basal cells which reside in the basal layer. Examination of the genes expressed in PACB cancer cells indicate that most of these tumors consist of cells derived from luminal cells but a minority of these tumors consist of cells derived from basal cells.

References

PD-icon.svg This article incorporates public domain material from Dictionary of Cancer Terms. U.S. National Cancer Institute.

  1. 1 2 Wellfire Interactive. "Pathology Thread". virginia.edu.
  2. ↑ Pervez S, Khan H (September 2007). "Infiltrating ductal carcinoma breast with central necrosis closely mimicking ductal carcinoma in situ (comedo type): a case series". Journal of Medical Case Reports. 1: 83. doi: 10.1186/1752-1947-1-83 . PMC   2014768 . PMID   17825107.
  3. ↑ Bonnier P, Body G, Bessenay F, Charpin C, Fétissof F, Beedassy B, et al. (May 1999). "Prognostic factors in ductal carcinoma in situ of the breast: results of a retrospective study of 575 cases. The Association for Research in Oncologic Gynecology". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 84 (1): 27–35. doi:10.1016/s0301-2115(99)00007-x. PMID   10413223.
  4. 1 2 3 "Diagnosis of DCIS". Breastcancer.org. 2018-02-20. Retrieved 2020-04-23.
  5. ↑ Tang P, Teichberg S, Roberts B, Hajdu SI (July 2001). "Ultrastructure of the periductal area of comedo carcinoma in situ of the breast". Annals of Clinical and Laboratory Science. 31 (3): 284–290. PMID   11508833.
  6. ↑ Pacifici S. "Comedo type ductal carcinoma in situ". Radiology Reference Article. Radiopaedia. Retrieved 2020-04-23.
  7. ↑ "Comedo DCIS / comedocarcinoma". www.pathologyoutlines.com. Retrieved 2020-04-23.
  8. 1 2 "Understanding Your Pathology Report: Ductal Carcinoma In Situ (DCIS)". www.cancer.org. Retrieved 2020-04-23.
  9. ↑ Pai K, Baliga P, Shrestha BL (May 2013). "E-cadherin expression: a diagnostic utility for differentiating breast carcinomas with ductal and lobular morphologies". Journal of Clinical and Diagnostic Research. 7 (5): 840–4. doi:10.7860/JCDR/2013/5755.2954. PMC   3681051 . PMID   23814724.
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