Pleomorphic lobular carcinoma in situ of the breast: a single institution experience with clinical follow-up and centralized pathology review

Abstract

Purpose The natural history of pleomorphic lobular carcinoma in situ (PLCIS) remains largely unknown. Methods A pathology database search (1995–2012) was performed to identify patients diagnosed with an LCIS variant. Patients with synchronous breast cancer and/or no evidence of pleomorphism were excluded. Original slides were re-evaluated by 3 pathologists to identify a consensus cohort of PLCIS. Borderline lesions with focal atypia were classified as LCIS with pleomorphic features (LCIS-PF). Clinical data were obtained from medical records. Results From 233 patients, we identified 32 with an LCIS variant diagnosis and no concurrent breast cancer. Following review, 16 cases were excluded due to lack of pleomorphism. The remaining 16 were classified as PLCIS (n=11) and LCIS-PF (n=5). 12/16 patients were treated with surgical excision +/− chemoprevention. Patients with a prior breast cancer history and those having mastectomy were excluded from outcome analysis. Among the remaining 7 patients with PLCIS/LCIS-PF, 4/7 (57%) developed ipsilateral breast cancer at a median follow-up of 67 months. Median age at the time of breast cancer diagnosis was 56 years old and median time from PLCIS/LCIS-PF to cancer diagnosis was 59 months (range, 45–66 months). The 4 cancers included 1 invasive lobular carcinoma (ILC), 1 microinvasive ILC, 1 invasive ductal carcinoma and 1 ductal carcinoma in situ. Conclusions We confirm that PLCIS in isolation is indeed a rare entity, further contributing to the difficulty in determining the actual risk conferred by this lesion. Long-term follow-up data on larger cohorts is needed to define standardized management and outcomes for patients with PLCIS.

Pre-operative management of Pleomorphic and florid lobular carcinoma in situ of the breast: Report of a large multi-institutional series and review of the literature

“…On the contrary, very limited data are available on the importance of resection margins involvement by F-LCIS and P-LCIS and recurrences 34 . In the series published by De Brot et al 35 , 4 of 7 patients with positive or close margins developed invasive carcinoma, on average, 54 months (range 46-67) after primary surgery. The present series did not include follow-up data.…”

Lobular Carcinoma In Situ

“…Information regarding the clinical follow-up of patients with diagnosis of P-LCIS remains extremely limited, but a few small series suggest that P-LCIS tends to recur locally with or without associated invasion. Some series found lower recurrence rates in patients treated with radiation therapy 20, 25, 34 .…”

“…In contrast to classic LCIS, P-LCIS is often detected mammographically as an area of calcifications, architectural distortion, and less frequently, as a mass lesion with or without associated calcifications 20, 22, 23, 25, 33, 34 . Patients with PLCIS tend to be significantly older than patients with classic LCIS 20, 23, 34 , and most are postmenopausal 20, 23, 25 . Some authors further categorize P-LCIS into apocrine and non-apocrine types 23 .…”

“…A survey sent to self-identified breast surgeons revealed that in cases of PLCIS present at the surgical margins, 53% of the surgeons would not re-excise, 23% sometimes re-excise, and 24% always re-excise 110 . All published series on outcomes of PLCIS are retrospective and adjuvant therapy was not uniform (Table 1) 20, 25, 34, 111 . According to the 2012 WHO consensus classification, “in the absence of better information on the natural history of pleomorphic LCIS, caution should be exercised in recommending more aggressive management strategies, such as excision to negative margins or mastectomy as a routine practice after a diagnostic surgical biopsy reveals pleomorphic LCIS” 111 .…”

Surgical Management of Lobular Carcinoma In Situ: Analysis of the National Cancer Database

“…However, pleomorphic subtype represents a very small proportion of LCIS (<6%). 25 Furthermore, the use of unilateral mastectomy would represent overuse even in the setting of pleomorphic rather than classic-type LCIS. Finally, we do not have details of the imaging characteristics that may have led to selection of a specific treatment plan or provider level data to assess variation based on practices of individual surgeons.…”