Lobular Carcinoma In Situ

Hannah Y Wen, Edi Brogi, Hannah Y Wen, Edi Brogi

Abstract

Lobular carcinoma in situ (LCIS) is a risk factor and a nonobligate precursor of breast carcinoma. The relative risk of invasive carcinoma after classic LCIS diagnosis is approximately 9 to 10 times that of the general population. Classic LCIS diagnosed on core biopsy with concordant imaging and pathologic findings does not mandate surgical excision, and margin status is not reported. The identification of variant LCIS in a needle core biopsy specimen mandates surgical excision, regardless of radiologic-pathologic concordance. The presence of variant LCIS close to the surgical margin of a resection specimen is reported, and reexcision should be considered.

Keywords: CDH1; Core biopsy; E-cadherin; Pleomorphic lobular carcinoma in situ; Variant lobular carcinoma in situ; p120.

Conflict of interest statement

DISCLOSURE:

The authors declare they have no conflict interest to disclose

Figures

Fig 1. Lobular carcinoma in situ, classic… — **Fig 1. Lobular carcinoma in situ, classic type**
The acini are expanded by monomorphic, evenly spaced dyshesive cells with low grade nuclear atypia. Magnification 200x.

Fig 2. Lobular carcinoma in situ, classic… — **Fig 2. Lobular carcinoma in situ, classic type, with Pagetoid growth in a duct**
Magnification 200x.

Fig 3. Lobular carcinoma in situ, classic… — **Fig 3. Lobular carcinoma in situ, classic type with small cells (type A cells)**
Dyshesive and nonpolarized cells, with scant cytoplasm, monotonous, round to oval nuclei, with regular nuclear membrane, uniform chromatin, and inconspicuous nucleoli. Magnification 400x.

Fig 4. Lobular carcinoma in situ with… — **Fig 4. Lobular carcinoma in situ with signet ring cells**
Magnification 400x.

Fig 5. Lobular carcinoma in situ, classic… — **Fig 5. Lobular carcinoma in situ, classic type with large cells (type B cells)**
The cells are slightly larger than Type A cells (compare with Figure 3), have more cytoplasm, slightly larger but uniform nuclei, with scattered nucleoli. Magnification 400x.

**Fig 6. Atypical lobular hyperplasia**
Small round dyshesive cells, cytologically similar to the cells of classic LCIS, involve less than 50% of the acinar spaces. Magnification 200x.

**Fig 7. Pleomorphic invasive lobular carcinoma**
Invasive lobular carcinoma with single file growth pattern, dyshesive cells, and marked nuclear pleomorphism. Magnification 400x.

Fig 8. Lobular carcinoma in situ, pleomorphic… — **Fig 8. Lobular carcinoma in situ, pleomorphic type**
Dyshesive proliferation of round to oval cells with abundant cytoplasm, large eccentric nuclei with irregular nuclear membrane, coarse chromatin, and prominent nucleoli. Foci of necrosis with calcifications are common. Magnification 200x.

**Fig 9**
**Ductal carcinoma in situ**, with solid growth pattern, high nuclear grade and necrosis. Magnification 200x.

Fig 10. Lobular carcinoma in situ with… — **Fig 10. Lobular carcinoma in situ with central necrosis**
This proliferation of cells morphologically indistinguishable from those of classic LCIS, is associated with massive acinar expansion (50 or more cells across the diameter of an expanded acinus) and central necrosis. Magnification 200x.

Fig 11. Ductal carcinoma in situ, extending… — **Fig 11. Ductal carcinoma in situ, extending to lobules**
a. H&E stain. b. Immunohistochemical stain for Ecadherin. The cells show strong membranous staining for E-cadherin, consistent with ductal phenotype. Magnification 200x.

Fig 12. Lobular carcinoma in situ, pleomorphic… — **Fig 12. Lobular carcinoma in situ, pleomorphic type, with central necrosis**
a. H&E stain. b. Immunohistochemical stain for E-cadherin. The LCIS cells are negative for E-cadherin. Magnification 200x.

Fig 13. Pleomorphic lobular carcinoma in situ,… — **Fig 13. Pleomorphic lobular carcinoma in situ, apocrine type**
a. H&E stain. b. Immunohistochemical stain for E-cadherin. The cells are dyshesive, with abundant eosinophilic granular cytoplasm, large nuclei, and prominent nucleoli. Instead of complete loss of E-cadherin expression, the cells composing PLCIS in this case show focal incomplete, attenuated, and granular membranous staining for E-cadherin. Magnification 200x.

Fig 14. Lobular carcinoma in situ with… — **Fig 14. Lobular carcinoma in situ with massive acinar expansion and central necrosis**
a. H&E stain. b. Immunohistochemical stain for E-cadherin. This variant form of lobular carcinoma in situ closely mimics solid DCIS. The LCIS cells are completely negative for E-cadherin. Magnification 200x.

Fig 15. A case with both lobular… — **Fig 15. A case with both lobular carcinoma in situ (left) and ductal carcinoma in situ (right)**
a. H&E stain. b. Immunohistochemical stain for p120. It demonstrates cytoplasmic expression of p120 in the lobular carcinoma in situ and membranous staining in ductal carcinoma in situ. Magnification 200x.

Fig 16. Lobular carcinoma in situ involving… — **Fig 16. Lobular carcinoma in situ involving collagenous spherulosis mimicking cribriform ductal carcinoma in situ**
a. H&E stain. b. Immunohistochemical stain for E-cadherin. Note the basement membrane-like material in the lumen and the dyshesive growth pattern of the neoplastic cells. The absent of immunoreactivity for E-cadherin in the neoplastic cells confirms the lobular phenotype. Magnification 200x.

**Fig 17. Sclerosing adenosis**
Magnification 200x.

**Fig 18. LCIS involving sclerosing adenosis**
a. H&E stain. b. Immunohistochemical stain for ADH5. ADH5 stain demonstrates the presence of myoepithelial cells surrounding adenosis and LCIS

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Lobular Carcinoma In Situ

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