Recently I experienced a case of ductal carcinoma in situ from a breast of a 48-year-old woman (wide excision). The patient underwent sentinel lymph node biopsy along with the wide excision and there was no tumor metastasis in the lymph nodes. The excised tumor was all embedded in the paraffin blocks and examined and there was no foci of invasive tumor. However, there were multiple foci of tumor emboli in the lymphatics which was proven by the immunohistochemical staining for D2-40.
How do you think about this situation?
What should I check more?
Metastasis is a complex multi-step process, Cells may invade lymphatic vessels but that does not mean that they have full metastatic potential.
Undoubtedly, the presence of malignant cells in lymphatic vessels shows that these cells have the capacity to migrate and invade, but this is not enough to colonize. Besides, there are immunologic mechanisms that may impede colonization at this early stage. Sooner or later these cells will develop the capacity to neutralize these defensive mechanisms.
I think there must be micro-invasion in tumor, that can be detected only by serial sectioning. But serial sectioning is tedious and time-consuming. So some invasions within a tumor might be difficult to detected.
This is an interesting topic. Further treatment depends on the The Van Nuys Prognostic Index (VPNI). You need to check for ER, PR and HER2 status.
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