Lobular neoplasia (so-called lobular carcinoma in situ) of the breast

Haagensen, C. D.; Lane, Nathan; Lattes, Raffaele; Bodian, Carol

doi:10.1002/1097-0142(197808)42:2<737::aid-cncr2820420247>3.0.co;2-t

Cited by 494 publications

(268 citation statements)

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“…A possible explanation arises from the finding of lobular carcinoma in situ (LCIS) in 66% of ipsilateral (Dixon et al, 1982) and 35% of contralateral breasts (Urban, 1967) in patients with invasive lobular carcinoma; LCIS lesions can also progress to invasive carcinoma (Haagensen et al, 1978;Rosen et al, 1978). These findings have important implications for the follow-up of patients with lobular carcinomas.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the clinical metastatic patterns of invasive lobular and ductal carcinomas of the breast

Dixon

Ellis²,

Elston³

et al. 1991

Br J Cancer

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Summary Seventy seven patients with metastases from an invasive lobular carcinoma of the breast have been compared with 72 consecutive metastatic ductal carcinomas. There was no difference in the metastatic free interval between the two groups. A distinct pattern of clinical presentation of metastases was seen; hepatic (P = 0.01) and peritoneal metastases (P =0.0003) occurred more commonly in lobular tumours. Bilateral cancers were more common in the lobular group (P = 0.01). No difference was seen in terms of meningeal and pulmonary metastases. Survival after metastases was significantly longer in patients with metastatic lobular carcinoma (P = 0.02).Differences in cell morphology, growth patterns and tissue response allow for the division of invasive adenocarcinomas of the breast into specific types (Gallagher, 1984); infiltrating ductal (80%) and lobular (8-14.7%) carcinomas are the commonest (Martinez & Azzopardi, 1979;Dixon et al., 1982). The largest sub-group (65-68%) show no specific characteristics and have been termed carcinoma NOS not otherwise specified (Fisher et al., 1975) or ductal NOS (Dixon et al., 1985). These histological differences have been shown to have important influences upon prognosis (Gallagher, 1984;Dixon et al., 1985). A study based on clinical and post-mortem material (Harris et al., 1984) showed that lobular carcinoma of the breast had a distinctly different metastatic pattern to that seen in ductal carcinomas: lobular types were associated with carcinomatous meningitis and both peritoneal and retroperitoneal metastases of a diffuse micro-nodular fashion; lung parenchymal metastases were more common with ductal tumours. This series of lobular carcinomas has been studied in an attempt to verify this observation. (Mantel, 1966). Fisher's exact test was used to determine statistical differences between sites of metastases. Patients and methods ResultsThe median age at development of metastases was 56 years (28-72 years) for invasive lobular tumours and 54 years (37-70 years) for ductal carcinomas (not significant); medial follow-up time for both groups was 72 months. The sites of distant metastases as diagnosed clinically are shown in Table I. Hepatic (P = 0.01) and peritoneal (0.0003) metastases were detected significantly more often in lobular carcinomas. The clinical presentation of the 14 lobular peritoneal metastases included: retroperitoneal ureteric obstruction (3), large bowel obstruction and perforation (1), 'linitis plastica' of the stomach (2), small bowel obstruction (3), omental masses (5). The six patients with obstructive/dysphagic symptoms underwent laparotomy, the operative findings in each case being tiny serosal nodules, widespread throughout the bowel. These nodules were confluent at the site of obstruction.No significant difference existed between the two pathological types in terms of skeletal, pulmonary, pleural and cerebral metastases. Eighteen of the 149 patients with metastases developed metachronous contralateral cancers (12%), 14 of these occurred in the ...

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Section: Discussionmentioning

confidence: 99%

A comparison of the clinical metastatic patterns of invasive lobular and ductal carcinomas of the breast

Dixon

Ellis²,

Elston³

et al. 1991

Br J Cancer

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“…Cases containing atypical lobular hyperplasia and lobular carcinoma in situ without adjacent invasive carcinomas are known to occur in only 0.5-3.8% of breast cases that are otherwise benign. 5,19 These lesions have rarely been studied at the molecular level. We have accrued a collection of cases fitting these criteria, making it possible to determine protein expression and gene alterations occurring at the stage of lobular neoplasia.…”

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confidence: 99%

E-cadherin alterations in atypical lobular hyperplasia and lobular carcinoma in situ of the breast

et al. 2005

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Tumor development from an early lesion through to invasive disease is not a clearly defined progression in the breast. Studies of invasive lobular carcinoma have reported mutations, loss of heterozygosity (LOH) and loss of protein expression in epithelial (E)-cadherin, a protein involved in cell adhesion. Our study examines in situ lobular neoplastic lesions without concurrent invasive carcinoma for E-cadherin gene alterations and protein expression, beta-catenin, alpha-catenin and p120-catenin protein expression, and LOH at the chromosome 16q locus, with the goal of determining the events occurring at the stage of lobular neoplasia. In all, 13 atypical lobular hyperplasia lesions and 13 lobular carcinoma in situ lesions from archived cases were examined. E-cadherin sequence alterations were evaluated using single strand conformation polymorphism and DNA sequencing, and PCR-based LOH analysis was carried out for the 16q locus. Using immunohistochemistry, we assessed protein expression. A total of 23 of 24 lesions evaluated by immunohistochemistry were negative for both E-cadherin and beta-catenin protein expression, and 21 of 23 lesions were negative for alpha-catenin. Cytoplasmic (rather than membrane) localization of p120-catenin was observed in 20 of 21 cases. Lobular carcinoma in situ cases were characterized by mutations; however, atypical lobular hyperplasia cases were not. LOH at 16q was an infrequent event. From our study, we conclude that an altered E-cadherin adhesion complex is an early event affecting atypical lobular hyperplasia as well as lobular carcinoma in situ and occurs prior to progression to invasive disease. However, the loss of protein expression is accompanied by E-cadherin DNA alterations in lobular carcinoma in situ but not in atypical lobular hyperplasia. These cases lacking both protein expression and gene alterations suggest that another mechanism is involved, possibly as early as at the hyperplastic stage, causing silencing of the E-cadherin complex.

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“…Long-term follow-up studies in patients treated with excisional biopsy suggest a risk of later ipsilatera1 invasive cancer of 5-15% at 10 years but possibly as high as 20-40% after 20 years (165,176,(178)(179)(180). However, the risk of cancer in the contralateral breast is nearly as high as the risk of an ipsilateral tumour (176,178). Thus, apart from local excision there is no sound rationale for aggressive surgery or radiation therapy in this disease.…”

Section: Breast-conserving Therapy For Intraductal and Intralobular Cmentioning

confidence: 81%

“…Intralobular cancer in situ does not as a rule produce palpable tumours itself, and is usually found coincidentally with benign lesions at biopsy (176). The disease is multicentric in about SOYO of cases (156) and about 1/3 of the patients have contralateral synchronous non-invasive lesions ( 177).…”

Section: Breast-conserving Therapy For Intraductal and Intralobular Cmentioning

confidence: 99%

“…The disease is multicentric in about SOYO of cases (156) and about 1/3 of the patients have contralateral synchronous non-invasive lesions ( 177). Long-term follow-up studies in patients treated with excisional biopsy suggest a risk of later ipsilatera1 invasive cancer of 5-15% at 10 years but possibly as high as 20-40% after 20 years (165,176,(178)(179)(180). However, the risk of cancer in the contralateral breast is nearly as high as the risk of an ipsilateral tumour (176, 178).…”

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Treatment of Early Breast Cancer with Conservation of the Breast a Review

1991

Acta Oncologica

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This paper reviews the current status of conservative treatment for early breast cancer. While the first patients were treated with such techniques more than 60 years ago, it is during the last decade that randomized trials have confirmed that such treatment is comparable to mastectomy in preventing breast cancer death. Radiotherapy to the breast after local tumour excision is important to prevent local breast relapse, but it is not clear whether it has any influence on the risk of distant metastases. Several questions remain to be answered. While most investigators agree that the breast should receive a radiation dose of about 50Gy in 5 weeks, there is no general agreement about the need for a tumour bed booster dose. Considering patients with tumour infiltration at the surgical resection line for whom it is not possible for cosmetic reasons to perform re-resection, it is not clear whether an acceptable local control rate can be achieved through application of a high booster dose in the tumour bed. More trials are needed to show whether certain patients with small invasive carcinomas should be treated with wide local excision without radiotherapy. The need for radiotherapy after local excision for small intraductal (ductal carcinoma in situ) cancers is being addressed in ongoing trials.Key words: Breast cancer, breast conserving therapy, local relapse risk, review.The term 'breast-conserving treatment' includes techniques by which radical eradication of an early breast cancer (TI -2, NO-I, MO) is achieved without ablation of the mammary gland. Such treatment techniques have attracted widespread interest and recently become accepted alternatives to more radical and mutilating surgical procedures. The possibility of treating limited breast cancers, without breast ablation was suggested more than 60 years ago. Hirsch. (1) in Berlin and Keynes (2) in London published their first results in 1927 and 1929 respectively. Mustakallio (3) in Helsinki published his first series in 1945, and the Institute Curie group headed by Baclesse published their results in 1949 (4). The preliminary results achieved by these pioneers suggested that survival after breastconserving treatment could be similar to that achieved after radical mastectomy. This view gained further support when a follow-up paper from St. Bartholomew's Hospital (5) in 1953 reported long-term survival to be similar among the patients treated conservatively by Keynes and breast cancer patients treated in the same hospital with mastectomy. During the 1960s more authors reported encouraging results with breast-conserving treatment (6-9). and during the last two decades multiple reports have been published:1. The survival rate and risk of distant metastases following breastconserving therapy and mastectomy have been compared in randomized trials. 2.Long-term ( > 25 years) follow-up reports containing large numbers of patients have provided important information on long-term survival and risk of locoregional failure. These studies also give important informat...

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Lobular neoplasia (so-called lobular carcinoma in situ) of the breast

Cited by 494 publications

References 10 publications

A comparison of the clinical metastatic patterns of invasive lobular and ductal carcinomas of the breast

A comparison of the clinical metastatic patterns of invasive lobular and ductal carcinomas of the breast

E-cadherin alterations in atypical lobular hyperplasia and lobular carcinoma in situ of the breast

Treatment of Early Breast Cancer with Conservation of the Breast a Review

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