Annals of Surgical Oncology

, Volume 18, Issue 7, pp 1845–1851 | Cite as

The Florid Subtype of Lobular Carcinoma In Situ: Marker or Precursor for Invasive Lobular Carcinoma?

  • Sanjay P. Bagaria
  • Jaime Shamonki
  • Michelle Kinnaird
  • Partha S. Ray
  • Armando E. Giuliano
Breast Oncology



Lobular carcinoma in situ (LCIS) is considered a risk factor—not a precursor—for both invasive lobular and ductal carcinoma. Florid LCIS (F-LCIS) is an architectural subtype of LCIS that does not express E-cadherin, yet has the histologic and often radiographic appearance of solid-type ductal carcinoma in situ (DCIS). Since DCIS is considered a precursor to invasive ductal carcinoma, should F-LCIS be considered a precursor to invasive lobular carcinoma (ILC)?


Review of an institutional database identified cases of LCIS and solid-type DCIS diagnosed by excisional biopsy, segmentectomy, or mastectomy between 1991 and 2000 to determine the prevalence of associated invasive breast cancer. Archival specimens were evaluated for florid and nonflorid LCIS, nuclear grade of LCIS, and the presence and subtype of invasive breast cancer. Solid-type DCIS that lacked E-cadherin expression was classified as F-LCIS.


Of 210 consecutive specimens of LCIS examined, 171 had nonflorid LCIS (81%) and 39 had F-LCIS (19%). Nonflorid LCIS had a diffuse pattern, whereas F-LCIS appeared as discrete foci adjacent to ILC. An invasive component was identified with 87% of F-LCIS lesions versus 73% of nonflorid LCIS lesions (P = 0.064); this component was lobular in 100% of F-LCIS lesions versus 82% of nonflorid LCIS lesions, a significant difference (P = 0.0044) that persisted when the analysis was adjusted for nuclear grade (P = 0.0082).


Its close spatial relationship to an invasive component and increased association with ILC suggest that F-LCIS may be a precursor for ILC.


Invasive Breast Cancer Invasive Ductal Carcinoma Core Needle Biopsy Invasive Lobular Carcinoma Nuclear Grade 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Supported by funding from the Margie and Robert E. Petersen Foundation (Los Angeles, CA), QVC and the Fashion Footwear Association of New York Charitable Foundation (New York, NY), Mrs. Lois Rosen (Los Angeles, CA), the Associates for Breast and Prostate Cancer Studies (Santa Monica, CA), Maria Lucia and Fernando Diez Barroso (Beverly Hills, CA), the Ruth and Martin H. Weil Fund (Los Angeles, CA), the Lance Armstrong Foundation (Austin, TX), the John Wayne Cancer Foundation (Newport Beach, CA), the Wrather Family Foundation (Los Alamos, CA), the Samueli Foundation (Corona Del Mar, CA) [Dr. Bagaria], and the Harold H. McAlister Charitable Foundation (Los Angeles, CA) [Dr. Ray].


  1. 1.
    Cornil A. Les tumeurs du sein. Paris: Libraire Germer; 1908.Google Scholar
  2. 2.
    Foote FW, Stewart FW. Lobular carcinoma in situ: a rare form of mammary carcinoma. Am J Pathol. 1941;17:491–9.PubMedGoogle Scholar
  3. 3.
    Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer. 1978;42:737–69.PubMedCrossRefGoogle Scholar
  4. 4.
    Rosen PP, Kosloff C, Lieberman PH, Adair F, Braun DW Jr. Lobular carcinoma in situ of the breast. Detailed analysis of 99 patients with average follow-up of 24 years. Am J Surg Pathol. 1978;2:225–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Page DL, Kidd TE, Jr, Dupont WD, Simpson JF, Rogers LW. Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol. 1991;22:1232–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Schnitt SJ, Morrow M. Lobular carcinoma in situ: current concepts and controversies. Semin Diagn Pathol. 1999;16:209–23.PubMedGoogle Scholar
  7. 7.
    Wheeler JE, Enterline HT, Roseman JM, Tomasulo JP, McIlvaine CH, Fitts WT Jr, et al. Lobular carcinoma in situ of the breast. Long-term followup. Cancer. 1974;34:554–63.PubMedCrossRefGoogle Scholar
  8. 8.
    Page DL, Schuyler PA, Dupont WD, Jensen RA, Plummer WD Jr, Simpson JF. Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study. Lancet. 2003;361:125–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Lakhani SR, Collins N, Sloane JP, Stratton MR. Loss of heterozygosity in lobular carcinoma in situ of the breast. Clin Mol Pathol. 1995;48:M74–8.PubMedCrossRefGoogle Scholar
  10. 10.
    De Leeuw WJ, Berx G, Vos CB, Peterse JL, Van de Vijver MJ, Litvinov S, et al. Simultaneous loss of E-cadherin and catenins in invasive lobular breast cancer and lobular carcinoma in situ. J Pathol. 1997;183:404–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Reis-Filho JS, Simpson PT, Jones C, Steele D, Mackay A, Iravani M, et al. Pleomorphic lobular carcinoma of the breast: role of comprehensive molecular pathology in characterization of an entity. J Pathol. 2005;207:1–13.PubMedCrossRefGoogle Scholar
  12. 12.
    Chen YY, Hwang ES, Roy R, DeVries S, Anderson J, Wa C, et al. Genetic and phenotypic characteristics of pleomorphic lobular carcinoma in situ of the breast. Am J Surg Pathol. 2009;33:1683–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Shin SJ, DeLellis RA, Knowles DM, Milligan L, Pan L, Rosen PP. “Florid” lobular carcinoma in situ with necrosis and calcification: a clinicopathologic, immunohistochemical and molecular analysis [abstract]. Mod Pathol. 2002;15:52A.Google Scholar
  14. 14.
    Vos CB, Cleton-Jansen AM, Berx G, de Leeuw WJ, ter Haar NT, van Roy F, et al. E-cadherin inactivation in lobular carcinoma in situ of the breast: an early event in tumorigenesis. Br J Cancer. 1997;76:1131–3.PubMedCrossRefGoogle Scholar
  15. 15.
    Roylance R, Droufakou S, Gorman P, Gillett C, Hart IR, Hanby A, et al. The role of E-cadherin in low-grade ductal breast tumourigenesis. J Pathol. 2003;200:53–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Simpson PT, Gale T, Fulford LG, Reis-Filho JS, Lakhani SR. The diagnosis and management of pre-invasive breast disease: pathology of atypical lobular hyperplasia and lobular carcinoma in situ. Breast Cancer Res. 2003;5:258–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Sapino A, Frigerio A, Peterse JL, Arisio R, Coluccia C, Bussolati G. Mammographically detected in situ lobular carcinomas of the breast. Virchows Arch. 2000;436:421–30.PubMedCrossRefGoogle Scholar
  18. 18.
    Fadare O, Dadmanesh F, Alvarado-Cabrero I, Snyder R, Stephen Mitchell J, Tot T, et al. Lobular intraepithelial neoplasia [lobular carcinoma in situ] with comedo-type necrosis: a clinicopathologic study of 18 cases. Am J Surg Pathol. 2006;30:1445–53.PubMedCrossRefGoogle Scholar
  19. 19.
    Tavassoli FA, Schnitt SJ. Pathology of the Breast. New York: Elsevier; 1992.Google Scholar
  20. 20.
    Rosen PP. Rosen’s Breast Pathology. Philadelphia: Lippincott-Raven; 1997.Google Scholar
  21. 21.
    Fisher ER, Land SR, Fisher B, Fisher B, Wickerham DL, Wang M, et al. Pathologic findings from the National Surgical Adjuvant Breast and Bowel Project: twelve-year observations concerning lobular carcinoma in situ. Cancer. 2004;100:238–44.PubMedCrossRefGoogle Scholar
  22. 22.
    Fisher ER, Costantino J, Fisher B, Palekar AS, Paik SM, Suarez CM, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) Protocol B-17. Five-year observations concerning lobular carcinoma in situ. Cancer. 1996;78:1403–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Fisher ER. Pathobiological considerations relating to the treatment of intraductal carcinoma (ductal carcinoma in situ) of the breast. CA Cancer J Clin. 1997;47:52–64.PubMedCrossRefGoogle Scholar
  24. 24.
    Sneige N, Wang J, Baker BA, Krishnamurthy S, Middleton LP. Clinical, histopathologic, and biologic features of pleomorphic lobular (ductal-lobular) carcinoma in situ of the breast: a report of 24 cases. Mod Pathol. 2002;15:1044–50.PubMedCrossRefGoogle Scholar
  25. 25.
    Chivukula M, Haynik DM, Brufsky A, Carter G, Dabbs DJ. Pleomorphic lobular carcinoma in situ (PLCIS) on breast core needle biopsies: clinical significance and immunoprofile. Am J Surg Pathol. 2008;32:1721–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Middleton LP, Grant S, Stephens T, Stelling CB, Sneige N, Sahin AA. Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol. 2003;16:120–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Cangiarella J, Guth A, Axelrod D, Darvishian F, Singh B, Simsir A, et al. Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy? A report of 38 cases and review of the literature. Arch Pathol Lab Med. 2008;132:979–83.PubMedGoogle Scholar
  28. 28.
    Ciocca RM, Li T, Freedman GM, Morrow M. Presence of lobular carcinoma in situ does not increase local recurrence in patients treated with breast-conserving therapy. Ann Surg Oncol. 2008;15:2263–71.PubMedCrossRefGoogle Scholar
  29. 29.
    Ben-David MA, Kleer CG, Paramagul C, Griffith KA, Pierce LJ. Is lobular carcinoma in situ as a component of breast carcinoma a risk factor for local failure after breast-conserving therapy? Results of a matched pair analysis. Cancer. 2006;106:28–34.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Sanjay P. Bagaria
    • 1
    • 3
  • Jaime Shamonki
    • 2
  • Michelle Kinnaird
    • 2
  • Partha S. Ray
    • 1
    • 4
  • Armando E. Giuliano
    • 1
  1. 1.Department of Surgical OncologyJohn Wayne Cancer Institute at Saint John’s Health CenterSanta MonicaUSA
  2. 2.Department of PathologySaint John’s Health CenterSanta MonicaUSA
  3. 3.Mayo ClinicJacksonvilleUSA
  4. 4.University of IllinoisUrbana-ChampaignUSA

Personalised recommendations