Department of Pathology and Radiology, Bradford Royal Infirmary, Bradford, UK.
Histopathology. 2010 Sep;57(3):472-8. doi: 10.1111/j.1365-2559.2010.03634.x. Epub 2010 Aug 19.
Pleomorphic lobular carcinoma in situ (PLCIS) is an uncommon, recently recognized variant of lobular carcinoma in situ (LCIS). Its natural history, biological behaviour and clinical characteristics are uncertain. The aim was to review the radiological and pathological findings in a series of screen-detected PLCIS diagnosed on needle core biopsy with a view to determining the diagnostic features, immunohistological profile and risk of concurrent invasive malignancy.
Ten cases of core biopsy-diagnosed, screen-detected PLCIS were identified. Core biopsy findings were compared with pathological findings at subsequent surgery. Two cases were associated with possible microinvasion on the core. Two of 10 had invasive lobular carcinoma and one had microinvasive lobular carcinoma on subsequent surgical excision (positive predictive value for malignancy = 30%). There was associated conventional LCIS on either core or excision biopsy in all cases except one. All three cases of oestrogen receptor (ER)-negative PLCIS arose in the context of ER+ conventional LCIS.
PLCIS is a potentially more aggressive lesion than conventional LCIS and may present as mammographic calcification through a breast screening programme. Diagnosis may be problematic and immunohistochemical markers including ER may prove a useful diagnostic adjunct. There is a significant risk of concurrent invasive carcinoma following a core biopsy diagnosis.
多形性小叶原位癌（PLCIS）是小叶原位癌（LCIS）中一种罕见的、最近才被认识的变异型。其自然史、生物学行为和临床特征尚不确定。本研究旨在回顾一系列经穿刺活检诊断为筛检性 PLCIS 的影像学和病理学表现，以确定其诊断特征、免疫组化特征和并发浸润性恶性肿瘤的风险。
确定了 10 例经核心活检诊断为筛检性 PLCIS 的病例。将核心活检结果与随后手术的病理结果进行比较。2 例核心活检存在可能的微浸润。在随后的手术切除中，有 2 例为浸润性小叶癌，1 例为微浸润性小叶癌（恶性肿瘤的阳性预测值=30%）。除 1 例外，所有病例在核心或切除活检中均有常规 LCIS 伴发。所有 3 例 ER 阴性 PLCIS 均发生在 ER 阳性常规 LCIS 背景下。
PLCIS 是一种比常规 LCIS 更具侵袭性的病变，可能通过乳房筛查计划表现为乳腺钙化。诊断可能具有挑战性，包括 ER 在内的免疫组化标志物可能是一种有用的诊断辅助手段。在核心活检诊断后，存在并发浸润性癌的显著风险。
