Morphologic subtypes of lobular carcinoma in situ diagnosed on core needle biopsy: clinicopathologic features and findings at follow-up excision

M Gabriela Kuba, Melissa P Murray, Kristen Coffey, Catarina Calle, Monica Morrow, Edi Brogi, M Gabriela Kuba, Melissa P Murray, Kristen Coffey, Catarina Calle, Monica Morrow, Edi Brogi

Abstract

Lobular carcinoma in situ (LCIS) is currently classified as classic (CLCIS), florid (FLCIS), and pleomorphic (PLCIS). Given the rarity of FLCIS and PLCIS, information on their clinico-pathologic features and biologic potential remains limited. We evaluated the upgrade rates at excision of FLCIS and PLCIS diagnosed on inhouse core needle biopsy (CNB) and their clinical presentation and follow-up. Over a period of 11 and a half years, there were a total of 36 inhouse CNBs with pure PLCIS (n = 8), FLCIS (n = 24), or LCIS with pleomorphic features (LCIS-PF) (n = 4). The upgrade rates to invasive carcinoma or ductal carcinoma in situ (DCIS) were 25% for PLCIS (2/8), 17% for FLCIS (4/24), and 0% for LCIS-PF (0/4). The overall upgrade rate of PLCIS and FLCIS combined was 19% (6/32). All but one case (not upgraded at excision) were radiologic-pathologic concordant. Apocrine features, previously reported only in PLCIS, were also noted in FLCIS. HER2 overexpression was seen in 13% of cases. This study highlights the more aggressive biologic features of PLCIS and FLCIS compared to CLCIS and supports surgical management for these lesions.

Conflict of interest statement

Conflict of Interest

The authors declare no conflict of interest.

© 2021. The Author(s), under exclusive licence to United States & Canadian Academy of Pathology.

Figures

Figure 1.
Figure 1.
Study cohort *Between 2009 and 2019 there were 322 CNBs with a diagnosis of CLCIS only.
Figure 2.
Figure 2.
Classic LCIS and morphologic variants. A-B) CLCIS showing a dyscohesive proliferation of type A and B cells expanding more than 50% of the acini. C) FLCIS with massive acinar expansion and central necrosis. D) FLCIS with apocrine features, showing marked expansion of the acini by dyscohesive cells with ample granular eosinophilic cytoplasm and minimal nuclear atypia. E) PLCIS is composed of a dyscohesive proliferation of cell with marked nuclear pleomorphism. F) PLCIS with apocrine features. G) LCIS-PF consists predominantly of type B cells with scattered cells showing enlarged and pleomorphic nuclei.

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