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Table of Contents
Definition / general | Epidemiology | Clinical features | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Cytology images | Positive stains | Negative stains | Molecular / cytogenetics description | Molecular / cytogenetics images | Differential diagnosis | Additional referencesCite this page: Lobular carcinoma - pleomorphic variant. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantlobularpleomorphic.html. Accessed July 14th, 2017.
Definition / general
- Aggressive variant with high grade tumor cells
Epidemiology
- Mean age 57 years, range 24 - 92 years
Clinical features
- 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
Images hosted on other servers:
Circumscribed tumor
Microscopic (histologic) description
- 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
Microscopic (histologic) images
Images hosted on PathOut server:
Signet ring type cells
Courtesy of Mark R. Wick, M.D.
Pagetoid spread, courtesy of Mark R. Wick, M.D.
In axillary, courtesy of Mark R. Wick, M.D.
Cadherin negative, courtesy of Mark R. Wick, M.D.
Images hosted on Flickr:
Courtesy of Dr. Semir Vranic
E cadherin- (residual
normal ducts), courtesy of
Dr. Semir Vranic
Images hosted on other servers:
Tumor cells
Tumor cells form single files
Pleomorphic tumor cells
Significant nuclear pleomorphism
With pleomorphic LCIS
E-cadherin negative
p53
LCIS
With DCIS
Cytology description
- 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
Images hosted on other servers:
Various images
Positive stains
Negative stains
- 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 / cytogenetics description
- 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)
Molecular / cytogenetics images
Images hosted on PathOut server:
HER2 amp, courtesy of Mark R. Wick, M.D.
Differential diagnosis
- Chemotherapy or radiation treatment effect
Additional references
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