title: Ductal carcinoma in situ of the breast: the importance of morphologic and molecular interactions.
abstract: Ductal carcinoma in situ (DCIS) of the breast is a lesion characterized by significant heterogeneity, in terms of morphology, immunohistochemical staining, molecular signatures, and clinical expression. For some patients, surgical excision provides adequate treatment, but a subset of patients will experience recurrence of DCIS or progression to invasive ductal carcinoma (IDC). Recent years have seen extensive research aimed at identifying the molecular events that characterize the transition from normal epithelium to DCIS and IDC. Tumor epithelial cells, myoepithelial cells, and stromal cells undergo alterations in gene expression, which are most important in the early stages of breast carcinogenesis. Epigenetic modifications, such as DNA methylation, together with microRNA alterations, play a major role in these genetic events. In addition, tumor proliferation and invasion is facilitated by the lesional microenvironment, which includes stromal fibroblasts and macrophages that secrete growth factors and angiogenesis-promoting substances. Characterization of DCIS on a molecular level may better account for the heterogeneity of these lesions and how this manifests as differences in patient outcome and response to therapy. Molecular assays originally developed for assessing likelihood of recurrence in IDC are recently being applied to DCIS, with promising results. In the future, the classification of DCIS will likely incorporate molecular findings along with histologic and immunohistochemical features, allowing for personalized prognostic information and therapeutic options for patients with DCIS. This review summarizes current data regarding the molecular characterization of DCIS and discusses the potential clinical relevance.
authors.affiliation: Department of Pathology, Thomas Jefferson University, Philadelphia, PA 19107. Electronic address: Stacey.Mardekian@jefferson.edu.
authors.forename: Stacey K
authors.initials: SK
authors.lastname: Mardekian
authors.affiliation: Department of Pathology, Albert Einstein Medical Center, Philadelphia, PA 19141. Electronic address: BombonaA@einstein.edu.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bombonati
authors.affiliation: Department of Pathology, Thomas Jefferson University, Philadelphia, PA 19107. Electronic address: Juan.Palazzo@jefferson.edu.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Palazzo
mesh_terms: D000818:Animals; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics*; D001706:Biopsy; D001943:Breast Neoplasms / Q000737:chemistry / Q000235:genetics* / Q000473:pathology / Q000628:therapy; D002277:Carcinoma / Q000737:chemistry / Q000235:genetics* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000737:chemistry / Q000235:genetics* / Q000473:pathology / Q000628:therapy; D018450:Disease Progression; D044127:Epigenesis, Genetic; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D020022:Genetic Predisposition to Disease; D006801:Humans; D007150:Immunohistochemistry; D008408:Mastectomy; D025202:Molecular Diagnostic Techniques; D009364:Neoplasm Recurrence, Local; D010641:Phenotype; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Biomarkers; Ductal carcinoma in situ; Gene expression; Invasive ductal carcinoma; Myoepithelial cells; Tumor microenvironment