41. Invasive ductal carcinoma

Last updated on March 7, 2021 at 22:50

Check the comments before studying the slide

Staining: HE

Organ: Breast

Description:

Normal breast tissue, including lots of adipose tissue, is visible on the left and right sides of the slide. In the middle is the invasive tumor. The tumor has a desmoplastic (fibrotic) neostroma, and the gland-like structures show mild atypia.

DCIS, the precursor lesion of invasive ductal carcinoma, is also visible on the top of the slide. It’s a large, dilated duct that is filled with tumor cells. Its myoepithelial cell layer is intact, which is the difference between DCIS and invasive carcinoma.

On the left of the slide apocrine metaplasia is visible. The cells of the ducts resemble apocrine sweat glands. These cells are larger than normal, have abundant eosinophilic cytoplasm, round nuclei and prominent nucleoli.

Diagnosis: Invasive ductal carcinoma

Risk factors for breast cancer:

  • Nulliparity
  • Excess oestrogen
  • Familial BRCA gene mutations
  • Positive family history

Theory:

The desmoplastic neostroma makes the tumor firm and therefore palpable.

The degree of differentiation of the gland-like structures the tumor forms decides the grade of the tumor. The grading system is called the Bloom-Richardson grading system.

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40. Paget disease

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42. Mucinous carcinoma

9 thoughts on “41. Invasive ductal carcinoma”

  1. according to Dr. bela there is apocrine metaplasia in the ducts , its seen in the left part of the slide near the normal breast tissue . ( I dont know if they will ask about it or not ) , good luck for the exam period .

  2. I’m sorry, but I don’t understand something… If we see a DCIS on the slide, why the topic’s title is invasive ductal carcinoma (IDC)? Where can we see the invasive parts?

  3. Oh, I think I understand now, the DCIS is only the little basophil cell-group on the top of the carcinoma. Sorry for disturbing you!

  4. Hi Nikolas!

    I think what you are showing in your pictures here as DCIS, is actually just hyperplasia. The DCIS is visible right below it, as a butterfly-shaped duct.

    1. I’m not an expert in pathohistology, but all figures are taken from my seminar teacher in pathology, so I think they should be correct. From what I can tell, the difference between ductal hyperplasia and DCIS is the atypia, and in my opinion the cells in the larger duct are atypic, although I agree that the cells in the smaller duct below are even more atypic.

      Has your seminar teacher said otherwise?

      1. I should have elaborated slightly. This year they have provided videos for each slide. The women presenting the female genital tract, described the round structure as a hyperplastic process, while the butterfly structure below it as the DCIS.

        Her explanation was that the morphology of the cells in case of the hyperplastic process are different in morphology compared to the tumor cells.

        I don’t imagine they would make a big deal out of it… But I do agree that they look slightly different 🙂

        I uploaded a screenshot here, if you want to know what I am referencing to: https://ibb.co/dBS8dmy

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