Invasive Lobular Carcinoma: Detection and Multiplicity with Multimodalities / 이화의대지

OBJECTIVES: We aimed to compare the diagnostic performances of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US), magnetic resonance imaging (MRI), breast specific gamma imaging (BSGI) and/or positron emission tomography/computed tomography (PET/CT) for the detection of invasive lobular carcinoma (ILC). METHODS: Index ILCs and multifocal/multicentric (multiple) ILCs were analyzed using various imaging modalities. The final surgical pathology was regarded as the reference standard. The detection rate for index cancers and the diagnostic performance for multiple ILCs per breast were evaluated. RESULTS: Seventy-eight ILCs in 76 women were enrolled. Twenty-six breasts had multiple ILCs. DM (n=72), DBT (n=15), US (n=77), MRI (n=76), BSGI (n=50), and /or PET/CT (n=74) were performed. For index cancer, the detection rate was 100% for DBT, US, and MRI. For multiple ILCs, the sensitivity was 100% for DBT and MRI (P<0.001). The diagnostic accuracy for multiple ILCs were 73.3% for DBT and 73.0% for PET/CT (P=0.460). CONCLUSION: DBT was the most accurate imaging modality for both index and multiple ILCs. PET/CT was also valuable for multiple ILCs, whereas DM and BSGI showed relatively low diagnostic performances. DBT and PET/CT have promising roles in the diagnosis of multiple ILCs.

Correlation of Prognostic Factors of Invasive Lobular Carcinoma with ADC Value of DWI and SUVMax of FDG-PET / 전남의대학술지

Invasive lobular carcinoma (ILC) is the second most common kind of breast cancer. Diffusion weighted imaging (DWI) and positron emission tomography/computed tomography (PET/CT) are functional modalities for presenting the biological characteristics of breast cancer. The purpose of this article is to study the relationship between DWI or PET/CT and ILC's prognostic factors. The relationship between the apparent diffusion coefficient (ADC) values, standard uptake value (SUV)max and prognostic factors of ILC were statistically evaluated. The ADC values were lower in mass types of ILC. SUVmax was statistically higher in grade 3 and 4 background parenchymal enhancement and positive lymph node metastasis. ADC values of DWI and SUVmax of PET/CT can be helpful in the prediction of the prognosis of ILC.

Analysis of stage and clinical pathological characteristics of invasive lobular carcinoma with the 8th AJCC Cancer Staging system / 国际外科学杂志

Objective To study the meaning of breast cancer staging system by AJCC eighth edition to invasive lobular carcinoma and analysis the clinical pathological characteristics.Methods According to the eighth edition of the AJCC staging to evaluate the TNM stage and prognosis evaluation of invasive lobular carcinoma cancer patient in Peking University Shenzhen Hospital from 2011 to 2016,and compared with others in clinical pathological data.Results There were 21 cases of invasive lobular carcinoma,accounting for 2.7％ of all invasive breast cancer.We found that invasive lobular carcinoma shows no significant difference (P ＞ 0.05) in ages,menstrual status,molecular features and anatomic staging and prognosis staging with others;histological grade were significantly different (P ＜ 0.05).There were significant differences in the prognosis and staging of invasive lobular carcinoma.Conclusions Eighth AJCC staging systemn provides a new reference for the clinical treatment of breast cancer,should be evaluated with anatomic stage.Histological grade is relatively good in invasive lobular carcinoma and the prognosis is good,needs more research to the individualized treatment of invasive lobular carcinoma.

Comparison of clinicopathological features and prognostic factors between advanced invasive lobular cancer and invasive ductal breast cancer / 肿瘤

Objective: To analyze and compare the clinicopathological features and prognostic factors between patients with advanced breast invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). Methods: Fifty-nine female patients with advanced breast ILC from Tianjin Medical University Cancer Institute and Hospital were included in this retrospective case-controlled study. Matched two hundred and thirty-six female patients with advanced breast IDC were selected according to age at diagnosis and the time of surgery (±2 years) in Tianjin Medical University Cancer Institute and Hospital between January 2008 and December 2016. Clinical and pathological features and prognostic factors were analyzed by using univariate and multivariate analyses. Results: The clinical pathological features of clinical stage at initial diagnosis, T stage, M stage, histological degree, estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor-2 (HER-2) status and molecular subtype were significantly different between two groups (all P < 0.05). The median ages at recurrence/metastasis of patients with breast ILC and IDC were 50 years (range: 28-73) and 51 years (range: 27-69), respectively. The differences in the number of first metastatic sites, lymph node metastasis, visceral metastasis, lung metastasis and bone metastasis were statistically significant between two groups (all P < 0.05). The median progression-free survivals of patients with breast ILC and IDC were 14 months (range: 2-62) and 11 months (range: 1-89), respectively (P = 0.121). The median metastasesoverall survivals (M-OS) of patients with ILC and IDC were 42 months (range: 5-78) and 44 months ((range: 1-110), respectively (P = 0.392). Multivariate analysis revealed that PR status, age at recurrence or metastasis and treatment of bone metastases were the independent predictors of survival in patients with advanced breast ILC (all P < 0.05). The molecular subtype, the number of first metastatic sites and pleural effusion were the independent prognostic factors in patients with breast IDC (all P < 0.05). Conclusion: Patients with advanced breast ILC have unique clinicopathological, recurrent/metastatic and prognostic features. It is necessary to reveal the definitive features of ILC and develop new personalized precision therapies.

Correlation of Prognostic Factors of Invasive Lobular Carcinoma with ADC Value of DWI and SUVMax of FDG-PET / 전남의대학술지

Invasive lobular carcinoma (ILC) is the second most common kind of breast cancer. Diffusion weighted imaging (DWI) and positron emission tomography/computed tomography (PET/CT) are functional modalities for presenting the biological characteristics of breast cancer. The purpose of this article is to study the relationship between DWI or PET/CT and ILC's prognostic factors. The relationship between the apparent diffusion coefficient (ADC) values, standard uptake value (SUV)max and prognostic factors of ILC were statistically evaluated. The ADC values were lower in mass types of ILC. SUVmax was statistically higher in grade 3 and 4 background parenchymal enhancement and positive lymph node metastasis. ADC values of DWI and SUVmax of PET/CT can be helpful in the prediction of the prognosis of ILC.

Clinicopathological characteristics and prognosis of patients with breast invasive lobular carcinoma by different molecular subtypes / 肿瘤

Objective: To investigate the clinical features and the relationship between molecular subtypes and the clinical features and prognosis of invasive lobular carcinoma (ILC) of breast. Methods: The clinical records of 381 patients with resectable breast ILC in Tianjin Medical University Cancer Institute and Hospital were collected from January 1, 2003 to December 31, 2012. Based on the result of immunohistochemistry, four molecular subtypes were determined, including Luminal A, Luminal B, human epidermal growth factor receptor 2 (HER2) over-expression and triple-negative breast cancer (TNBC). The correlations of the prognosis in patients with different breast cancer molecular subtypes and the clinicopathological characteristics were analyzed. Results: The proportions of the four molecular subtypes were different; Luminal B accounted for the highest proportion (66.4%) and the proportions of Luminal A, HER2 over-expression and TNBC were 16.8%, 5.5% and 11.3%, respectively. There were statistical differences among different molecular subtypes of breast ILC regarding the age, menopausal status and lymph node metastasis (all P<0.05). The univariate analysis showed that factors affecting the prognosis of breast ILC were tumor size, axillary lymph node metastasis, clinical stage, molecular subtypes, surgical method, post-operative radiotherapy and endocrine therapy (all P<0.05). The 5-year overall survival rates of patients with Luminal A and Luminal B subtypes were 100.0% and 91.2%, respectively, which were significantly higher than those of the HER2 over-expression and TNBC subtypes (55.6% and 50.9%, respectively). Multivariate analysis found that the tumor size, molecular subtypes, axillary lymph node metastasis and endocrine therapy were the independent prognostic factors of breast ILC (all P<0.05). Conclusion: Molecular subtype classification has great significance in predicting the prognosis of breast ILC. Further studies are needed to guide the individual treatment of breast ILC.

Expression of EZH2 and p53 in breast cancer and their clinical significance / 临床与实验病理学杂志

Purpose To investigate the expression of EZH2 and p53 protein in breast cancer and to analyze their relationship with the clinical pathologic characteristics and prognosis. Methods The expression of EZH2 and p53 protein were detected by immunohisto-chemical method in 50 cases of breast adenosis tissues, 92 cases of breast invasive lobular carcinoma ( ILC) and 200 cases of breast in-vasive ductal carcinoma ( IDC) , and their correlation was also analyzed. Results There was no statistical significance of EZH2 be-tween ILC and IDC (P>0. 016 7), while its expression in breast adenosis tissues was lower than that in ILC and IDC (P0. 016 7), while its expression in IDC was higher than that in ILC and breast adenosis tissues (P<0. 016 7). Its expression had no related to patient age, menopausal status, tumor size, lymph node metastasis in breast cancer, but related to histological types, pTNM stage, molecular subtype and sur-vival status (P<0. 05). The Kaplan-Meier survival analysis showed the expression of EZH2 and p53 had correlated with disease-free and overall survival rates of breast cancer (P<0. 05). Multivariate COX regression analysis showed that the expression of EZH2 and p53 were independent affecting factors to breast cancer patients. Conclusion The expression of EZH2 and p53 protein increase in the breast adenosis, ILC and IDC gradually, and they have positive correlation. The expression levels of EZH2 and p53 protein have im-portant value to evaluate the prognosis of breast cancer patients.

Clinicopathologic characteristics of invasive lobular carcinoma of the breast / 临床与实验病理学杂志

Purpose To investigate the clinicopathological characteristics and the survival outcomes of invasive lobular carcinoma. Methods A retrospective analysis of 98 patients with invasive lobular carcinoma and 530 invasive carcinoma of no special type was performed in order to observe the histological features and the clinical outcomes of invasive lobular carcinoma. Results Median follow-up was 68. 5 months for invasive lobular carcinoma and 67 months for invasive carcinoma of no special type. Invasive lobular carcinoma presented with a larger tumor size, more histopathological grade 2 tumors, increased rate of hormonal receptor positivity, human epider-mal growth factor 2 (HER-2) negativity, and had a lower proliferative index as compared to invasive carcinoma of no special type, more frequently presented with the luminal A subtype (P<0. 001). The classical invasive lobular carcinoma presented with a smaller tumor size, to have a lower histological grade and proliferative index compared to the non-classic type, and more frequently presented with the luminal A subtype, whereas the non-classic invasive lobular carcinoma patients more frequently presented with the luminal B, HER-2 overexpression, or triple negative subtype (P=0. 035). A statistically significant difference in the outcome was observed at un-ivariate analysis for patients with non-classic for disease-free survival (P=0. 043) and for overall survival (P=0. 048), as compared with patients with classical invasive lobular carcinoma. The disease-free survival difference between the invasive lobular carcinoma and the invasive carcinoma of no special type was not significant (P=0. 537), and the overall survival rates were not statistically different between the two groups (P=0. 397). A statistically significant difference of overall survival was observed at multivariate analysis for patients with HER-2 positive and triple negative subtypes versus patients with luminal A invasive lobular carcinoma (P=0. 015, P=0. 016) . Conclusions The outcome of invasive lobular carcinoma is significantly correlated with histological and immunohistochemi-cally defined molecular subtypes. New tailored strategies should be explored in these subgroups of patients with poor outcome.

Pleomorphic lobular carcinoma of breast:a clinicopathologic study of 7 cases / 临床与实验病理学杂志

Purpose To investigate the clinical and morphological features as well as immunophenotype of pleomorphic lobular carcino-ma ( PLC) . Methods Seven cases of PLC were retrieved from 34 cases of invasive lobular carcinoma. The clinical data, histologic features, immunohistochemical findings were analyzed. Results The mean age of the patients was 56. 6 years, with a range of 47 to 74 years. PLC might be nodular mass in general macroscopy. Histologically, PLC retained classical or non-classical single cells, but exhibited a greater degree of cellular atypia and pleomorphism and a higher mitotic rate than classic invasive lobular carcinoma ( ILC) . PLC was accompanied by ductal carcinoma in situ ( DCIS) and pleomorphic lobular carcinoma in situ ( PLCIS) . Immunohistochemistry and HER-2 FISH were detected. PLC showed E-cadherin negative (7/7) and p120 cytoplasmic positive (7/7), ER (5/7), PR (5/7), and HER-2 (7/7) mostly negative. 5 cases were characterized by triple negative breast cancer, two of which are basal-like pheno-type. Some cases could be observed nerve invasion (3/7) and axillary lymph node metastasis (4/7). Conclusion PLC is a very rare subtype of invasive lobular carcinoma. In some cases there are nerve invasion and lymph node metastasis. The diagnosis of PLC de-pends on the pathological morphological and immunohistochemical markers.

Invasive Lobular Carcinoma: MRI Features and Clinicohistological Characteristics According to the ER, PR, and HER2 Statuses

PURPOSE: To investigate correlations of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor type 2 (HER2) statuses with magnetic resonance imaging (MRI) features and clinicohistological characteristics in patients with invasive lobular carcinoma (ILC). MATERIALS AND METHODS: Data from 64 histologically confirmed ILCs were analyzed retrospectively. Preoperative breast MRI was reviewed for morphology and dynamic contrast-enhanced kinetics of the tumor. Pathologic reports were reviewed for ER, PR, and HER2 positivity, tumor size, lymph node metastasis, and the number of metastatic lymph nodes. Furthermore, there was an investigation of the MRI features and clinicohistologic characteristics, according to the ER, PR, and HER2 statuses. RESULTS: A significant difference in MRI features and clinicohistological tumor characteristics were observed only in relation to PR status. Of the 64 ILCs, 10 (15.6%) were PR negative. PR negative cancers, compared with PR positive cancers, were more likely to present as non-mass enhancement (P = 0.027); have a significantly larger mean tumor size (5.00 +/- 1.05 cm vs. 2.57 +/- 0.21 cm, P = 0.021); and have significantly more metastatic lymph nodes (P = 0.010). CONCLUSIONS: PR negative ILC presented more frequently as non-mass enhancement on MRI, with larger tumors and increased numbers of metastatic lymph nodes. Therefore, the PR status plays an important role in determining MRI features and clinicohistological characteristics of ILC.

Clinical characteristics and prognosis of invasive lobular carcinoma of breast: a report 125 cases / 肿瘤研究与临床

Objective To analyze clinicopathologic characteristics and prognostic factors of the patients with invasive lobular carcinoma of breast. Methods Clinical data of 125 patients with invasive lobular carcinoma of breast treated at Cancer Center of Sun Yat-sen University from Jan. 1990 to Dec. 2008, were analyzed. The clinical characteristics, recurrence and survival of the patients were summarized. Results Median age of 125 patients was 45 years old (range, 27 to 76 years old). The patients with large tumor mass (≥ 3cm), positive local lymph node, more than Ⅱ stage and positive hormone receptor at diagnosis were 77 cases(61.6 %), 64 cases(51.2 %), 101 cases(80.8 %) and 112 cases(89.6 %), respectively. The median time of follow-up was 58 months (range, 11-222 months). Of the 125 patients, 32 had local recurrence and metastasis, and 18 died. The 5-year disease-free and overall survival rates were 82.2 % and 87.3 %, respectively. Multivariate COX regression analysis showed that whether endocrine therapy or not was only a prognostic factor of patients with invasive lobular carcinoma of breast. Conclusion There is no difference in media age of patients with invasive lobular carcinoma of breast at diagnosis from other pathologic type of breast cancer. These patients are usually with larger tumor masses, more lymph node metastasis and a higher proportion of positive hormone receptor. The prognosis of patients is not affected by clinicopathologic parameters.

Metastatic Medullary Carcinoma of Thyroid to Breast; A Case Initially Diagnosed as Primary Invasive Lobular Carcinoma: A Case Report

Metastasis to the breast from medullary carcinoma of the thyroid is extremely rare. We report a case of metastatic medullary carcinoma of the thyroid which presented as multiple breast masses with ipsilateral axillary lymphadenopathy in a 48-year-old woman. Six years ago, she underwent total thyroidectomy and neck dissection because of palpable neck masses, with a diagnosis of medullary thyroid carcinoma. Histological features of breast masses showed single- file or linear-cord arrangements, with plasmacytoid appearance, and the initial diagnosis was invasive lobular carcinoma. She underwent modified radical mastectomy. The tumor cells were diffusely positive for E-cadherin, calcitonin and thyroid transcription factor-1 (TTF-1) and were metastatic medullary carcinoma of thyroid. In the patients with a history of medullary carcinoma of the thyroid, a careful examination is necessary for a breast mass composed of solid and cord-like clusters of small round to ovoid cells with plasmacytoid appearance. Immunohistochemical staining for E-cadherin, calcitonin and TTF-1 could be helpful for differential diagnosis.

Clinicopathological Characteristics of Invasive Lobular Carcinoma in the Breast: Multifocality and Difficulty in Preoperative Diagnosis

PURPOSE: Infiltrating lobular carcinoma (ILC) represents approximately 10% of all breast cancers. Its detection and staging for appropriate surgical planning may be difficult on account of its unique growth pattern, including a linear file arrangement of the tumor cells and a planar growth pattern and the resulting low density of the lesions. The purpose of this study was to evaluate the clinicopathological features of an ILC of the breast including multifocality, the preoperative accuracy of the pathological diagnostic tools, and its impact on the surgical procedure. METHODS: Between 1997 and 2003 at the Asan Medical Center, a group of 63 patients with a pathologically proven invasive lobular carcinoma who had undergone surgery were included. They were all in stage I~III, and their medical records, mammographic and sonographic results, and pathologic findings were reviewed retrospectively. RESULTS: Of the 63 patients with a mean age of 48 years (range 35 to 70), multifocal lesions were identified in 27.0% by a pathological examination. For a preoperative evaluation of a multifocal lesion, the sensitivity and positive prediction value were 21.4% and 50% by mammography, and 92.9% and 52.0% by ultrasonography, respectively. Only 27.0% of all patients were confirmed as having an ILC preoperatively; surgical excision or incision biopsies 75%, core-needle biopsy 36.4%, frozen biopsy 22.7%, FNA 5.9%. Conservative surgery was performed in only 14.3% and a mastectomy was performed on 85.5%. The mean tumor size was 3.0 cm, and according to the TNM stage, stage I was found in 22.2%, stage II in 58.7%, stage III in 19.1%. ER-positive was found in 83.9% and PR-positive was found in 74.2%. Seven out of 11 patients, who underwent the planed conserving surgery, had a positive resection margin, 1 case had re- excision, 2 cases underwent mastectomies, and 4 cases underwent radiation therapy without additional surgery. CONCLUSION: Since invasive lobular carcinomas have more often multifocal lesions and a preoperative accurate evaluation may be difficult pathologically or radiologically, a careful evaluation of the accurate tumor extent as well as the multifocal lesion is needed particularly for patients with an ILC considering conserving surgery.

Nodular Metastatic Carcinoma from Invasive Lobular Breast Cancer

Among breast cancers, the incidence of invasive lobular carcinoma is rather low, varying in the literature 0.7% to 20% and there have been no reports concerning the frequency of cutaneous metastases from invasive lobular carcinoma. Herein, we describe an interesting case of nodular metastatic lesions from invasive lobular carcinoma.

Invasive Lobular Carcinoma of the Breast Associated with Mixed Lobular and Ductal Carcinoma In Situ: A Case Report

Mixed lobular and ductal carcinoma in situ is very rare. We recently experienced a case of invasive lobular carcinoma associated with mixed lobular and ductal carcinoma in situ in a 50-year-old female. The infiltrating portions of lobular carcinoma revealed thread-like strands of tumor cells. Lobular carcinoma in situ with pagetoid spread into the ducts and ductal carcinoma in situ of the predominantly papillary type were also noted in the same mass.

Clinical Analysis of an Invasive Lobular Carcinoma in the Breast

BACKGROUND: The frequency of invasive lobular carcinomas is about 3% to 15% of all breast carcinomas. It is known that an invasive lobular carcinoma is different from other forms of breast cancer in the aspect of clinical characteristics and metastatic pattern. METHOD: To search of clinical characteristics of invasive lobular carcinomas, we restrospectively investigated 31 cases of invasive lobular carcinomas that had been treated from 1985 to 1996 at the Department of Surgery, Severance Hospital. RESULTS: The peak incidence was in the 40's (12 cases, 38.7%), and the average age was 45.8. The main clinical manifestation was a palpable mass on the breast at the time of visit to the hospital (30 cases, 96.8%), and the most frequent site was the upper outer quadrant (18 cases, 58.1%), followed by the upper inner quadrant (6 cases, 19.4%), of the breast. The most prevalent tumor size was 2-4 cm (14 cases, 45.2%), and the mean size was 3.27 cm. The negativity of the axillary nodes for invasive lobular carcinoma was 67.7%. According to the TNM system, there was 5 casess (16.1%) in stage I, 17 cases (54.8%) in stage IIa, 7 cases (22.6%) in stage IIb, and 2 cases (6.5%) in stage IIIb. The positivity of the estrogen receptor (ER) was 35.7%, and the positivity of the progesterone receptor (PR) was 54.5%. The overall 5-year survival rate was 82%, the overall 5-year disease-free survival was 70%, and the mean survival was 108 months. CONCLUSION: The clinical characteristics of an invasive lobular carcinoma seem to be similar to those of an invasive ductal carcinoma. Further studies are required to search for the clinical characteristics and for an adequate treatment.