Metastatic basaloid carcinoma present in a lymph node of unknown primary (A, hematoxylin-eosin) lacks diffuse staining for BerEp4 (B), shows diffuse staining for cytokeratin 14 (C), except in zones of comedonecrosis
, and shows patchy staining for cytokeratin 17 (D) in the metastatic epithelial component.
They feature large ducts with solid, papillary, and comedonecrosis
areas (figure 1).
The latter may appear as nests of basal-type cells with scanty cytoplasm, central comedonecrosis
, and peripheral palisading.
Grading variants of adenocarcinoma include ductal adenocarcinomas, which should be graded as Gleason score 4 + 4 = 8, whereas prostatic intraepithelial neoplasia-like adenocarcinoma should be graded as Gleason pattern 3 and ductal adenocarcinoma with comedonecrosis
should be graded as Gleason pattern 5, retaining the diagnostic term ductal adenocarcinoma to denote unique clinical and pathologic findings.
A high number of mitotic figures is present, and the tumor shows extensive coagulative necrosis with areas of central comedonecrosis
is diagnostic of IDC-P but is only present in a subset of cases (Figure 2, E).
True tumor comedonecrosis
suggests malignancy (figure 2, B).
A solid pattern of the intraductal component and, rarely, comedonecrosis
may be also found.
The authors concluded that this group of tumors merited distinction as an independent entity and proposed the name adnexal clear cell carcinoma with comedonecrosis
Mitotic figures and comedonecrosis
may also be seen.
A precursor high-grade ductal carcinoma in situ with comedonecrosis
and a basal immunophenotype has been identified (27) and represents hope that future screening mammography, instituted earlier than for white patients, might detect the associated microcalcifications, allowing surgical intervention before invasion develops.
Necrosis in AC has a characteristic punctate appearance located in the centers of tumor nodules resembling comedonecrosis
(Figure 2, C).