Skip to main content

Advertisement

SpringerLink
Log in

Pleomorphic Lobular Carcinoma In Situ: Radiologic–Pathologic Features and Clinical Management

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pleomorphic lobular carcinoma in situ (PLCIS) is an unusual variant of LCIS for which optimal management remains unclear.

Methods

We conducted a 15-year (2000–2014) retrospective chart review of the radiologic, pathologic, clinical management, and recurrence rates of patients with PLCIS on diagnostic biopsy. Fifty-one patients were found to have PLCIS either alone or with concomitant breast cancer. Of these, 23 were found to have pure PLCIS on diagnostic biopsy. Rates of upstaging after local excision, positive or close margins, mastectomy, and recurrence associated with pure pleomorphic lobular carcinoma in situ were examined.

Results

Of the 21 patients who underwent surgical excision following diagnostic biopsy, 33.3 % (7/21) were found to have invasive carcinoma, and 19 % (4/23) were found to have ductal carcinoma in situ. Extensive or multifocal PLCIS was present in 47.6 % (10/21) of patients, corresponding to at least one PLCIS-positive or close margin in 71.4 % (15/21). In total, there were 11 local re-excisions in nine patients, and 12 mastectomies. No ipsilateral breast cancer events have occurred, including in those with positive or close surgical margins (mean follow-up 4.1 years).

Conclusions

Patients with isolated PLCIS on diagnostic biopsy are at high risk of upgrading to invasive cancer or ductal carcinoma in situ at diagnostic excision. PLCIS often is extensive, with high rates of positive or close surgical resection margins. If negative PLCIS margins are pursued, rates of successful breast conservation are low. In light of this and low recurrence rates, caution should be exercised in aggressively treating PLCIS with excision to clear margins.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Page DL, Dupont WD, Rogers LW, Rados MS. Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer. 1985;55(11):2698–708.

    Article  CAS  PubMed  Google Scholar 

  2. Page DL, Kidd TE, 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(12):1232–9.

    Article  CAS  PubMed  Google Scholar 

  3. Li CI, Malone KE, Saltzman BS, Daling JR. Risk of invasive breast carcinoma among women diagnosed with ductal carcinoma in situ and lobular carcinoma in situ, 1988–2001. Cancer. 2006;106(10):2104–112. doi:10.1002/cncr.21864.

    Article  PubMed  Google Scholar 

  4. Haagensen CD, Lane N, Lattes R, Bodian C. Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer. 1978;42(2):737–69.

    Article  CAS  PubMed  Google Scholar 

  5. Nagi CS, O’Donnell JE, Tismenetsky M, Bleiweiss IJ, Jaffer SM. Lobular neoplasia on core needle biopsy does not require excision. Cancer. 2008;112(10):2152–8. doi:10.1002/cncr.23415.

    Article  PubMed  Google Scholar 

  6. Sullivan ME, Khan SA, Sullu Y, Schiller C, Susnik B. Lobular carcinoma in situ variants in breast cores: potential for misdiagnosis, upgrade rates at surgical excision, and practical implications. Arch Pathol Lab Med. 2010;134(7):1024–8. doi:10.1043/2009-0300-OA.1.

    PubMed  Google Scholar 

  7. Shah-Khan MG, Geiger XJ, Reynolds C, Jakub JW, DePeri ER, Glazebrook KN. Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Ann Surg Oncol. 2012;19(10):3131–8. doi:10.1245/s10434-012-2534-9.

    Article  PubMed  Google Scholar 

  8. Theriault R, Carlson R. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. National Comprehensive Cancer Network; 2013.

  9. Nelson HD, Smith MEB, Griffin JC, Fu R. Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;158(8):604–14. doi:10.7326/0003-4819-158-8-201304160-00005.

    Article  PubMed  Google Scholar 

  10. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90(18):1371–88. doi:10.1093/jnci/90.18.1371.

    Article  CAS  PubMed  Google Scholar 

  11. Rosen PP, Hoda SA. Breast pathology. Lippincott Williams & Wilkins, Philadelphia; 2010.

    Google Scholar 

  12. Pieri A, Harvey J, Bundred N. Pleomorphic lobular carcinoma in situ of the breast: can the evidence guide practice? World J Clin Oncol. 2014;5(3):546–53. doi:10.5306/wjco.v5.i3.546.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Murray L, Reintgen M, Akman K, et al. Pleomorphic lobular carcinoma in situ: treatment options for a new pathologic entity. Clin Breast Cancer. 2012;12(1):76–9. doi:10.1016/j.clbc.2011.08.007.

    Article  PubMed  Google Scholar 

  14. 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(11):1721–6. doi:10.1097/PAS.0b013e31817dc3a6.

    Article  PubMed  Google Scholar 

  15. Carder PJ, Shaaban AM. Pleomorphic lobular carcinoma in situ. Diagn Histopathol. 2012;18:119–123.

    Article  Google Scholar 

  16. Khoury T, Karabakhtsian RG, Mattson D, et al. Pleomorphic lobular carcinoma in situof the breast: clinicopathological review of 47 cases. Histopathology. 2014;64(7):981–93. doi:10.1111/his.12353.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Blair SL, Emerson DK, Kulkarni S, Hwang ES, Malcarne V, Ollila DW. Breast surgeon’s survey: no consensus for surgical treatment of pleomorphic lobular carcinoma in situ. Breast J. 2013;19(1):116–8. doi:10.1111/tbj.12062.

    Article  PubMed  Google Scholar 

  18. Murray L, Reintgen M, Akman K, et al. Pleomorphic lobular carcinoma in situ: treatment options for a new pathologic entity. Clin Breast Cancer. 2012;12(1):76–9. doi:10.1016/j.clbc.2011.08.007.

    Article  PubMed  Google Scholar 

  19. Burstein HJ, Polyak K, Wong JS, Lester SC, Kaelin CM. Ductal carcinoma in situ of the breast. N Engl J Med. 2004;350(14):1430–41. doi:10.1056/NEJMra031301.

    Article  CAS  PubMed  Google Scholar 

  20. Downs-Kelly E, Bell D, Perkins GH, Sneige N, Middleton LP. Clinical implications of margin involvement by pleomorphic lobular carcinoma in situ. Arch Pathol Lab Med. 2011;135(6):737–43. doi:10.1043/2010-0204-OA.1.

    PubMed  Google Scholar 

  21. Rendi MH, Dintzis SM, Lehman CD, Calhoun KE, Allison KH. Lobular in situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 2012;19(3):914–21. doi:10.1245/s10434-011-2034-3.

    Article  PubMed  Google Scholar 

  22. Esserman LE, Lamea L, Tanev S. Should the extent of lobular neoplasia on core biopsy influence the decision for excision? Breast J. 2007. doi:10.1111/j.1524-4741.2006.00363.x.

    Google Scholar 

  23. Hussain M, Cunnick GH. Management of lobular carcinoma in situ and atypical lobular hyperplasia of the breast–a review. Eur J Surg Oncol. 2011;37(4):279–89. doi:10.1016/j.ejso.2011.01.009.

    Article  CAS  PubMed  Google Scholar 

  24. Downs-Kelly E, Bell D, Perkins GH, Sneige N, Middleton LP. Clinical implications of margin involvement by pleomorphic lobular carcinoma in situ. Arch Pathol Lab Med. 2011;135(6):737–43. doi:10.1043/2010-0204-OA.1.

    PubMed  Google Scholar 

  25. Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ. WHO classification of tumours of the breast. 4th edn. Lyon: International Agency on Cancer Research; 2012:78–80.

    Google Scholar 

  26. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. doi:10.1016/j.jbi.2008.08.010.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgment

Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Washington School of Medicine.26 MRF was supported by T32 grant support from the National Cancer Institute under Award Number CA009168. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosures

The authors report no disclosures or conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Washington Medical Center, Seattle, WA, USA

    Meghan R. Flanagan MD, Kristine E. Calhoun MD, Benjamin O. Anderson MD & Sara H. Javid MD

  2. Department of Anatomic Pathology, University of Washington Medical Center, Seattle, WA, USA

    Mara H. Rendi MD, PhD

Authors
  1. Meghan R. Flanagan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mara H. Rendi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kristine E. Calhoun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin O. Anderson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sara H. Javid MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara H. Javid MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Flanagan, M.R., Rendi, M.H., Calhoun, K.E. et al. Pleomorphic Lobular Carcinoma In Situ: Radiologic–Pathologic Features and Clinical Management. Ann Surg Oncol 22, 4263–4269 (2015). https://doi.org/10.1245/s10434-015-4552-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4552-x

Keywords

Search

Navigation