Pleomorphic Lobular Carcinoma in Situ Diagnosed by Breast Core Biopsy: Clinicopathologic Features and Correlation With Subsequent Excision


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Abstract

Pleomorphic lobular carcinoma in situ (PLCIS) is a variant of LCIS with high grade morphologic features. However, the number of case series are limited, and the natural history and optimal clinical management are not well-defined. We report the largest breast core biopsy series of PLCIS which included 37 patients with PLCIS diagnosed on core biopsy. Upgrade rate to invasive carcinoma on excision was 60%, which was multifocal in 46%. Over one-half of our cohort had a family history of breast cancer.Introduction:Pleomorphic lobular carcinoma in situ (PLCIS) is a variant of LCIS with high-grade morphologic features. The number of case series studying PLCIS is limited, and clinical management of patients with PLCIS is controversial. We report a breast core biopsy (BCBx) series of PLCIS.Materials and Methods:We reviewed 37 cases of PLCIS with or without microinvasion diagnosed by BCBx. PLCIS was defined as dyscohesive cells showing acinar expansion and loss of immunohistochemical membranous expression of e-cadherin or beta-catenin with nuclear pleomorphism with at least 2- to 3-fold variation in nuclear size, membrane irregularities, and variably prominent nucleoli. Clinical information and findings on excision were evaluated.Results:Thirty-one (84%) patients presented with mammographic calcifications, 4 (11%) presented with ultrasound findings, 1 (3%) presented with magnetic resonance imaging enhancement, and 1 (3%) with combined imaging abnormality. The mean patient age was 62.3 years. Nineteen patients (51%) had a family history of breast cancer. Microinvasion was present on BCBx in 9 (24%) of the 37 patients. Excision, available in 34 patients, demonstrated invasive carcinoma in 24 (65%), which was multifocal in 11 (46%). Twenty-three patients with PLCIS without microinvasion on BCBx, and without known history of ipsilateral invasive cancer, underwent excision; 14 of these patients demonstrated invasive carcinoma, representing an upgrade to invasive carcinoma of 60%.Conclusion:We report the largest BCBx series of PLCIS and confirm its aggressive biology and frequent association with multifocal invasive lobular carcinoma, as well as frequent presentation in patients with a family history of breast cancer. Our results support excision to negative margins.

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