DUCTAL HYPERPLASIA AND DUCTAL CARCINOMA I N-SITU

This review emphazises the pathology of premalignant ductal breast dis eases and its practical relevance to the patients management. The hist ological criteria for recognizing Ductal Hyperpiasia (DH) are now well established. These include an intraluminal heterogenous proliferation of glandular cells positive for keratins 8/18/19 and epithelial cells with expression of keratins 5/6/14. As a hyperplastic process the epi thelial cells disclose an haphazard irregular growth with slit like ir regular lumina (fenestrated growth pattern). The florid DH indicates a slight subsequent increased risk for cancer development. Our knowledg e of the nature of noninvasive ductal neoplasia continues to evolve. R ecent molecular genetic and immunohistochemical efforts have disclosed that atypical ductal hyperplasia (ADH) constituted a clonal neoplasti c proliferation of an epithelial cell. Histological hallmarks of ADH a re their cytologic features of uniformity and monotony of proliferatio n of cells and its micropapillary, cibriform or solid growth pattern. So from histology ADH simulates the highly differentiated DCIS, but ca n be distinguished from the latter quantitavely by the aggregate cross sectional diameter or the number of ducts that are completely involve d by the atypical proliferation. ADH indicates a few fold subsequent i ncreased risk for developing carcinoma. So this leson requires a close follow up with 3 to 4 examinations per year and annual mammograms. Du ctal carcinoma in situ (DCIS) consists of cytologically malignant cell s in the parenchyma that have not invaded into the stroma. Recent stud ies have shown that DCIS is a heterogenous group of tumors. Attempts h ave been made to classify it into histologic patterns, nuclear grades, tumors with or without comedo-necroses etc. We can draw the conclusio n from several studies that the most important histologic feature is t he nuclear grade. Holland et al. have suggested a very useful classifi cation scheme that includes nuclear grade and histological features. T he modifiers of treatment are as follows: 1. nuclear grade or differen tiation of the DCIS 2. extention of the lesion 3. excision with clear margins So efforts to classify DCIS underscore the central role of pat hology in determining the grade of the DCIS, its size and the adequacy of the surgical excision in terms of free margins. All three paramete rs are included in a score system of the Van Nuys Prognostic Index.