Ductal carcinoma in situ

Case contribution: Dr Radhiana Hassan


  • A 50 years old lady
  • No known medical illness
  • Presented with left breast lump for 2 weeks duration.
  • No family history of breast cancer
  • Associated with pain, no fever
Bilateral mammogram in mediolateral oblique (MLO) views
Bilateral mammogram

Mammogram findings:

  • A focal stromal distortion is seen at left lower inner quadrant (yellow arrows)
  • No suspicious clustered microcalcification
  • Minimal skin thickening seen
  • No nipple retraction, no abnormal axillary nodes
  • Well-defined small lesions seen in the right breast
Ultrasound breast

Ultrasound findings:

  • A spiculated mass at Lt9H measuring 13×9 mm
  • The lesion is taller than its width
  • Presence of posterior shadowing
  • Penetrating vessels seen
  • Breast cysts at right breast (images not shown)
  • No abnormal lymph nodes

Progress of patient:

  • Biopsy done shows minimal tissue obtained. Suspicious area of malignancy seen
  • Wide local excision done shows DCIS infiltrative gland. Axillary sampling shows all nodes removed were clear
  • ER, PR +ve. HER2-negative
  • Impression: intraductal DCIS low to intermediate, mitosis grade 2, histopathological grade 1.

Diagnosis: Ductal carcinoma in situ


  • Ductal carcinoma in situ (DCIS) is a breast carcinoma limited to the ducts with no extension beyond the basement membrane
  • It accounts for 25-40% of mammographically detected breast cancers
  • DCIS have varied appearance on mammogram.
  • Casting-type calcifications is the most common (present in 50-75% of cases)
  • It can be also be seen as an uncalcified, round, oval, irregular or microlobulated, mass with partially circumscribed or spiculated margins, distortion, parenchymal asymmetry or diffuse change.
  • On ultrasound, the most common feature is a microlobulated mild hypoechoic mass with ductal extension.
  • On MRI, DCIS most commonly appears as non-mass enhancement, most commonly with a segmental or linear distribution and clumped or heterogeneous internal enhancement pattern.


  • El-Feky and Radswiki et al, Ductal carcinoma in situ. At https://radiopaedia.org/articles/ductal-carcinoma-in-situ
Author: radhianahassan