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| Infiltrating Duct Carcinoma |
| Etiology • Unknown |
| Pathogenesis • BRCA1 either inherited or somatically mutated with loss of heterozygosity may remove suppression of cell growth by gene product • Gene product is a granin (same family as chromogranin seen in neurosecretory granules) • Bound to RNA polymerase II holoenzyme with impact on transcription • Other pathogenetic mechanisms not known., |
| Epidemiology • Affects 1 of 9 women in the U.S. • Increases with increasing age • More frequent in women of low parity with first child after 30 • Increased in obesity • Increased in women with history of atypical hyperplasia • Increased in women with history of breast carcinoma • Increased in women with mother or sibling with breast cancer • Increased in women with mutations in BRCA1 or BRCA2 genes |
| General Gross Description • Most are gritty and extremely hard • Stellate • Gray-white with yellow streaks |
| General Microscopic Description • Ducts embedded in fibrous stroma (desmoplasia) • Ducts may be well formed or show only an occasional lumen • Cells have large round to oval nuclei, prominent nucleoli, and an increased N:C • Cytoplasm usually contains mucin • Mitoses may be abundant • Microcalcification seen either in tumor or associated intraductal carcinoma or adjacent benign disease • Often associated with in situ disease • Grading dependent on nuclear atypia, how well glands are formed and mitotic activity |
| Clinical Correlation • Neoplasm spreads to regional (axillary) lymph nodes and then to distant sites including lungs, liver, and bones • Treatment and prognosis dependent on tumor size and presence of metastatic disease in lymph nodes or distant sites (stage) and estrogen and progesterone receptor status • Tumor grade, DNA content and proliferative index, and presence of c-erbB2 amplification also have prognostic implications • Therapy includes local treatment (surgery and/or radiation treatment of the breast) and systemic therapy if warranted with either anti-estrogens (if the neoplasm is receptor positive) or chemotherapy |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th edition. Philadelphia, W.B. Saunders, 1994, pp. 1099-1108. |
| Infiltrating Duct Carcinoma |
| Synopsis by: Melinda Sanders M.D. (T04000M85003)[306] |
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