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Breast malignant, males, children

In situ carcinoma

Pleomorphic lobular carcinoma in situ (PLCIS)


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 10 November 2012, last major update January 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Terminology
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● Also called ductal-lobular carcinoma in situ
● Has features distinct from classic LCIS (Am J Surg Pathol 2009;33:1683)

Case reports
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● 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 and prognosis
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● 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)

Micro description
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● 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

Micro images
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Various images


Central necrosis and calcification


With infiltrating lobular carcinoma


Needle biopsy

           
In situ and invasive disease

           
E-cadherin: in situ and invasive disease


Fig A: moderate Ki-67, Fig B: E-cadherin negative


Negative E-cadherin with internal control (normal breast)


E-cadherin: LCIS vs. DCIS

Other images: Plasmacytoid cells in linear pattern (PDF)

Cytology description
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● 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 - PDF)
Ductal lavage: epithelial cells in small clusters, single file arrangement or solitary, cytoplasmic vacuoles and nuclear atypia (Acta Cytol 2008;52:207)

Cytology images
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Plasmacytoid cells (PDF)

Positive stains
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● ER (90-100%), P120 catenin (cytoplasmic-dominant, Am J Surg Pathol 2008;32:1721)
● GCDFP-15 (74%), PR (50%), HER2 (5-25%), Ki-67 > 20% (47%)

Negative stains
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● E-cadherin (100%), p53 (75%)

Molecular / cytogenetics description
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● 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
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● 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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Mod Pathol 2002;15:1044

End of Breast malignant, males, children > In situ carcinoma > Pleomorphic lobular carcinoma in situ (PLCIS)


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