A 38-year-old woman has a 1.8 cm breast mass on imaging. Core biopsy shows malignant cells arranged in cribriform architecture within distended ducts with central necrosis and high nuclear grade. No stromal invasion is identified. Which is the most likely diagnosis?
- A Cribriform ductal carcinoma in situ, high grade ✓
- B Solid ductal carcinoma in situ, low grade
- C Microinvasive ductal carcinoma
- D Atypical ductal hyperplasia
Correct answer: A. Cribriform ductal carcinoma in situ, high grade
Explanation
The combination of cribriform architecture within distended ducts, central necrosis, and high nuclear grade in a non-invasive lesion is diagnostic of high-grade DCIS (comedo/cribriform type). Solid DCIS lacks cribriform spaces. Microinvasive carcinoma requires a focus of invasion beyond the basement membrane. ADH is a partial duct filling by a monomorphic proliferation, smaller and lacking necrosis and high-grade nuclei.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.