What is Lobular Carcinoma?
Invasive Ductal Carcinoma, Non-Special Type (Duct NST); Invasive Ductal Carcinoma
Invasive ductal carcinoma
- Invasive ductal cancer, non-specific (ductal NOS) is the largest group of heterotypic tumors in the classification of invasive breast cancer. Due to the lack of rich features, it is difficult to classify it into a special histological type like lobular or tubular cancer. . ICD-O code 8500/3
History and meaning of invasive ductal cancer
- Invasive Ductal Carcinoma, Non-Special Type (Duct NST); Invasive Ductal Carcinoma
- There have been many names for this type of breast cancer, including hard, simple, and spheroid cell carcinoma. Invasive ductal carcinoma was proposed by the American Institute of Military Pathology (AFIP) and was previously adopted by the WHO classification. This name continues the traditional concept that invasive ductal carcinoma originates from ductal epithelium of the breast, which can be distinguished from lobular carcinoma derived from breast lobules (there is no evidence that lobular carcinoma originates from breast lobules). Another study showed that most breast cancers originate from the peripheral duct-lobular unit (TDLU). Some classification methods retain the term "catheter" but add "non-specificity (NOS)", while other classifications tend to use "non-specificity (NST)" to emphasize differentiation from specific types of tumors. The latter view is increasingly accepted internationally. Because the term "catheter" is widely used, "invasive ductal cancer, ductal NOS or NST" is a better choice for naming.
Epidemiology of invasive ductal cancer
- Non-specific ductal cancer (ductal NOS) accounts for the vast majority of breast cancer, and its epidemiological characteristics are generally consistent with breast cancer. Non-specific ductal cancer is the most common type of breast cancer, accounting for 40-75% of published cases in the literature. It may be due to the lack of strict criteria to distinguish from specific cancers, and some studies have not classified non-specific cancers. Mixed cancers of specific ductal cancer and specific cancer are grouped separately, but they are combined into a group of non-specific ductal cancer.
- Non-specific ductal cancer is rare in women under 40, as is all breast cancer, but the proportion of tumor classification is the same for young women and older women. There is no significant difference in the incidence of non-specific ductal cancers associated with known risk factors such as geography, culture / lifestyle, and fertility. Certain diseases such as atypical ductal hyperplasia and intralobular tumors during cancer development are associated with most specific breast cancers with a high risk of onset, especially tubular cancer and typical lobular cancer. Familial breast cancers associated with BRCA1 gene mutations are usually non-specific ductal carcinomas, but have the characteristics of myeloid carcinomas, high numbers of mitotic divisions, and most have continuous peripheral depressive margins. Compared with sporadic breast cancer, lymphatics Cell infiltration was evident. Familial breast cancers associated with BRCA2 gene mutations are also often non-specific ductal cancers, but in the histological grade, the tubular structure score is high (small number of tubules), and most tumors have a continuous marginal marginal pressure, and Sporadic breast cancer has a lower number of mitotic cells.
Macroscopic examination of invasive ductal cancer
- These tumors have no obvious features on the naked eye, and they vary in size, ranging from 10mm to more than 100mm. The shape of the tumor is irregular, stellate or nodular, the edges are clear or the boundaries are unclear, and there is no clear boundary with the surrounding tissues. It feels firm or hard to the touch and cuts it into a grit. The cut surface is usually off-white with yellow stripes.
Histopathology of invasive ductal carcinoma
- Tumors have different morphologies and lack regular structural features. Tumor cells are arranged in a cord-like, cluster-like or trabecular shape. Some tumors are solid or accompanied by infiltration of syncytia, and there are few stroma. In some cases, adenoid differentiation is obvious, and a tubule structure with a central cavity can be seen in the tumor cell cluster. Occasionally, some regions with a single layer of linear infiltrating or target ring structure are seen, but the morphological features of invasive lobular carcinoma are lacking. Tumor cells have various shapes, rich cytoplasm, eosinophilic, regular nucleus shape, consistent size or high polymorphism, with multiple nucleoli and obvious, and lack of or extensive mitotic appearance. Related ductal carcinoma in situ lesions (DCIS) can be seen in more than 80% of cases, usually of acne type, with advanced histological grade, and other forms are also visible.
- In some cases, it is a subtype of non-specific ductal cancer, that is, invasive ductal cancer with extensive in situ carcinoma component infiltration. Tumor stroma can manifest in a variety of forms, some of which are fibroblast proliferation, or less connective tissue, or visible hyalinization. Focal elastic fibrosis can be seen around the duct or around the blood vessels. Focal necrosis can also be seen, with occasional extensive necrosis. In rare cases, lymphoplasmic cell infiltration is seen. For the diagnosis of a type of mixed cancer, a representative slice should be selected for careful observation. Only more than 50% of the tumor area can be diagnosed as non-specific ductal cancer. If only 10-49% of the tumor area shows no specificity, and the rest shows the characteristics of the identified special breast cancer, then this may be a type of mixed cancer: mixed duct and special cancer or mixed duct And lobular cancer. In addition, very few lesions are confused with non-specific ductal cancer.
Histological grade of invasive ductal cancer
- The WHO Breast Tumor Pathology and Genetic Classification (2003) recommends the use of Bloom-Richardson semi-quantitative histological classification modified by Elston and Ellis for histological classification of invasive ductal carcinoma of the breast (non-specific).
- The measurement parameters of this method include: the number of glandular ducts (based on the total area of the infiltrating component, and a sufficient number of sections), the degree of nuclear polymorphism and atypia (with the most prominent area of atypia in the tumor as the detection site) Number of mitotic images (counted in the most active area of tumor mitosis, and the value is determined according to the diameter or area of the high magnification field).
- This histological grading system can be used in principle for all invasive breast cancers, but it is not actually suitable for most special types of breast cancer (tubular cancer, invasive sieve cancer, mucinous cancer, myeloid cancer, and invasive lobular cancer) .
- Schedule: Elston and Ellis' modified Bloom-Richardson semi-quantitative grading method for invasive ductal carcinoma of the breast
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Invasive ductal carcinoma
- ICD-O code 8022/3
- Polymorphic carcinoma is a rare variant of advanced non-specific ductal carcinoma classified by histology. It is characterized by the increase of giant cells in singular polymorphic tumors, accounting for more than 50% of tumor cells. Its background is adenocarcinoma or adenocarcinoma With spindle and squamous differentiation. Patients ranged in age from 28 to 96 years, with an average of 51 years. Most patients present with palpable masses, and in 12% of cases the initial symptoms are metastatic tumors. The average tumor size is 5.4 cm, and most tumors can be cystic and necrotic.
- In most cases, tumor giant cells account for more than 75%, and the number of mitotic cells is greater than 20/10 HPF. All tumors were graded histologically. The intraepithelial components line up into a usually high-grade duct structure with necrosis. Lymphatic infiltration was present in 19% of cases.
- Usually BCL2, ER and PR are negatively expressed, TP53 is positive in 2/3 cases, and S-100 is positive in 1/3 cases. All cases are positive for CAM5.2, EMA, pan-cytokeratin (AE1 / AE3, CK1). Appears positive. The chromosomes of most tumor cells (68%) are aneuploid, of which 47% are triploid. 63% of cases showed a high S-score (> 10%). Axillary lymph node metastasis occurs in 50% of cases, often involving 3 or more lymph nodes. Most patients present with advanced disease.
Invasive ductal carcinoma with osteoclast-like giant cells
- ICD-O code 8035/3
- These tumors most often show osteoclast-like giant cells in the stroma, with inflammatory cell infiltration, fibroblasts, and angiogenesis, extravasated red blood cells, lymphocytes, and monocytes, as well as monocytes and binuclear cells. The tissue cells are lined together, some of which contain heme-containing. Giant cells vary in size, are surrounded by epithelial components, or exist in a cavity formed by cancer cells and contain varying numbers of nuclei. Giant cells and reactive angiogenesis can be seen in metastatic lymph nodes and recurrent lesions.
- The cancerous tissue type is usually invasive ductal carcinoma with high to moderate differentiation. Other types are also visible, especially invasive sieve carcinoma, tubal carcinoma, mucinous carcinoma, papillary carcinoma, lobular carcinoma, squamous cell carcinoma, and other metaplastic carcinomas.
- Lymphatic metastasis has been reported in approximately one-third of cases, with a five-year survival rate of approximately 70%, which is basically similar to or higher than that of common invasive cancer. The prognosis is related to related cancerous characteristics, but it does not seem to be affected by the tumor size in the stroma Cell effects.
- Giant cells all expressed CD68 (confirmed by KP1 antibodies in paraffin sections), and S-100, actin, cytokeratin, EMA, ER, and PR were negative. Acid phosphatase, non-specific esterase, and lysozyme were all strongly positive, while alkaline phosphatase expression was negative. In addition, the morphological characteristics of giant cells were similar to histiocytes and osteoclasts.
- Some cell ultrastructure and immunohistochemical studies have confirmed that this particular type of cancer can show the histological characteristics of osteoclasts. Recent in vitro experiments have also demonstrated that monocytes and macrophage precursor cells can directly form osteoclasts Cells and tumor-associated macrophages can differentiate into multinucleated cells that affect bone resorption during metastasis. Osteoclast-like giant cells present in cancer may also be associated with TAMs. Cancer-induced angiogenesis and leukocyte chemotaxis may be related to the migration of tissue cells to the tumor area and eventual transformation into osteoclast-like giant cells.
Invasive Ductal Carcinoma with Features of Choriocarcinoma
- Human -chorionic gonadotropin (-HCG) can be elevated in the plasma of patients with non-specific ductal cancer, and -HCG positive cells can be found in 60% of cases. The histological basis of choriocarcinoma-like differentiation is very small, only a few cases have been reported, and the age is between 50 and 70 years.
Invasive ductal carcinoma with melanin-like cancer
- Some case reports describe breast parenchymal tumors that share the characteristics of ductal carcinoma and malignant melanoma, and some of them have a transition from one cell to another. A recent genetic study of these types of lesions has demonstrated that all tumor cells show a loss of heterozygosity at the same site on the chromosome, suggesting that the tumor cells originate from the same tumor cell clone.
- The presence of melanin in breast cancer cells does not explain the basis of melanocyte differentiation. When breast cancer invades the skin and the dermal-epidermal junction, melanin deposits can appear in the cells. In addition, a careful distinction should be made between breast cancer with melanocyte differentiation and breast cancer with significant cytosolic lipofuscin deposition.
- Most breast melanomas are metastatic foci of malignant melanoma that originate outside the breast. Primary melanoma can occur anywhere on the breast skin, but the nipple areola area is extremely rare. The differential diagnosis of malignant melanoma in the nipple and areola area must include Paget's disease, which occasionally contains melanin deposits, which will be discussed in the section on Paget's disease.
Genetics of invasive ductal cancer
- The overall genetic variation of breast cancer is also reflected in non-specific ductal carcinoma, and it has recently been difficult to analyze or explain it. As the histological grade of the tumor increases (the degree of differentiation decreases), its genetic changes gradually increase. This phenomenon supports the hypothesis of a general linear evolution pattern of non-specific ductal cancer and invasive breast cancer. The results of recent studies on specific genetic variations associated with tumor histological types or non-specific ductal cancer grades do not support the above point of view, suggesting that the occurrence of non-specific ductal cancer includes some tumor evolution pathways that are not related to genetic factors. Specific breast cancers, including lobular and tubular cancers, show fundamental differences. Moreover, recent cDNA microarray analysis has demonstrated that non-specific ductal carcinomas can be classified into subtypes based on gene expression patterns.
Recipes for invasive ductal cancer
- Prescription:
- 30g of seaweed, 30g of kelp, 30g of cassia seed, 25g of Ligustrum lucidum. Decoction daily 2 times. Shanghai Cancer Hospital.
- Three root soup: 60g of vine pear root, 30g of wild grape root, 30g of osmanthus tree root, 30g of cloud fruit, 3g of star anise gold plate, 3g of raw southern star. Take orally, 1 dose daily, fry 2 times. Boil the raw Nanxing for 1-2 hours, then add other medicines to cook. We report 1 case of breast cancer cured by taking 2 months. Fangyuan Medical Station of Siwu Brigade, Majian Commune, Zhuji County, Zhejiang Province.
- Remedy:
- Musk 0.5 grams, 3 grams of Pinellia ternate, 3 grams of cloves, 3 grams of woody notes. Collaborate on fines, wrapped in a thin cotton gauze, and stuffed into the nostril on the opposite side.
- 100 grams of antlers. 100 grams of Xue Liguo. 10 grams daily, yellow sugar and vinegar.
- A few pieces of tortoise shell are roasted with yellow ground powder, and the meat of black jujube is smashed into pills, 10 grams per day, delivered with boiling water.
Surgical resection of invasive ductal cancer
- Surgical resection is one of the commonly used methods for the treatment of invasive ductal cancer. The surgical treatment of invasive ductal cancer is mainly based on radical surgery. Its principles are:
- Invasive ductal cancer nests and regional lymph nodes should be removed as a whole.
- Removal of all breast tissues, while extensively resect the skin covered by the surface.
- The pectoralis major and pectoralis minor were excised.
- The axillary lymph nodes are thoroughly dilated. Due to the wide range of resection, the patient's body is difficult to recover, and the appearance is also very significant. With the improvement of surgical techniques, improved surgical methods such as radical mastectomy and lumpectomy are increasingly used in the treatment of invasive ductal cancer Coming. Imitation radical surgery is a radical operation that preserves the pectoralis major muscle but removes its fascia. Through clinical observation, many scholars believe that the effect of imitation radical surgery is comparable to that of radical surgery. Lumpectomy is mainly used for the treatment of invasive ductal carcinoma with early infiltration.