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Table of Contents
Terminology | Case reports | Treatment | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Molecular / cytogenetics description | Differential diagnosis | Additional referencesCite this page: Pleomorphic lobular carcinoma in situ (PLCIS). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantpleolcis.html. Accessed July 14th, 2017.
Terminology
- Also called ductal-lobular carcinoma in situ
- Has features distinct from classic LCIS (Am J Surg Pathol 2009;33:1683)
Case reports
- 67 year old woman with mammographic calcifications, in situ and invasive disease (Case of Week #168)
- Almost pure signet ring cell morphology (Pathol Int 2006;56:683)
Treatment
- 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 (histologic) description
- 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
Microscopic (histologic) images
Images hosted on PathOut server:
In situ and invasive disease
E-cadherin: in situ and invasive disease
Images hosted on other servers:
Various images
E-cadherin: LCIS vs. DCIS
Cytology description
- 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)
Positive stains
Negative stains
- E-cadherin (100%), p53 (75%)
Molecular / cytogenetics description
- Molecular features are distinct from classic LCIS (Am J Surg Pathol 2009;33:1683), but resemble invasive lobular carcinoma more than invasive ductal carcinoma (J Pathol 2008;215:231)
Differential diagnosis
- DCIS: no lobular involvement, cells are cohesive, nuclei not eccentric, strongly E-cadherin+ (Arch Pathol Lab Med 2009;133:1116), pleomorphic cells are ER-, HER2+
Additional references
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