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Introduction & History.
• Carcinoma that doesn’t invade basement
membrane is call in-situ carcinoma .
• With increased use of mammography now
patient are presenting with these in greater
• currently accounts for approximately 25%
of all newly diagnosed breast cancers in
• LCIS was initially believed to be a
malignant lesion, but is now regarded more
as a risk factor for the development of
• outline of the normal lobule is maintained.
• The papillary and cribriform types of DCIS
are generally of lower grade
• The solid and comedo types of DCIS are
generally higher grade lesions.
• DCIS transforms into an invasive cancer.
• DCIS sometimes coexist with invasive
• The calcifications seen on a mammogram
generally correspond to areas within the
central involved duct in which there is often
necrosis and debris.
• an area of clustered calcifications on a
screening mammogram, without an
associated palpable abnormality.
• Rarely, DCIS will be manifested as a
• Unilateral, single-duct nipple discharge.
• Clustered calcifications without an
• Calcifications coexisting with an associated
• Density alone .
• DCIS calcifications
– tend to cluster closely together
– are pleomorphic,
– and may be linear or branching, thus suggesting
their ductal origin.
• treatment aims to remove the DCIS to prevent
progression to invasive disease
• Because the risk for metastatic disease in patients
with DCIS without demonstrable invasion is rare
(<1%), systemic chemotherapy is not required.
• Hormonal therapy may be used for prevention of
new primary tumors and to improve local control
after breast-conserving therapy but is generally
only recommended when the DCIS is positive for
ER on immunohistochemistry.
• Treatment recommendations for an
individual patient with DCIS are based on
the extent of disease within the breast,
histologic grade, ER status, and presence of
microinvasion, as well as patient age and
• Treatment options for DCIS include
mastectomy, breast-conserving surgery with
irradiation, and breast-conserving surgery
• When the patient is treated with breast
conservation or unilateral mastectomy, there
is also the option of adjuvant hormonal
therapy with tamoxifen as risk reduction for
future breast cancers.
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