Regressive change in high-grade ductal carcinoma in situ of the breast: histopathologic spectrum and biologic importance.
OBJECTIVE
High-grade ductal carcinoma in situ (HG-DCIS) of the breast often shows tumor attenuation and reactive fibrosis. These changes, previously described as "regressive," have been paradoxically associated with an increased risk of invasive carcinoma. We aimed to further characterize the spectrum of the so-called regressive changes (RCs) in HG-DCIS.


METHODS
We reviewed 52 consecutive cases of HG-DCIS on biopsy specimens followed by excision. RCs were divided into early (stage 1) and advanced (stages 2 and 3) stages according to the degree of ductal fibrosis and tumor effacement. The presence of inflammation, hormone receptor status, and diagnosis on excision were recorded.


RESULTS
RCs were seen in 51 (98%) cases: 96%, 76.4%, and 39.2% cases showed stages 1, 2, and 3, respectively. Periductal T cells with a normal CD4/CD8 ratio were constantly seen. Advanced RCs and inflammation were more frequent in estrogen and progesterone receptor-negative tumors. RCs were not associated with invasion but correlated with a larger residual HG-DCIS volume on excision.


CONCLUSIONS
Regression in HG-DCIS is frequent. It may reflect a targeted immune response to certain phenotypes, mainly hormone receptor-negative lesions. Nonetheless, RCs do not lead to complete tumor obliteration but correlate with aggressive tumor characteristics instead.
From the Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital and Eastern Ontario Regional Laboratory Association, Ottawa, Canada.
Jason K
JK
Wasserman
From the Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital and Eastern Ontario Regional Laboratory Association, Ottawa, Canada. cparra@toh.on.ca.
Carlos
C
Parra-Herran
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading
Breast cancer; Breast pathology; Ductal carcinoma in situ; Regression