• Slide 1: Low power view of DCIS cribriform type involving multiple dilated ducts. Periductal fibrosis and chronic inflammation occur in the stroma.
• Slide 2: Extension of DCIS into lobules, so called cancerization of lobules, results in solid expansion of the acini and ductules. Notice the preservation of lobular architecture.
• Slide 3: Cross section of excised specimen for abnormal mammographic calcifications. The cystic lesion on the left side of the slide represents intraductal papilloma. On the right side of the papilloma is fibrous breast tissue, in which the presence of DCIS is confirmed microscopically. There is no lesion evident by gross examination. Without proper handling the specimen with black and red dyes indicating surgical margins, the involved margin may be accurately determined.
• Slide 4: Extensive comedo type of DCIS. This firm tan tissue has multiple tiny spaces containing necrotic material, evident when compressing the specimen.
• Slide 5: DCIS, papillary type. The dilated ducts are lined by multiple finger-like projections.
• Slide 6: DCIS, papillary type. Higher magnification of slide 5 to reveal most of the papillary projections are not supported by fibrovascular cores.
• Slide 7: DCIS, papillary type. Dilated ducts are lined by multiple isolated papillae, some of which are fused to form Roman arches. The lumens contain necrotic and secretory material.
• Slide 8: DCIS, papillary type. Higher magnification to demonstrate roman arches derived from fusion of individual papillae. Notice the lack of fibrovascular cores within the papillae.
• Slide 9: DCIS, cribriform type. Multiple sieve-like glandular spaces occur within a large duct.
• Slide 10: DCIS, cribriform type. Higher magnification to reveal cribriform spaces made up of a homogeneous population of cells which have uniformly round to oval nuclei. These nuclei have low grade atypia.
• Slide 11: DCIS, solid type. Solid filling of the ducts by malignant cells without necrosis.
• Slide 12: DCIS, solid type. Higher magnification to reveal the nuclei to be enlarged, hyperchromatic, irregular in size and shape. Nucleoli are small and few in number. The nuclear grade falls into the intermediate category.
• Slide 13: DCIS, comedo type. Solid sheets of malignant cells fill the Dilated ducts. The center of the involved ducts undergoes necrosis (pink color) and calcification (purple color).
• Slide 14: DCIS, comedo type. Coarse calcifications occur within the center of involved ducts by DCIS.
• Slide 15: DCIS, comedo type. The lining cells have large, round to oval hyperchromatic nuclei and prominent nucleoli characteristic of high grade appearance.
• Slide 16: Low nuclear grade. Small to medium sized nuclei which are uniformly round to oval in shape. There is little variation in nuclear size. The chromatin particles are finely granular and evenly distributed. Nucleoli are absent or indistinct.
• Slide 17: Intermediate nuclear grade. The nuclei are medium to large in size and moderately irregular in shape. The chromatin particles vary from finely to coarsely granular. Small nucleoli are evident.
• Slide 18: High nuclear grade. The nuclei are large, hyperchromatic, and highly variable in size and shape. The chromatin particles are coarsely granular and unevenly distributed. The nucleoli are large and easily seen.
• Slide 19: High nuclear grade. The nuclei are pleomorphic and gigantic. The vesicular appearance results from uneven distribution of coarse chromatin. The nucleoli are prominent and multiple.

References

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• Silverstein MJ, Lagios MD, Craig P, et al: A prognostic index for ductal carcinoma in situ of the breast. Cancer 1996; 77:2267-74.
• Silverstein MJ, Poller DN, Waisman JR, et al: Prognostic classification of breast ductal carcinoma-in-situ. Lancet 1995; 345:1154-57.
• Tavassoli FA: Pathology of the Breast. Elsevier, New York, 1992