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Query: UMLS:C0007124 (ductal carcinoma in situ)
 3,833 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have investigated the effects of preoperative radiotherapy on T1 N0 breast cancer and studied the relationships between residual cancer after lumpectomy and II clinicopathological factors. Radiotherapy was basically ineffective against intraductal carcinoma. However, in the preoperative radiation group, there were more hormone-receptor positive and histologically well-differentiated cases than in the non-radiated stage I patients. Mitotic figures were also significantly reduced after radiotherapy, whereas the expression of c-erb-B-2 protein was unchanged between the two groups. Residual cancer rates were 40% and significantly higher in patients with: 1) tumor diameters of 3.1 cm or larger; 2) tumors beneath or in the vicinity of the nipple-areola; 3) malignant calcifications noted in mammography findings; 4) serous or bloody nipple discharge, particularly with positive cytologic findings; 5) papillotubular carcinoma; 6) lymphatic invasion by tumor cells; and 7) a high degree (n > or = 4) of lymph node metastases. Our date indicate the varying radiosensitivity of breast cancer cells, the indications for hormone therapy and the prognostic usefulness of these seven clinicopathological factors in breast conservation therapy.
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PMID:[Problems of breast conservation therapy--residual cancers after lumpectomy and effects of preoperative radiotherapy]. 803 84

In case of abnormal nipple discharge of the female breast, galactography can detect variations of ductal calibre, intraductal alterations and ductal discontinuities. Between 1964 and 1990 we examined 2588 women by galactography and performed 826 duct excisions. In one out of 8 patients (13.4%) we diagnosed invasive carcinoma or ductal carcinoma in situ. In more than 40% a solitary ductal papilloma was detected. 13.7% of the patients were found to have extensive intraductal solid papillary or adenomatous epithelial proliferations. Comparison with collected statistical data reveals that other investigators are able to detect malignant changes in 1-23% of cases. We have managed the largest number of cases and have diagnosed pathologic ductal secretion in more than 3% of women we screened by physical inspection, mammography and sonography. The colour of the ductal discharge is of minor importance, as histologic analysis is mandated by the presence of ductal system alterations.
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PMID:Nipple discharge and abnormal galactogram. Results of a long-term study (1964-1990). 826

Thirty-one consecutive cases of ductal carcinoma in situ (DCIS) were retrospectively analysed to determine the spectrum of mammographic appearances. 68 per cent of the lesions appeared as microcalcifications, 52% as structural or irregular, poorly defined soft-tissue abnormalities, respectively. A mass lesion was noted in 23% of cases. 4 patients presenting with DCIS had negative mammograms and were diagnosed by means of additional examination techniques such as galactography, sonography, and cytologic evaluation in case of bloody nipple discharge. The authors conclude that there is a wide spectrum of mammographic imaging of DCIS.
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PMID:[Breast ductal carcinoma in situ. The clinical image in the mammogram]. 830 89

The treatment of intraductal breast carcinoma, ranging from local incision alone to modified radical mastectomy, remains controversial. Seventy-nine patients were treated for intraductal breast carcinoma, noncomedo type at our institution from 1975 to 1991. There were 78 females and one male with a mean age of 58 years and a range from 32 to 90 years. Clinical presentation included a palpable mass in 25 patients, abnormal mammogram in 60 patients, and nipple discharge in 12 patients. Treatment consisted of local excision in 19 patients, simple mastectomy in 25 patients, and modified radical mastectomy in 35 patients. Twenty-five patients underwent simultaneous prophylactic contralateral mastectomy. Choice of treatment was determined by physician preference and no differences were seen in family history, parity, nipple discharge, history of fibrocystic disease, presence of palpable lymph nodes, tumor size, tumor location, patient age, or mammographic findings. Forty-five patients had multicentric tumors on final pathology. One patient demonstrated an axillary lymph node metastasis following modified radical mastectomy raising the question of undetected invasive carcinoma. All patients were free of disease at last evaluation and no differences in survival were noted between different treatment groups with a mean follow up of 5 years. We conclude that local excision is an appropriate option for treatment of intraductal breast carcinoma noncomedo type.
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PMID:Treatment of intraductal breast cancer--noncomedo type. 838 87

Endocrine ductal carcinoma in situ (E-DCIS), first characterized by Cross et al. in 1985, is an uncommon entity, and there is little information on its pathobiologic features and natural history in the literature. This report describes the largest series of 34 cases: 14 cases were pure in situ (group A), and 20 were accompanied by an invasive component (group B). All except three patients were over the age of 60 years, with the mean being 69.5 years for group A and 72.6 years for group B. Except for six patients in group A who had nipple discharge, all had a breast mass. On follow-up, one of five group A patients developed local recurrence 5 years after mastectomy, and two of seven group B patients developed another invasive primary in the contralateral breast. Histologically, E-DCIS showed expansile intraductal growths forming solid sheets and festoons traversed by delicate fibrovascular septa. Accumulation of basophilic mucin might be found within the growth and the fibrovascular septa. There were variable degrees of stromal sclerosis. In some cases, the solid intraductal cellular proliferations were focally punctuated by microglandular spaces and rosettes. Comedo necrosis was absent. Intraductal papillomas were found in the immediate vicinity of the tumors in 18 cases and invariably showed pagetoid involvement by E-DCIS. Pagetoid spread into the adjacent ducts and ductules was also a common feature (17 cases). The tumor cells were polygonal, oval, or spindly, often with eccentrically placed, bland-looking, ovoid nuclei and abundant eosinophilic granular cytoplasm. Intracellular mucin was commonly demonstrable. Immunostaining for myoepithelium using muscle-specific actin antibody confirmed the in situ nature of the E-DCIS component. The majority of tumor cells showed strong staining with the neuroendocrine markers chromogranin, synaptophysin, and neuron-specific enolase (monoclonal). Immunostaining also dramatically highlighted the pagetoid spread into the papillomas and ductules by outlining the tumor cells between the negatively stained residual ductal epithelium and myoepithelium. All cases were immunoreactive for estrogen and progesterone receptor, but not p53 and c-erbB2. The Ki-67 index was < 5%. Ultrastructural studies on four cases showed many dense-core neurosecretory granules and larger mucigen granules. In group B cases, the invasive component, which comprised 5-95% of the tumor, included colloid carcinoma, 12; "carcinoid" tumor, 3; mixed "carcinoid"/colloid carcinoma, 4; and small cell neuroendocrine carcinoma, 1. Neuroendocrine markers were also consistently demonstrable in the invasive component. In conclusion, E-DCIS is predominantly a disease of older women that is frequently accompanied by papillomas in the vicinity and may present as nipple discharge (an uncommon presentation in the usual forms of DCIS). It can mimic epitheliosis histologically, but the pagetoid spread is a helpful clue to its neoplastic nature. The bland nuclear morphology, lack of necrosis, and biologic marker profile suggest that E-DCIS is a form of low-grade DCIS despite its solid growth pattern. The invasive carcinomas associated with E-DCIS are also neuroendocrine programmed rather than the usual types of ductal carcinomas, suggesting that E-DCIS represents a biologically distinctive category of DCIS.
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PMID:Endocrine ductal carcinoma in situ (E-DCIS) of the breast: a form of low-grade DCIS with distinctive clinicopathologic and biologic characteristics. 871 93

Breast papillomas with areas of atypical proliferation reminiscent of ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH) are rare, but pose considerable diagnostic difficulty when encountered. The clinicopathologic features of 20 women 27 to 78 years of age with papillomas having atypical proliferations are reviewed. They presented with palpable masses or nipple discharge. Histologically, parts of all lesions had features of papillomas with a biphasic proliferation of benign epithelial cells and myoepithelial (ME) cells. Part of the lesion in each papilloma also had an expansile proliferation of larger uniform cells having evenly spaced, round nuclei and a solid to subtle cribriform growth pattern, similar to ADH or DCIS. These lesions tended to be large, complex or multiple. Twelve patients had 4 to 20 years of follow-up after biopsy only. One each had concurrent and previous contralateral breast carcinoma. Two developed invasive carcinoma of the contralateral breast in 15 and 18 years, respectively. Two developed DCIS on the same side in 2 and 8 years. Six had recurrent papillomas with (5) or without (1) ADH in 1 to 7 years all of whom had no further problems. Only 3 of 12 patients are event free. In contrast, only 8 recurrent papillomas, and 1 ipsilateral invasive carcinoma and 2 contralateral carcinomas occurred in 60 patients with papillomas without ADH in 4 to 18 years. Thus, the patients having ADH within papillomas seem to have greater likelihood of subsequent disease such as recurrences or overt neoplasia, but the length of follow-up and number of patients are not large enough to provide definitive answers. Because none of the patients developed invasive carcinoma on the same side, conservative management with close observation similar to that following a diagnosis of ADH seems to be appropriate.
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PMID:Breast papillomas with atypical ductal hyperplasia: a clinicopathologic study. 891 36

In this study, 26 cases of nonpalpable breast cancer with nipple discharge treated at our department were reviewed. Their discharge was either bloody or serous with a positive hematest, but all except for one were negative for cytology, while CEA value of the discharge was high in 72.7%. Mammograms were found to be unreliable for diagnosis, while abnormal findings were observed in 84.6% by ductography. However, final diagnosis was determined histopathologically from surgical specimens, showing 14 intraductal and 12 invasive ductal cancers, none with components of comedo carcinomas. Seventeen patients underwent mastectomy following duct-lobular segmentectomy and a small remnant of intraductal carcinoma was found microscopically in only one patient. All patients except for one have survived for 98 months on average with no symptoms of metastasis. These findings suggest that duct-lobular segmentectomy with an adequate surgical margin should be adopted as the final operation for selected patients with nonpalpable breast cancer involving nipple discharge.
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PMID:Nonpalpable breast cancer with nipple discharge: how should it be treated? 906 22

From 1970 to 1992, 31 pure ductal carcinoma in situ (DCIS) of the male breast treated in 19 French Regional Cancer Centres were reviewed. They represent 5% of all breast cancers treated in men in the same period. The median age was 58 years, but 6 patients were younger than 40 years. TNM classification (UICC, 1978) showed 12 T0 (discovered only by bloody nipple discharge), 10 T1, 5 T2 and four unclassified tumours (Tx). 11 patients (35.5%) had clinical gynecomastia, and three (10%) had a family history of breast cancer. 6 patients underwent lumpectomy, and 25 mastectomy. Axillary dissection was performed in 19 cases. 6 cases received postoperative irradiation. 15 out of 31 lesions were of the papillary subtype, pure or associated with a cribriform component. The size of the 12 measured lesions varied from 3 to 45 mm. All lymph nodes sampled were negative. With a median follow-up of 83 months, 4 patients (13%) presented a local relapse (LR), respectively, at 12, 27, 36 and 55 months. 3 of these patients had been initially treated by lumpectomy. In one case LR was still in situ, but already infiltrating in the 3 others. Radical salvage surgery was performed in 3 cases, but one patient developed metastases and died 30 months later. The last patient was treated by multiple local excisions and tamoxifen. One 43-year-old patient developed a contralateral DCIS and three others developed a metachronous cancer. The aetiology and risk factors of male breast cancer remain unknown. Gynecomastia, which implies an imbalance between androgen and oestrogen, may be a predisposing factor. As in women, DCIS in the male breast has a good prognosis. Total mastectomy without axillary dissection is the basic treatment. Frequently, the first symptom is a bloody nipple discharge. The age of occurrence is younger than for infiltrating carcinoma, suggesting that DCIS is the first step in the development of breast cancer.
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PMID:Ductal carcinoma in situ of the male breast. Analysis of 31 cases. 907 92

A new method of galactography using magnetic resonance imaging for a patient with nipple discharge is developed. The method is as follows; coronal T1-weight images are obtained after an injection of contrast medium of 1 mmol/L Gd-DTPA directly into the discharge duct, before and after rapid intravenous infusion of Gd-DTPA. A case of a 29-year-old woman with ductal carcinoma in situ with minimal invasion is reported, in which all portions of the entire discharge duct system is clearly shown as viewed from the surface and the surrounding area is enhanced with Gd-DTPA. The enhanced area is coincidental with the extent of the disease. This magnetic resonance galactography for patients with nipple discharge may be used to supplement conventional mammography and/or galactography especially for the evaluation of the extent of disease, although it is somewhat inferior to mammographic galactography in terms of differential diagnosis of ductal disease.
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PMID:Magnetic resonance galactography for a patient with nipple discharge. 911 23

Currently, mammography is the only method of detecting nonpalpable, early breast cancer. At this stage, 90% of the cancers are curable. Clearly, this fundamental tenet accentuates the importance of compliance and knowledge of guidelines. Although risks of mammography are minimal to nil, interpretation occasionally can be challenging, with equivocal results. New technologies are being evaluated and advances in measurement of cellular electrical potential differentials in breast tissue have produced exciting results, when compared with mammography and ultrasound. These screening efforts have increased the diagnosis of both invasive and noninvasive ductal and lobular carcinoma of the breast. For DCIS in particular, conservative, contemporary treatment options exist. These include lumpectomy with breast irradiation excluding axillary dissection. Selected patients may be treated with only lumpectomy. Although breast carcinoma is a major focus due to incidence, morbidity and mortality, the varieties of benign conditions cause many women genuine concern. Treatment options for fibrocystic change run a gamut, including cost-effective basic dietary changes, vitamin use, "health"/natural type treatments, analgesic, as well as hormonal manipulations and, on occasion, surgical intervention. Fortunately, with most patients, common sense and conservatism prevail. The presence of fibroadenomas diagnosed clinically, by ultrasound or mammography, in women aged 18-25 and beyond can create perplexing diagnostic dilemmas. Should the lesion be removed or observed? Differences of opinion exist and must be tempered by recent observations that women with complex fibroadenomas, sclerosing adenosis, epithelial calcification or papillary appocrine changes have a two- to threefold increased risk of breast cancer. The key to management in all these clinical situations is individualization. Conservatism is particularly acceptable in women under the age of 25 if a fibroadenoma is not increasing in size or not psychologically disturbing. Provoked or unprovoked nipple discharge is a clinical conundrum for patients. It is unsuspected and unwanted. While some whitish discharges result from stimulation or medication, others may have a more subtle etiology. Serous, serosanguineous, or bloody discharges mandate evaluation. Duct injection mammography and frequent excision of ductal systems are necessary. The clinician cannot forget other less common conditions, such as thrombophlebitis, fat necrosis, or infection. All clinical conditions of the breast provide a constellation of diagnostic and management problems. They are of real concern for every woman and must be resolved in an appropriate, prompt, and conscientious fashion.
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PMID:Breast disease: a primer on diagnosis and management. 940 32


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