Histopathology. 2008 Nov;53(5):545-53.

Neovascularization in mucinous ductal carcinoma in situ suggests an alternative pathway for invasion.

Gadre SA, Perkins GH, Sahin AA, Sneige N, Deavers MT, Middleton LP.

Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.

Abstract

AIMS: Ductal carcinoma in situ (DCIS) associated with invasive mucinous carcinoma (IMC) has not been well characterized. The aim was to characterize mucinous DCIS (mDCIS) of the breast and to describe, to our knowledge for the first time, neovascularization in mucin.

METHODS AND RESULTS: The pathology reports and slides were reviewed from 44 patients treated between 2003 and 2006 at The University of Texas M. D. Anderson Cancer Center, whose diagnosis fulfilled the criteria of IMC or DCIS with mucin production. The patients, all female, had a mean age of 62 years. DCIS was present in 93% of cases and the predominant histological types were solid, cribriform and micropapillary. The DCIS was grade 1 in 12 of 41 cases (29.3%), grade 2 in 25 of 41 cases (61%) and grade 3 in four of 41 cases (9.8%). Mucin was seen in the lumen of the ducts involved by DCIS in 88% of cases, mucin and vessels in 63.4% of cases and neither mucin nor vessels in 12.2%. The DCIS was vascular endothelial growth factor-positive, platelet-derived growth factor receptor-beta-positive and CDX-2-negative (100%). Occasional luminal cells within the DCIS were immunopositive for CD68.

CONCLUSIONS: A significant number of mDCIS showed neovascularization in intraluminal mucin. When identified on core needle biopsy, the presence of vascularized mucin should not be used alone to discriminate between invasive and in situ carcinoma. A hypothesis proposed for the source of recruitment of vessels in the mucin is that mucin can promote neovascularization and that tumour cells invade not into the adjacent fibroconnective tissue, but rather into the mucinous, richly vascularized stroma that they have induced. Alternatively, it is possible that both cells and their secretory product invade together. To our knowledge, this is the first study to characterize neovascularization within the mucinous component of DCIS associated with and without IMC.

1）有此一说：

黏液外溢时，肌上皮存在；如果没有ADH或DCIS，漂浮的上皮条索呈线状；如果有ADH或DCIS，其形态与周围ADH或DCIS相似。粘液癌时，漂浮的癌细胞团无肌上皮。当然这是纯理论，实际工作中即使染肌上皮也可能无法区分。

另一说：脱落的上皮保持周围管腔的轮廓。

2）无充分依据的推测：

原位癌进展为浸润性癌，在细胞遗传学上需要获得某种基因突变，能够突破基底膜、促血管、在原来的生长部位之外继续存活繁殖。机械作用造成的上皮移位（包括原位癌），其细胞没有上述突变，因此不能存活，会发生退变、死亡。因此无转移危险。

另一个推测依据：做细胞培养时，条件非常严格，普通细胞很难在另一种环境下存活、生长。

这两个问题非常期望有研究经验的老师解答，或者提供资料。

谢谢金老师！