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Breast-malignant, males, children
Morphologic variants of DCIS
Pleomorphic lobular carcinoma in situ
Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.
Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)
Revised: 31 August 2009
Last major update: August 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Terminology
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● Also called ductal-lobular carcinoma in situ
● Has features distinct from classic LCIS (Am J Surg Pathol 2009 Aug 20 [Epub ahead of print])
Case reports
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● Almost pure signet ring cell morphology (Pathol Int 2006;56:683)
Treatment and prognosis
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● May have more aggressive behavior than classic LCIS
● Treated similar to DCIS (excision with negative margins, variable radiation)
● Responded to trastuzumab in 4 cases (J Clin Oncol 2008;26:5823)
Microscopic description
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● One or more lobular units with distended terminal ducts and acini
● Medium/large dyscohesive cells with eosinophilic, granular and occasionally vacuolated cytoplasm
● Often apocrine features (Hum Pathol 1992;23:655, Pathol Oncol Res 2002;8:151)
● Eccentrically placed nuclei are 4x size of lymphocytes, exhibit moderate/marked pleomorphism, distinct nucleoli
● Central necrosis in 60%, microcalcifications in 40%
● “Classic” LCIS is often seen
● Morphologic features of pleomorphic LCIS and coexisting invasive disease (if present) are similar
Micro images
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Various images Central necrosis and With infiltrating lobular
calcification carcinoma
Various images Needle biopsy Invasive and in situ tumors
Plasmacytoid cells in
linear pattern
Fig A: moderate Ki-67, Negative E-cadherin with E-Cadherin: LCIS vs. DCIS
Fig B: E-cadherin negative internal control (normal breast)
Cytology description
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● Features are hybrid of ductal and lobular tumor cells - cellular smears with tumor cells 2-3x size of classic invasive lobular, with moderate to abundant eosinophilic, granular/apocrine to finely vacuolated cytoplasm, moderate nuclear pleomorphism, prominent nucleoli; may have plasmacytoid appearance due to eccentric nuclear location (Journal of Cytology 2007; 24:193)
● Ductal lavage - epithelial cells in small clusters, single file arrangement or solitary, cytoplasmic vacuoles and nuclear atypia (Acta Cytol 2008;52:207)
Cytology images
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Plasmacytoid cells
Positive stains
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● ER (90-100%), P120 catenin (cytoplasmic-dominant, Am J Surg Pathol 2008;32:1721)
● GCDFP-15 (74%), PR (50%), HER2 (5-25%), Ki-67 > 20% (47%)
Negative stains
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● E-cadherin (100%), p53 (75%)
Molecular / cytogenetics
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● Similar changes as classic LCIS, but distinct from DCIS (J Pathol 2008;215:231)
Differential diagnosis
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● DCIS - no lobular involvement, cells are cohesive, nuclei not eccentric, E-cadherin+ (Arch Pathol Lab Med 2009;133:1116), pleomorphic cells are ER-, HER2+
Additional references
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End of Breast – Malignant, Males, Children > Pleomorphic lobular carcinoma in situ
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