Atypical lobular hyperplasia and classic
lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary.
Lobular carcinoma in situ represents both a risk factor and a nonobligate precursor for the development of invasive carcinoma in either breast.
At our institution, patients with low-grade ductal carcinoma in situ,
lobular carcinoma in situ, atypical ductal hyperplasia, or atypical lobular hyperplasia in RMP specimens were offered "high-risk" screening and in some cases, prophylactic hormonal treatment.
(%) Abbreviations: ADH, atypical ductal hyperplasia; ALH, atypical lobular hyperplasia; CCC, columnar cell change; DCIS, ductal carcinoma in situ; FCC, fibrocystic change; FEA, flat epithelial atypia; H/o, history of; LCIS,
lobular carcinoma in situ. Table 2.
(21,24)
Lobular carcinoma in situ often exhibits weak, fragmented, membranous E-cadherin staining that is considerably less intense that in adjacent benign breast glandular tissue and is usually not diffuse in distribution (Figure 6, A and B).
E, Pleomorphic
lobular carcinoma in situ. F, Invasive carcinoma (hematoxylin-eosin, original magnifications X40 [D], X100 [E], and 320 [F]).
Follow-up of the 20 patients (21 biopsies) who had unremarkable/normal breast tissue on MRI-guided biopsy revealed the following: 11 patients had resolution of the initial lesion on follow-up MRI, 1 patient had a prophylactic mastectomy with concordant benign pathology at the 2 MRI biopsy sites, 4 women underwent rebiopsy that yielded benign breast tissue or fibrocystic changes, 3 women were lost to follow-up, and 1 had a follow-up ultrasound guided biopsy that revealed focal
lobular carcinoma in situ in a background of columnar cell change.
Examples of pleomorphic
lobular carcinoma in situ (A and B), florid
lobular carcinoma in situ (C and D), and
lobular carcinoma in situ (LCIS) (E through G).
(%) <.001 Benign 2814 (60.9) 119 (33.1) Atypia or LCIS 183 (4.0) 58 (16.2) DCIS/invasive carcinoma 1625 (35.1) 182 (50.7) Abbreviations: DCIS, ductal carcinoma in situ; LCIS,
lobular carcinoma in situ. (a) Includes excisional biopsy, lumpectomy, and mastectomy procedures.
Case of pleomorphic
lobular carcinoma in situ involving sclerosing adenosis.
The discussion expands to include other apocrine lesions including apocrine ductal carcinoma in situ (DCIS), apocrine carcinoma, and pleomorphic
lobular carcinoma in situ. The authors highlight important diagnostic criteria and pitfalls, as well as clinical implications for management.
Pathologic Entities Encompassed by the Term Atypical Papilloma Intraductal papilloma with florid UDH Intraductal papilloma with infiltrating epitheliosis Intraductal papilloma with DIN1B/ADH Intraductal papilloma with LIN/ALH/LCIS Intraductal papilloma with low-grade DCIS Intraductal papillary carcinoma Encapsulated papillary carcinoma Solid papillary carcinoma Abbreviations: ADH, atypical ductal hyperplasia; ALH, atypical lobular hyperplasia; DCIS, ductal carcinoma in situ; DIN, ductal intraepithelial neoplasia; LCIS,
lobular carcinoma in situ; LIN, lobular intraepithelial neoplasia; UDH, usual duct hyperplasia.
