Lobular Neoplasia: Morphology and Management

Abstract

Context.-Lobular neoplasia encompasses a spectrum of disease, including atypical lobular hyperplasia and lobular carcinoma in situ. Although classic forms of lobular neoplasia are predominantly heralded as a risk marker, the pleomorphic form of lobular carcinoma in situ is generally regarded as a more aggressive subtype and a possible cancer precursor, and thus is treated in a manner more similar to ductal carcinoma in situ than classic forms of lobular neoplasia.Objective.-To focus on the morphologic spectrum of lobular neoplasia as highlighted by 3 cases and current management recommendations. Areas of diagnostic challenge and controversy are addressed.Data Sources.-A review of the pertinent published literature and current national guidelines was conducted.Conclusions.-Correct classification of classic lobular neoplasia and pleomorphic lobular carcinoma in situ is critical because of differences in clinical management, with current treatment strategies focused on risk reduction for patients with classic lobular neoplasia and eradication of the lesion for those with pleomorphic lobular carcinoma in situ.

Lobular carcinoma in situ of the breast – correlation between minimally invasive biopsy and final pathology

“…This histologic form was significantly related to other risk factors: BIRADS category 5, mass presentation, and larger lesion size. Pleomorphic LCIS is characterised by nuclear pleomorphism, prominent nucleoli, nuclear membrane irregularity, mitotic figures and central necrosis with associated calcifications [7]. Cytologic and histologic findings can make it difficult to distinguish from high-grade ductal carcinoma in situ, but as for other lobular proliferations, E-cadherin expression is usually absent [30].…”

“…However, the distinction between ALH and LCIS is postulated by some because of the substantial difference in the risk of subsequent invasive cancer, associated with the extent of lobular proliferation [6]. There is still no consensus whether LCIS is just a marker of an increased risk of invasive malignancy (ipsi- and contralateral, lobular and ductal) or represents a direct precursor of invasive breast cancer (IBC) [7, 8]. Hence, the optimal management of LCIS found on minimally invasive breast biopsy remains a subject of debate.…”

Lobular Carcinoma in Situ with Atypical Mass Presentation: a Case Report

“…1 The condition is defined by at least half of the acini in a lobe being filled and distended by monomorphic cells, and it is part of a spectrum of abnormalities called lobular intraepithelial neoplasia. [2][3][4] Lobular intraepithelial neoplasia is associated with an increased risk of breast cancer, ranging from 3-to 4-fold in the case of atypical lobular hyperplasia (ALH) to 8-to 10-fold in the case of LCIS. Diagnosis is usually more common among 40-to 50-year-old women, 5 15 years prior to the mean age at which an invasive carcinoma occurs 2,3 and 7 to 8 years earlier than the occurrence of ductal carcinoma in situ (DCIS).…”

“…4,7 It is usually found incidentally in biopsies and is associated with an increased risk of bilateral malignancy. 3,8,9 It can be found in up to 3.6% of breast biopsies and is multicentric 68% of the time and bilateral in 30% of cases. 3,8 However, the actual incidence is unknown because in most cases, it is not detectable by imaging methods.…”

“…3,8,9 It can be found in up to 3.6% of breast biopsies and is multicentric 68% of the time and bilateral in 30% of cases. 3,8 However, the actual incidence is unknown because in most cases, it is not detectable by imaging methods. 4,10 The clinical picture is typically poor, and imaging tests do not seem to play a true role in LCIS diagnosis.…”