Pleomorphic Lobular Carcinoma in Situ: Treatment Options for a New Pathologic Entity

Murray, Lauren; Reintgen, Michael; Akman, Kurt; Cox, Charles E.; Cox, John M.; Reintgen, Douglas S.; Greenberg, Harvey; Vrcel, Verne

doi:10.1016/j.clbc.2011.08.007

Cited by 9 publications

(4 citation statements)

References 15 publications

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“…Therefore, LN has been defined as an entity that includes both ALH and LCIS and qualifies as a non-obligate precursor lesion, as well as a risk indicator for breast carcinoma [1, 3, 4, 6, 7]. …”

Section: Lobular Neoplasiamentioning

confidence: 99%

“…In contrast to its counterpart LCIS, PCLIS occurs predominantly in postmenopausal women; in the majority of cases patients present with clusters of microcalcifications on their mammograms [6]. …”

Section: Lobular Neoplasiamentioning

confidence: 99%

“…However, the most important feature of PLCIS is its association with ILC, which is found in approximately 50 % of cases [6, 11]. …”

Section: Lobular Neoplasiamentioning

confidence: 99%

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Evolving concepts in breast lobular neoplasia and invasive lobular carcinoma, and their impact on imaging methods

et al. 2014

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Invasive lobular carcinoma (ILC) and lobular neoplasia (LN) are two distinct conditions that still pose challenges regarding to their classification, diagnosis and management. Although they share similar cellular characteristics, such as discohesive neoplastic cells and absence of e-cadherin staining, they represent completely different conditions. LN encompasses atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), which are currently considered risk factors and non-obligatory precursors of breast neoplasia. These lesions are diagnosed as incidental findings in percutaneous biopsies or appear as non-specific clusters of punctate calcifications in mammograms. ILC is the second most common breast malignancy and has typical histological features, such as infiltrative growth and low desmoplasia. These histological features are reflected in imaging findings and constitute the reasons for typical subtle mammographic features of ILC, as architectural distortion or focal asymmetries. Ultrasonography (US) may detect almost 75 % of the ILCs missed by mammography and represents the modality of choice for guiding biopsies. Magnetic resonance imaging (MRI) exhibits a high sensitivity for the diagnosis of ILC and for detecting synchronous lesions.Teaching Points• LN includes ALH and LCIS, risk factors and non-obligatory precursors of breast cancer.• Absence of e-cadherin staining is crucial for differentiation among ductal and lobular lesions.• ILC has typical histological features, such as infiltrative growth and low desmoplasia.• Mammographic features of ILC are often subtle and reflect the histological features.• MRI exhibits a high sensitivity for the diagnosis of ILC and for detecting synchronous lesions.

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Section: Lobular Neoplasiamentioning

confidence: 99%

Section: Lobular Neoplasiamentioning

confidence: 99%

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Evolving concepts in breast lobular neoplasia and invasive lobular carcinoma, and their impact on imaging methods

et al. 2014

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“…17 In an effort to advance our knowledge on the outcomes and management of PLCIS after diagnostic biopsy, we conducted a 15-year review of PLCIS cases at our institution. 16,18 The objectives of this study were threefold: (1) to report the radiologic characteristics associated with PLCIS; (2) to report pathologic findings observed after excision of PLCIS, including rates of upgrade to DCIS or invasive cancer; and (3) to examine the clinical management and recurrence rate of patients with PLCIS at our institution.…”

mentioning

confidence: 99%

Pleomorphic Lobular Carcinoma In Situ: Radiologic–Pathologic Features and Clinical Management

et al. 2015

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Background Pleomorphic lobular carcinoma in situ (PLCIS) is an unusual variant of LCIS for which optimal management remains unclear. Methods We conducted a 15-year (2000–2014) retrospective chart review of the radiologic, pathologic, clinical management, and recurrence rates of patients with PLCIS on diagnostic biopsy. Fifty-one patients were found to have PLCIS either alone or with concomitant breast cancer. Of these, 23 were found to have pure PLCIS on diagnostic biopsy. Rates of upstaging after local excision, positive or close margins, mastectomy, and recurrence associated with pure pleomorphic lobular carcinoma in situ were examined. Results Of the 21 patients who underwent surgical excision following diagnostic biopsy, 33.3 % (7/21) were found to have invasive carcinoma, and 19 % (4/23) were found to have ductal carcinoma in situ. Extensive or multifocal PLCIS was present in 47.6 % (10/21) of patients, corresponding to at least one PLCIS-positive or close margin in 71.4 % (15/21). In total, there were 11 local reexcisions in nine patients, and 12 mastectomies. No ipsilateral breast cancer events have occurred, including in those with positive or close surgical margins (mean followup 4.1 years). Conclusions Patients with isolated PLCIS on diagnostic biopsy are at high risk of upgrading to invasive cancer or ductal carcinoma in situ at diagnostic excision. PLCIS often is extensive, with high rates of positive or close surgical resection margins. If negative PLCIS margins are pursued, rates of successful breast conservation are low. In light of this and low recurrence rates, caution should be exercised in aggressively treating PLCIS with excision to clear margins.

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High Risk Lesions

Dietz

2013

Breast Cancer

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Pleomorphic Lobular Carcinoma in Situ: Treatment Options for a New Pathologic Entity

Cited by 9 publications

References 15 publications

Evolving concepts in breast lobular neoplasia and invasive lobular carcinoma, and their impact on imaging methods

Evolving concepts in breast lobular neoplasia and invasive lobular carcinoma, and their impact on imaging methods

Pleomorphic Lobular Carcinoma In Situ: Radiologic–Pathologic Features and Clinical Management

High Risk Lesions

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