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Carcinoma in situ



Ductal carcinoma in situ (DCIS)



 See also additional examples prepared for the Sloane Project website.


College of American Pathologists Guidelines for grading DCIS:



Low grade DCIS (Example 1)
Low grade DCIS


Low grade DCIS

Low grade DCIS (Example 2)- Low Power Left; High Power Right
Cribriform pattern expansion of duct by a single population of uniform epithelial cells This view emphasises the rigid structures seen in DCIS with apparently cleanly punched out holes,  a lack of 'streaming' of cells and a lack of apparent nuclear overlap. It is the uniformity of the proliferation that is typical of low and intermediate grade DCIS


Low grade cribriform DCIS (Example 3) - 'Mouse over' for high power view
Low grade cribriform DCIS - example 3


Low grade micropapillary DCIS (Example 4) - 'Mouse over' for high power view
Note how the tufts of DCIS sit on a peripheral rim of intact myoepithelial cells (recognized by their clear cytoplasm in this example)
Low grade micropapillary DCIS - example 4

Intermediate grade DCIS (Example 1) - Core biopsy showing luminal calcs
Intermediate grade DCIS with luminal calcs - core biopsy

Intermediate grade DCIS (Example 2)- Core biopsy - medium and high power
Intermediate grade DCIS - med power
Intermediate grade DCIS - high power

Intermediate grade DCIS - Medium power Left; high power Right
Cribriform pattern expansion of duct by a single population of uniform epithelial cells This view emphasises the rigid structures seen in DCIS with apparently cleanly punched out holes,  a lack of 'streaming' of cells and a lack of apparent nuclear overlap. It is the uniformity of the proliferation that is typical of low and intermediate grade DCIS



Intermediate grade DCIS (Example 3)- Excision biopsy - medium power
Intermediate grade cribriform DCIS - medium power



Intermediate grade DCIS - Excision biopsy - high power
Intermediate grade cribriform DCIS - high power

Intermediate grade DCIS - CK 5/6 (Left) - arrows point to small numbers of peripheral basal cells. There is no basal/myoepithelial population admixed with the cells expanding this duct; P63 staining highlights the peripheral myoepithelial population (Right)
Very faint peripheral rim of CK 5/6 staining around duct contents - intermediate grade DCIS P63 immunostain highlights the myoepithelial layer around this dict expanded by intermediate grade DCIS

Intermediate grade DCIS - Intracystic papillary DCIS with focus of invasion (Lower right of each image)
E cadherin immunostaining (right) helps emphasise the invasive focus
Invasive carcinoma arising from an adjacent intracystic papillary carcinoma - click mouse for medium power view Area of intracystic papillary carcinoma

Medium power view of intracystic papillary carcinoma (upper)
and invasive focus (lower)

High grade comedo DCIS
High grade comedo DCIS


High grade comedo DCIS - medium power
High grade comedo DCIS - medium power


High grade comedo DCIS - high power
High grade comedo DCIS - high power


High grade DCIS
Strongly positive ER - Left; Almost uniformly negative CK 5/6 - Right
Two ducts showing changes of comedo (central necrosis) DCIS - the grade cannot be assessed at this power Severe cytological atypia in high grade comedo DCIS



High grade DCIS with central comedo necrosis
Low Power Left; High Power Right
Two ducts showing changes of comedo (central necrosis) DCIS - the grade cannot be assessed at this power Severe cytological atypia in high grade comedo DCIS



High grade DCIS with cancerisation of lobules (Example 1) - 'Mouse over' for high power view
The duct is shown upper left with its lobules lower right
Cancerisation - example 2



Cancerisation of lobules (Example 2)
Extension of DCIS tumour cells into lobules - note associated perilobular inflammation High power view of cancerisation showing high grade nuclear features
Extension of DCIS tumour cells into lobules - specialised lobular stroma and non-specioalised intervening stroma can be distinguished clearly in this photograph Cancerisation of lobules showing high grade nuclear features

See also Image of the Quarter 2013/3 use of pan cytokeratin immunostain to identify small invasive foci accompanying DCIS.