Are the imaging features of the pleomorphic variant of invasive lobular carcinoma different from classic ILC of the breast?

Abstract

The aim of this study was to evaluate whether pleomorphic invasive lobular carcinoma (PILC) is different from classic invasive lobular carcinoma (CILC) in terms of radiologic and clinicopathologic features. We compared the radiologic and clinicopathologic features of 22 surgically confirmed PILCs in 21 patients from 2004 to 2009 and 47 CILCs from 47 consecutive patients. For all cases, we reviewed the imaging findings, medical records and pathological results. PILC had a higher T stage, N stage, nuclear and histologic grade compared to CILC. PILC was more commonly negative for estrogen receptors and positive for HER2 than CILC (all p < 0.05). However, there were no significant differences in age, symptoms, tumor size, extensive intraductal component, lymphovascular invasion, triple negative profile, or multiplicity between the two groups. PILC was not detected on mammography in 1 (4.5%) of 22 cases, whereas CILC was not detected on mammography in 7 (14.9%) of 47 cases and on MRI in 2 (5.0%) of 40 (p = 0.42 and p = 1.000, respectively). MRI identified more frequent multiplicity than mammography for both PILC and CILC (p < 0.001), but was similar to US (p = 0.066). Most lesions showed a spiculated mass or architectural distortion with or without calcifications on mammography and ultrasound. No differences in mass and/or non-mass lesions or kinetics on MRI were observed between the two groups. PILC shows more pathologically aggressive features, but cannot be differentiated from CILC based on imaging findings.

Invasive Pleomorphic Lobular Carcinoma of the Breast: Pathologic, Clinical, and Therapeutic Considerations

“…1 Clinical and Diagnostic Imaging Presentation of PLC Compared to IDC patients, PLC patients tend to be older, to have larger tumors, and to exhibit more axillary lymph node involvement (higher T and N stages) by the time of presentation. 15,16 Median tumor size in one series was 20 mm compared to 15 mm for classical ILC. 9 In addition, PLC often displays evidence of lymphovascular invasion and a higher proliferative index.…”

“…Pleomorphic lobular carcinomas represent less than 1% of all breast cancers 15,16 and approximately 15% of ILCs. [5][6][7] PLC has been associated with older age and postmenopausal status.…”

Pleomorphic Lobular Carcinoma of the Breast: A Morphologically and Clinically Distinct Variant of Lobular Carcinoma

“…20 Radiologically, the tumor is most commonly detected as a spiculated mass on mammography or ultrasonography. Alternatively, it can present as an architectural distortion, a vague asymmetric density, or calcifications.…”

“…Alternatively, it can present as an architectural distortion, a vague asymmetric density, or calcifications. 11,20 Despite improved imaging modalities, the single-cell infiltrative pattern of these tumors makes detection difficult, and cases of radiographically occult tumors that present with distant metastasis continue to be reported. 9 …”

Carcinoma Lobular Invasor Bilateral: relato de caso

“…A Ressonância Magnética tem maior sensibilidade que a ultrassografía e a mamografía, e combina a análise da arquitetura e vascularização do tumor. No entanto, é particularmente útil para demonstrar extensão e envolvimento multifocal e bilateral 7,9 . Pacientes portadoras de CLI podem ser tratadas adequadamente com cirurgia conservadora, tudo depende do caso, é por isso que as pacientes devem ser individualmente avaliadas: para que o tratamento indicado seja o mais apropriado ao caso 2 .…”