Clinical outcome in pleomorphic lobular carcinoma: a case-control study with comparison to classic invasive lobular carcinoma

Abstract

Aim Pleomorphic lobular carcinoma (PLC) is a variant of invasive lobular carcinoma (ILC) that is described in the literature as an aggressive tumor with poor prognosis. Multiple studies have shown a decrease in overall survival when compared to classic ILC (cILC). In the current study, we sought to compare the clinicopathologic parameters of PLC to cILC. Materials and methods All cases with a diagnosis of ILC, Nottingham grade II-III between 1990 and 2010 were retrieved from the pathology files in the anatomic pathology database at Mayo Clinic in Rochester, MN. The cases were reviewed, and those that met the criteria for pleomorphic lobular carcinoma (PLC) were selected. An E-cadherin immunostain confirmed the lobular immunophenotype. Clinicopathological data was assessed and analyzed. A control group of cILC, Nottingham grade I was selected, comprising two controls for each case, matched according to age and year of diagnosis. Results PLC was more associated with in situ carcinoma (p = 0.03), and had lower PR expression (p = 0.03) when compared to cILC. Both disease-free and overall survival was similar between patients with PLC and matched cILC controls, and depended on disease stage, tumor size and lymph node status. Conclusion PLC has a similar behavior to cILC in terms of survival and outcome.

Pleomorphic lobular carcinoma of the breast: a comparison of cytopathological features with other lobular carcinoma variants

“…In our cases, the patients in the PLC group were older and had a higher incidence of axillary lymph node metastasis compared to non‐PLC patients, and both were factors associated with a worse prognosis. However, we were not able to identify a significant difference in the clinical follow‐up data between the two groups, consistent with reports by Jacobs and Narendra . Based on our findings, it is tempting to assume that PLC may not be an aggressive subtype of breast cancer, as has been reported previously.…”

“…Narendra et al . compared the clinical outcomes of 52 PLC and 103 classic ILC patients and found that disease‐free survival and overall survival were similar between the two groups, both of which were dependent on their disease stage, tumour size and lymph node status . Rakha et al .…”

“…4 Narendra et al compared the clinical outcomes of 52 PLC and 103 classic ILC patients and found that disease-free survival and overall survival were similar between the two groups, both of which were dependent on their disease stage, tumour size and lymph node status. 12 Rakha et al showed that the presence of pleomorphic features might not provide a prognostic value for patients with ILC. 30 In our cases, the patients in the PLC group were older and had a higher incidence of axillary lymph node metastasis compared to non-PLC patients, and both were factors associated with a worse prognosis.…”

“…Several reports have stressed that PLC is an aggressive variant of ILC with a poor clinical outcome, because patients with PLC often present at an advanced stage and are more likely to develop lymph node and distant metastasis than patients with other variants of ILC . Contrary to these reports, recent studies have indicated that PLC is not associated with increased mortality and that there is no significant difference in the survival rate compared with that of other variants of ILC . Thus, the clinical picture and prognosis of PLC are still under debate, but no studies have investigated the clinicopathological aspects of PLC in comparison with those of other variants of ILC in Japanese patients.…”

“…[6][7][8][9][10] Contrary to these reports, recent studies have indicated that PLC is not associated with increased mortality and that there is no significant difference in the survival rate compared with that of other variants of ILC. 4,11,12 Thus, the clinical picture and prognosis of PLC are still under debate, but no studies have investigated the clinicopathological aspects of PLC in comparison with those of other variants of ILC in Japanese patients. Fine needle aspiration (FNA) is a minimally invasive and cost effective way of diagnosing malignancy in women with palpable breast tumours.…”