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

Foschini, Maria Pia; Miglio, Rossella; Fiore, Roberta; Baldovini, Chiara; Castellano, Isabella; Callagy, Grace; Bianchi, Simonetta; Kaya, Hakan; Amendoeira, Isabel; Querzoli, Patrizia; Poli, Francesca; Scatena, Cristian; Córdoba, Alicia; Pietribiasi, Francesca; Kovács, Anikó; Faistova, Hana; Quinn, Cecily

doi:10.1016/j.ejso.2019.07.011

Cited by 33 publications

(17 citation statements)

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“…Particular attention should be paid to HG-LN characterized by necrosis, microcalcifications, and pleomorphism (namely P-LCIS or florid LCIS). These lesions were recently described by Foschini et al with an upgrade rate of almost 44% [18]. Accordingly, the present series showed that the upgrade rate of these lesions was 50%, confirming that excision is mandatory.…”

Section: Discussionsupporting

confidence: 87%

The lobular neoplasia enigma: management and prognosis in a long follow-up case series

et al. 2021

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Background Many oncologists debate if lobular neoplasia (LN) is a risk factor or an obligatory precursor of more aggressive disease. This study has three aims: (i) describe the different treatment options (surgical resection vs observation), (ii) investigate the upgrade rate in surgically treated patients, and (iii) evaluate the long-term occurrences of aggressive disease in both operated and unoperated patients. Methods A series of 122 patients with LN bioptic diagnosis and follow-up information were selected. Clinical, radiological, and pathological data were collected from medical charts. At definitive histology, either invasive or ductal carcinoma in situ was considered upgraded lesions. Results Atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and high-grade LN (HG-LN) were diagnosed in 44, 63, and 15 patients, respectively. The median follow-up was 9.5 years. Ninety-nine patients were surgically treated, while 23 underwent clinical-radiological follow-up. An upgrade was observed in 28/99 (28.3%). Age ≥ 54 years (OR 4.01, CI 1.42–11.29, p = 0.009), Breast Imaging-Reporting and Data System (BI-RADS) categories 4–5 (OR 3.76, CI 1.37–10.1, p = 0.010), and preoperatory HG-LN diagnosis (OR 8.76, 1.82–42.27, p = 0.007) were related to upgraded/aggressive disease. During follow-up, 8 patients developed an ipsilateral malignant lesion, four of whom were not initially operated (4/23, 17%). Conclusions BI-RADS categories 4–5, HG-LN diagnosis, and age ≥ 54 years were features associated with an upgrade at definitive surgery. Moreover, 17% of unoperated cases developed an aggressive disease, emphasizing that LN patients need close surveillance due to the long-term risk of breast cancer.

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Section: Discussionsupporting

confidence: 87%

The lobular neoplasia enigma: management and prognosis in a long follow-up case series

et al. 2021

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“…This was not followed by the 8 th edition of the Union for International Cancer Control (UICC) TNM classification published in the same year 12 , 13 , contrarily to what is written about this in the 5 th edition 5 . Thus, followers of the UICC classification still continue to stage LCIS as pTis(LCIS), which may be supported by the findings that screen-detected, biopsy sampled florid and pleomorphic LCIS are too often associated with upstaging to invasive lobular carcinomas on excision 14 .…”

Section: The Classificationsmentioning

confidence: 94%

Histological type and typing of breast carcinomas and the WHO classification changes over time

Cserni

2020

Pathologica

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Summary The World Health Organization’s new classification of breast tumors has just been published. This review aims to examine the morphological categorization of breast carcinomas which is still principally based on histological features and follows the traditions of histological typing. It gives a subjective and critical view on the WHO classifications and their changes over time, and describes the changes related to some of the most common or challenging breast carcinomas: in situ carcinomas, invasive breast carcinomas of no special type, lobular, cribriform, tubular, mucinous, papillary, metaplastic carcinomas and carcinomas with medullary pattern and those with apocrine differentiation are discussed in more details. Although the 5 th edition of the classification is not perfect, it has advantages which are mentioned along with problematic issues of classifications.

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“…PLCIS is therefore characterised by its degree of cytological atypia, whereas FLCIS describes an architectural pattern (confluent, mass-like growth) with proliferation that is of classic type (CLCIS). Unlike CLCIS, PLCIS and FLCIS are more likely to have comedo-necrosis and calcifications and hence clinical and radiological presentations [23,24]. CLCIS is invariably ER and PR positive, and HER2 negative; FLCIS exhibits a similar phenotype, though may occasionally be HER2 positive, whilst PLCIS exhibits a more varied phenotype, with less frequent hormone receptor positivity, and an increased likelihood for HER2 overexpression, particularly in the apocrinetype of PLCIS as well as a higher proliferative index [23,[25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Invasive lobular carcinoma of the breast: the increasing importance of this special subtype

et al. 2021

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Invasive lobular carcinoma (ILC) is the most common of the breast cancer special types, accounting for up to 15% of all breast cancer cases. ILCs are noted for their lack of E-cadherin function, which underpins their characteristic discohesive growth pattern, with cells arranged in single file and dispersed throughout the stroma. Typically, tumours are luminal in molecular subtype, being oestrogen and progesterone receptor positive, and HER2 negative. Since last reviewing the lobular literature (McCart Reed et al., Breast Cancer Res 17:12, 2015), there has been a considerable increase in research output focused on this tumour type, including studies into the pathology and management of disease, a high-resolution definition of the genomic landscape of tumours as well as the evolution of several potential therapeutic avenues. There abounds a huge amount of new data, which we will review herein.

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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

Abstract: 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.

Cited by 33 publications

References 40 publications

The lobular neoplasia enigma: management and prognosis in a long follow-up case series

The lobular neoplasia enigma: management and prognosis in a long follow-up case series

Histological type and typing of breast carcinomas and the WHO classification changes over time

Invasive lobular carcinoma of the breast: the increasing importance of this special subtype

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