A comparison of the clinical metastatic patterns of invasive lobular and ductal carcinomas of the breast

Abstract

Summary Seventy seven patients with metastases from an invasive lobular carcinoma of the breast have been compared with 72 consecutive metastatic ductal carcinomas. There was no difference in the metastatic free interval between the two groups. A distinct pattern of clinical presentation of metastases was seen; hepatic (P = 0.01) and peritoneal metastases (P =0.0003) occurred more commonly in lobular tumours. Bilateral cancers were more common in the lobular group (P = 0.01). No difference was seen in terms of meningeal and pulmonary metastases. Survival after metastases was significantly longer in patients with metastatic lobular carcinoma (P = 0.02).Differences in cell morphology, growth patterns and tissue response allow for the division of invasive adenocarcinomas of the breast into specific types (Gallagher, 1984); infiltrating ductal (80%) and lobular (8-14.7%) carcinomas are the commonest (Martinez & Azzopardi, 1979;Dixon et al., 1982). The largest sub-group (65-68%) show no specific characteristics and have been termed carcinoma NOS not otherwise specified (Fisher et al., 1975) or ductal NOS (Dixon et al., 1985). These histological differences have been shown to have important influences upon prognosis (Gallagher, 1984;Dixon et al., 1985). A study based on clinical and post-mortem material (Harris et al., 1984) showed that lobular carcinoma of the breast had a distinctly different metastatic pattern to that seen in ductal carcinomas: lobular types were associated with carcinomatous meningitis and both peritoneal and retroperitoneal metastases of a diffuse micro-nodular fashion; lung parenchymal metastases were more common with ductal tumours. This series of lobular carcinomas has been studied in an attempt to verify this observation. (Mantel, 1966). Fisher's exact test was used to determine statistical differences between sites of metastases. Patients and methods ResultsThe median age at development of metastases was 56 years (28-72 years) for invasive lobular tumours and 54 years (37-70 years) for ductal carcinomas (not significant); medial follow-up time for both groups was 72 months. The sites of distant metastases as diagnosed clinically are shown in Table I. Hepatic (P = 0.01) and peritoneal (0.0003) metastases were detected significantly more often in lobular carcinomas. The clinical presentation of the 14 lobular peritoneal metastases included: retroperitoneal ureteric obstruction (3), large bowel obstruction and perforation (1), 'linitis plastica' of the stomach (2), small bowel obstruction (3), omental masses (5). The six patients with obstructive/dysphagic symptoms underwent laparotomy, the operative findings in each case being tiny serosal nodules, widespread throughout the bowel. These nodules were confluent at the site of obstruction.No significant difference existed between the two pathological types in terms of skeletal, pulmonary, pleural and cerebral metastases. Eighteen of the 149 patients with metastases developed metachronous contralateral cancers (12%), 14 of these occurred in the ...

Bone metastases from breast carcinoma: histopathological – radiological correlations and prognostic features

“…This finding helps to support the argument that less-aggressive tumour phenotypes are more likely to be associated with the development of bone metastases. In common with several previous studies, we found no evidence that patients with lobular carcinoma were more likely to develop bone metastases compared to patients with ductal carcinomas (Dixon et al, 1991;Fondrinier et al, 1997). Others have suggested that lobular carcinomas have a tendency to metastasise to bone (Borst et al, 1993;Sastre-Garau et al, 1996).…”

“…As has also been previously demonstrated (Williams et al, 1986;Robertson et al, 1992), once a patient develops metastatic disease then neither the lymph node status nor the size of the primary tumour is relevant as predictors of survival. It is well known that the metastatic patterns of lobular and ductal carcinomas are different, with gastrointestinal and peritoneal metastases being more common in lobular carcinomas (Dixon et al, 1991). There has been debate in the literature as to whether tumour type has any bearing on the development of bone metastases.…”

Advanced breast cancer and its prevention by screening

“…One of the main prognostic discriminants is the site and number of metastases, which makes it difficult to compare (inter-) national data deriving from different hospitals. Nevertheless, median post-recurrence survival is mostly in the range of 18-24 months (Powles et al, 1980;Patel et al, 1986;Tomin & Donegan, 1987;Perez et al, 1990;Dixon et al, 1991), which strongly resembles our data (20.3 mo). Almost 60% of the women in the three hospitals had received radiation treatment for advanced disease.…”

Gastrointestinal Metastases from Breast Cancer, a Diagnostic Dilemma

“…Histological studies have found that lobular carcinoma metastasized to the same metastatic sites as ductal carcinoma; however lobular carcinoma frequently metastasized to unusual sites like the gastrointestinal tract, peritoneum, and adnexa [8][9][10][11][12]. In one of the earliest papers on the subject, all of the metastases to the stomach were infiltrating lobular cancer, and other papers had between 75-97% lobular histotype [13][14][15][16] …”

“…In an autopsy study performed on 707 cases of metastatic breast cancer, the stomach was involved in 10% of cases, small intestine in 9%, and large intestine in 8%, with the peritoneum involved in 25% of cases. Overall, the gastrointestinal tract was involved in 16% of cases [6] A non-autopsy study done in 2005 at The Mayo Clinic showed that of 12,000 diagnosed with metastatic disease secondary to breast cancer, 73 (0.6%) were found in either the GI tract or peritoneum: esophagus (8%), stomach (28%), small intestine (19%), and colon and rectum (45%) [7].Histological studies have found that lobular carcinoma metastasized to the same metastatic sites as ductal carcinoma; however lobular carcinoma frequently metastasized to unusual sites like the gastrointestinal tract, peritoneum, and adnexa [8][9][10][11][12]. In one of the earliest papers on the subject, all of the metastases to the stomach were infiltrating lobular cancer, and other papers had between 75-97% lobular histotype [13][14][15][16] …”