0:00

Case 3 is a 30 year old

0:03

with the palpable area. What is the best

0:06

by right descriptor slash assessment for these calcifications?

0:12

Great. So here all of

0:15

you guys, right? It's a case of fine pleomorphic

0:18

calcifications.

0:22

What is leomorphic calcification means it's different

0:25

shape size and density

0:28

over line the pectoralis muscle

0:31

extending all the way to the suburular region

0:34

which spanned about six centimeters.

0:37

So let's go over some of the distribution of calcification

0:40

segmental means it's a

0:43

triangle that's pointing towards the nipple.

0:47

So here you could see it's a segmental distribution. It's

0:50

a triangle that's pointing which is a suspicious distribution grouped

0:53

means when you have a minimum

0:56

of five calcifications within one centimeter, or

0:59

you can have a large number of calcifications within

1:02

two centimeters of each other.

1:05

Regional distribution is when you have greater than

1:08

two centimeters, but not in a segmental

1:11

or linear distribution. Obviously diffuses

1:14

entire breast.

1:17

So the pathology yielded

1:20

dcis and given the extent

1:23

of the calcification and the dense breast MRI was

1:26

performed prior to the surgical treatment one is

1:30

to evaluate the relationship of the tumor to

1:33

the fascia and to see if there's any petrolysis muscle

1:36

Invasion and obviously for any multi-centric or

1:39

contralateral disease in this dense breast cream and

1:42

Apostle patient.

1:45

So we did an MRI you could see non-massive non-mass

1:49

enhancement in segmental distribution extending

1:52

to the fascia, but there was no pectoralis

1:55

Invasion, which was confirmed on her

1:58

mastectomy.

2:02

So the next question is like which histologic feature

2:05

distinguished dcis from invasive

2:08

ductal carcinoma?

2:11

So the answer to

2:14

that is the Integrity of the basement membrane.

2:18

So dcis has intact a layer of

2:21

basement membrane and myopothelial cells. Whereas invasive

2:24

cancers invaded through that basement membrane.

2:29

So the degree of nuclear plantomorphism actually determines

2:32

the grade of the breast cancer

2:35

so nuclear pleomorphism means

2:38

how much does the tumor cells vary in size

2:41

and shape compared to normal breast epithelial

2:44

cells, obviously if it varies a

2:47

lot it becomes grade 3 or high grade cancer.

2:51

And if it's if it's close to the normal epithelial cells

2:54

in it becomes a low grade or grade one

2:57

cancer.

2:58

The number of mitosis which is how fast

3:01

it is proliferating also determines the

3:04

grade of the cancer. So if the mitotic activity

3:07

is low, then it's considered gray what

3:10

grade one cancer and obviously if the mitotic activity

3:13

is high then it's considered a great three cancer.

3:20

For D the presence and absence of micro calcifications. The

3:23

calcifications can be seen with dcis

3:26

and invasive cancer and on the

3:29

other hand dci's can be non calcified just

3:32

like invasive ductal carcinoma can be named calcified

3:35

as well.