Case 39: Invasive Lobular Carcinoma

Abstract

The patient was a 43-year-old woman, otherwise healthy, who presented with a palpable mass in the entire upper right breast, centered at the 12-o'clock position. She also had vague thickening of the upper left breast at the radiologist's clinical examination. IMAGING FINDINGSPreliminary clinical examination findings demonstrated a broad, approximately 7 ϫ 8-cm area of palpable thickening in the upper right breast extending from the 9-through the 3-o'clock position. Bilateral mediolateral oblique and craniocaudal mammograms (Fig 1a, 1b) and spot compression of the palpable area in the right breast (Fig 1c) showed dense tissue with no discrete abnormalities. Sonography of the upper right breast revealed numerous irregular hypoechoic masses from the 11-to the 3-o'clock position that were not discrete and demonstrated moderate posterior acoustic shadowing suggestive of invasive lobular carcinoma (ILC) (Fig 2a). Sonography of the left breast was also performed in a region of mildly palpable thickening felt by the radiologist at the 12-o'clock position, and the findings included an indistinct, approximately 17-mm focus of decreased echogenicity with moderate posterior acoustic shadowing (Fig 2b) that was also considered suspicious for cancer.Sonographically guided core-needle biopsy of the suspicious mass at the 12-o'clock position in the right breast with a 14-gauge automated biopsy gun revealed ILC. Sonographically guided core-needle biopsy of the suspicious area in the left breast, which revealed fibrosis, was also performed with a 14-gauge automated gun.A contrast material-enhanced magnetic resonance (MR) imaging examination was performed 42 days after the biopsy to evaluate the extent of disease and to plan treatment. Findings of MR imaging examination showed lobulated marked early enhancement of nearly the entire upper right breast that measured 7.3 ϫ 5.5 ϫ 5.0 cm and extended below the level of the nipple (Fig 3), which was compatible with cancer. The area in question in the left breast showed negligible enhancement, concordant with the core-needle biopsy finding of fibrosis. (2) that are loosely dispersed, whereas invasive ductal carcinoma (IDC) is more typically a discrete mass. ILC frequently invades the normal tissues without invoking the vigorous desmoplastic response that usually accompanies IDC. Cells of ILC often encircle ducts, thus preserving the architecture of the ducts (3). These histopathologic features tend to produce more subtle imaging findings with ILC than with IDC. DISCUSSION Infiltrating or invasive lobular carcinoma is the diagnosis in 7%-10% of all breast cancer (1-3). ILC is characterized microscopically by similar cells forming linear invasive columnsMammographically, as in our patient, often no focal mass or clustered microcalcifications are evident, particularly in dense parenchyma. As a result, ILC tends to be larger than IDC at diagnosis, with an average size of 29 mm compared with 23 mm for IDC in one series (4). Hilleren et al (5) retrospectively reviewed 137 cases of ILC and found...

The Yale University Experience of Early-Stage Invasive Lobular Carcinoma (ILC) and Invasive Ductal Carcinoma (IDC) Treated with Breast Conservation Treatment (BCT): Analysis of Clinical-Pathologic Features, Long-Term Outcomes, and Molecular Expression of COX-2, Bcl-2, and p53 as a Function of Histology

“…ILC has been traditionally described as histologically and clinically distinct from IDC, and has been associated with a worse overall prognosis. Microscopically, ILC is characterized by hyperchromatic, spindle‐shaped or round cells forming linear invasive columns classically described as “Indian filing” (3), whereas IDC more typically presents as a discrete cluster of cells forming a mass, and is more often associated with micro‐calcifications. ILC frequently invades the normal tissues without inducing the intense desmoplastic response that commonly accompanies IDC.…”

Unilateral mastitis obliterans presented as a palpable breast mass in a patient with long-standing diabetes mellitus

“…Another reasonable diagnostic option in the absence of mass or microcalcifications on mammography and the palpable tumor is infiltrating lobular carcinoma, but the ultrasonography showed absence of posterior shadowing and linear tracts, not supporting the diagnosis [1].…”

Influence of E-cadherin Expression on the Mammographic Appearance of Invasive Nonlobular Breast Carcinoma Detected at Screening

“…E-cadherin is normally expressed in the majority (50%-65%) of NLCs, and although it does not have a true tumor suppressor role in this group, E-cadherin loss is associated with poorer prognostic features, including larger size, higher tumor grade, development of metastases, a basal phenotype, and triple negativity (4,5,11). The effect of E-cadherin loss on normal cell adhesion is thought to have a role in the characteristic histologic appearance of ILC of loosely dispersed linear columns of cells, unlike the typical discrete mass in invasive ductal cancer (6). This more diffuse infiltrative pattern of tumor morphologic features may explain some of the typical imaging appearances of ILC, such as reduced conspicuity at mammography and US.…”

“…-cadherin is a cell adhesion molecule expressed in normal breast tissue but typically absent in most (84%-100%) invasive lobular cancers (ILCs) (1)(2)(3) and reduced or absent in 35%-50% of nonlobular cancers (NLCs) (4,5). In ILC, E-cadherin is a tumor suppressor gene and absent expression is considered to lead to their characteristic pathologic growth pattern of infiltrative linear columns of discohesive cells, rather than the more well-circumscribed discrete mass of cohesive cells usually seen in invasive ductal cancer (6). This, in addition to the known reduced rate of microcalcification in ILC, influences their appearance at imaging, with often reduced conspicuity at both mammography and ultrasonography (US).…”