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Solid papillary ductal carcinoma in situ versus usual ductal hyperplasia in the breast: a potentially difficult distinction resolved by cytokeratin 5/6.
Hum Pathol. 2006 Jul; 37(7):787-93.HP

Abstract

The solid papillary variant of ductal carcinoma in situ is an uncommon entity, which usually presents in the seventh or eighth decade and may be associated with invasive mucinous carcinoma. Solid papillary ductal carcinoma in situ (SP-DCIS) shares many morphological features with usual ductal hyperplasia (UDH) involving a papilloma: papillary architecture, solid growth, cellular streaming, and low-grade nuclear features. These similarities can make the distinction between these 2 entities challenging. Recent studies have demonstrated that immunohistochemical staining for cytokeratin 5/6 can distinguish UDH from conventional forms of ductal carcinoma in situ. Most of the epithelial cells of UDH express cytokeratin 5/6, but the tumor cells of ductal carcinoma in situ do not. We tested the hypothesis that the results of staining for cytokeratin 5/6 can distinguish UDH from the solid papillary variant of ductal carcinoma in situ. Immunohistochemical staining of 14 cases of SP-DCIS and 9 cases of UDH (4 involving papillomas) was performed using cytokeratin 5/6 antibody clone D5/16 B4. Strong cytoplasmic or membrane staining was considered positive. The hyperplastic cells in all cases of UDH showed strong staining for cytokeratin 5/6. The percentage of positive cells ranged from 50% to 80%. None of the SP-DCIS tumor cells stained for cytokeratin 5/6; however, many cases did show staining of occasional entrapped, benign epithelial, and myoepithelial cells. We conclude that the absence of strong cytokeratin 5/6 expression by SP-DCIS distinguishes it from its morphological mimic, UDH. Pathologists must guard against misinterpreting SP-DCIS as UDH in those cases in which the carcinoma cells engulf cytokeratin 5/6-expressing residual, native epithelial cells.

Authors+Show Affiliations

Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA. joseph.rabban@ucsf.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16784976

Citation

Rabban, Joseph T., et al. "Solid Papillary Ductal Carcinoma in Situ Versus Usual Ductal Hyperplasia in the Breast: a Potentially Difficult Distinction Resolved By Cytokeratin 5/6." Human Pathology, vol. 37, no. 7, 2006, pp. 787-93.
Rabban JT, Koerner FC, Lerwill MF. Solid papillary ductal carcinoma in situ versus usual ductal hyperplasia in the breast: a potentially difficult distinction resolved by cytokeratin 5/6. Hum Pathol. 2006;37(7):787-93.
Rabban, J. T., Koerner, F. C., & Lerwill, M. F. (2006). Solid papillary ductal carcinoma in situ versus usual ductal hyperplasia in the breast: a potentially difficult distinction resolved by cytokeratin 5/6. Human Pathology, 37(7), 787-93.
Rabban JT, Koerner FC, Lerwill MF. Solid Papillary Ductal Carcinoma in Situ Versus Usual Ductal Hyperplasia in the Breast: a Potentially Difficult Distinction Resolved By Cytokeratin 5/6. Hum Pathol. 2006;37(7):787-93. PubMed PMID: 16784976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Solid papillary ductal carcinoma in situ versus usual ductal hyperplasia in the breast: a potentially difficult distinction resolved by cytokeratin 5/6. AU - Rabban,Joseph T, AU - Koerner,Frederick C, AU - Lerwill,Melinda F, Y1 - 2006/05/26/ PY - 2006/01/05/received PY - 2006/02/12/revised PY - 2006/02/21/accepted PY - 2006/6/21/pubmed PY - 2006/8/5/medline PY - 2006/6/21/entrez SP - 787 EP - 93 JF - Human pathology JO - Hum Pathol VL - 37 IS - 7 N2 - The solid papillary variant of ductal carcinoma in situ is an uncommon entity, which usually presents in the seventh or eighth decade and may be associated with invasive mucinous carcinoma. Solid papillary ductal carcinoma in situ (SP-DCIS) shares many morphological features with usual ductal hyperplasia (UDH) involving a papilloma: papillary architecture, solid growth, cellular streaming, and low-grade nuclear features. These similarities can make the distinction between these 2 entities challenging. Recent studies have demonstrated that immunohistochemical staining for cytokeratin 5/6 can distinguish UDH from conventional forms of ductal carcinoma in situ. Most of the epithelial cells of UDH express cytokeratin 5/6, but the tumor cells of ductal carcinoma in situ do not. We tested the hypothesis that the results of staining for cytokeratin 5/6 can distinguish UDH from the solid papillary variant of ductal carcinoma in situ. Immunohistochemical staining of 14 cases of SP-DCIS and 9 cases of UDH (4 involving papillomas) was performed using cytokeratin 5/6 antibody clone D5/16 B4. Strong cytoplasmic or membrane staining was considered positive. The hyperplastic cells in all cases of UDH showed strong staining for cytokeratin 5/6. The percentage of positive cells ranged from 50% to 80%. None of the SP-DCIS tumor cells stained for cytokeratin 5/6; however, many cases did show staining of occasional entrapped, benign epithelial, and myoepithelial cells. We conclude that the absence of strong cytokeratin 5/6 expression by SP-DCIS distinguishes it from its morphological mimic, UDH. Pathologists must guard against misinterpreting SP-DCIS as UDH in those cases in which the carcinoma cells engulf cytokeratin 5/6-expressing residual, native epithelial cells. SN - 0046-8177 UR - https://www.unboundmedicine.com/medline/citation/16784976/Solid_papillary_ductal_carcinoma_in_situ_versus_usual_ductal_hyperplasia_in_the_breast:_a_potentially_difficult_distinction_resolved_by_cytokeratin_5/6_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0046-8177(06)00119-5 DB - PRIME DP - Unbound Medicine ER -