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Breast malignant, males, children

Carcinoma subtypes

Pleomorphic variant of lobular carcinoma


Reviewer: Monika Roychowdhury, M.D., (see Reviewers page)
Revised: 14 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Aggressive variant with high grade tumor cells

Epidemiology
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● Mean age 57 years, range 24-92 years

Clinical features
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● Presents at more advanced stage than classic lobular carcinoma (J Surg Oncol 2008;98:314)
● Traditionally considered to have aggressive clinical course (Am J Surg Pathol 2000;24:1650) but see Ann Diagn Pathol 2012;16:185
● Poorer clinical outcome: older patients, negative hormonal receptor status

Gross images
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Circumscribed tumor

Micro description
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● Multifocal nodular aggregates of dyscohesive, pleomorphic, high-grade tumor cells in dense fibrotic breast parenchyma
● Also single file and targetoid pattern of classic lobular carcinoma
● Often signet ring cells (29%), globoid plasmacytoid cells with eosinophilic or foamy or vacuolated cytoplasm, high nuclear grade and often multiple nucleoli
● Pleomorphic LCIS (45%) and classic LCIS (21%) often present
● 3-10 mitoses per 10 HPF
● Usually no microcalcifications, no duct formation present

Micro images
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Pleomorphic tumor cells

   
Signet ring type cells

   
With pleomorphic LCIS

               
Contributed by Dr. Semir Vranic

   
E-cadherin negative (staining of residual normal ducts), by Dr. Semir Vranic


p53

Other images: pleomorphic tumor cells,   E-cadherin negative

Cytology description
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● More cellular than classic lobular, large tumor cells with single filing, tumor cells have cytoplasmic vacuoles and pleomorphic nuclei (Cancer 1997;81:29)
● May have apocrine features and resemble atypical mesothelial cells (Diagn Cytopathol 2008;36:657)
Ductal lavage: similar features, although less striking, including epithelial cells in small clusters, single-file or isolated; also nuclear atypia, cytoplasmic vacuoles and signet ring features (Acta Cytol 2008;52:207)

Cytology images
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Various images

Virtual slides
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With ductal NOS

Positive stains
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● GCDFP-15 (71%, due to apocrine nature), HER2 (2+ to 3+ in 81%), p53 (48%)
● Variable ER and PR

Negative stains
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● E-cadherin (Mod Pathol 2003;16:674), beta-catenin (membrane staining is absent, Appl Immunohistochem Mol Morphol 2007;15:260)
● 13% are triple negative (Histopathology 2012;61:365)

Molecular / cytogenetic description
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● Resembles infiltrating lobular carcinoma more than infiltrative ductal carcinoma (J Pathol 2008;215:231)
● Frequent gains on 1q and 16p, losses on 11q and 16q, and genomic amplifications of 8q24, 11q13, 12q13, 17q12 and 20q13 (Future Oncol 2009;5:233)
● More frequent p53 mutations than classic lobular (Cell Oncol (Dordr) 2012;35:111)

Differential diagnosis
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Chemotherapy or radiation treatment effect

Additional references
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Hum Pathol 1992;23:1167, Hum Pathol 1992;23:655, Mod Pathol 1998;11:814

End of Breast malignant, males, children > Carcinoma subtypes > Pleomorphic variant of lobular carcinoma


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