De Brot Marina, Koslow Mautner Starr, Muhsen Shirin, Andrade Victor P, Mamtani Anita, Murray Melissa, Giri Dilip, Sakr Rita A, Brogi Edi, King Tari A
Department of Pathology, A.C.Camargo Cancer Center, Sao Paulo, SP, 01509-010, Brazil.
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Breast Cancer Res Treat. 2017 Sep;165(2):411-420. doi: 10.1007/s10549-017-4334-1. Epub 2017 Jun 13.
The natural history of pleomorphic lobular carcinoma in situ (PLCIS) remains largely unknown.
A pathology database search (1995-2012) was performed to identify patients diagnosed with an LCIS variant. Patients with synchronous breast cancer and/or no evidence of pleomorphism were excluded. Original slides were re-evaluated by three pathologists to identify a consensus cohort of PLCIS. Borderline lesions with focal atypia were classified as LCIS with pleomorphic features (LCIS-PF). Clinical data were obtained from medical records.
From 233 patients, we identified 32 with an LCIS variant diagnosis and no concurrent breast cancer. Following review, 16 cases were excluded due to lack of pleomorphism. The remaining 16 were classified as PLCIS (n = 11) and LCIS-PF (n = 5). 12/16 patients were treated with surgical excision ± chemoprevention. Patients with a prior breast cancer history and those having mastectomy were excluded from outcome analysis. Among the remaining 7 patients with PLCIS/LCIS-PF, 4/7 (57%) developed ipsilateral breast cancer at a median follow-up of 67 months. Median age at the time of breast cancer diagnosis was 56 years old and median time from PLCIS/LCIS-PF to cancer diagnosis was 59 months (range 45-66 months). The four cancers included 1 invasive lobular carcinoma (ILC), 1 microinvasive ILC, 1 invasive ductal carcinoma, and 1 ductal carcinoma in situ.
We confirm that PLCIS in isolation is indeed a rare entity, further contributing to the difficulty in determining the actual risk conferred by this lesion. Long-term follow-up data on larger cohorts are needed to define standardized management and outcomes for patients with PLCIS.
多形性小叶原位癌（PLCIS）的自然病史在很大程度上仍不清楚。
进行病理数据库检索（1995 - 2012年）以识别诊断为小叶原位癌（LCIS）变异型的患者。排除同时患有乳腺癌和/或无多形性证据的患者。由三名病理学家重新评估原始切片以确定PLCIS的共识队列。具有局灶性异型性的交界性病变被分类为具有多形性特征的LCIS（LCIS - PF）。从医疗记录中获取临床数据。
在233例患者中，我们识别出32例诊断为LCIS变异型且无并发乳腺癌的患者。经复查，16例因缺乏多形性而被排除。其余16例被分类为PLCIS（n = 11）和LCIS - PF（n = 5）。12/16例患者接受了手术切除±化学预防。有乳腺癌病史和接受乳房切除术的患者被排除在结局分析之外。在其余7例PLCIS/LCIS - PF患者中，4/7（57%）在中位随访67个月时发生同侧乳腺癌。乳腺癌诊断时的中位年龄为56岁，从PLCIS/LCIS - PF到癌症诊断的中位时间为59个月（范围45 - 66个月）。这四例癌症包括1例浸润性小叶癌（ILC）、1例微浸润性ILC、1例浸润性导管癌和1例导管原位癌。
我们证实孤立的PLCIS确实是一种罕见的实体，这进一步增加了确定该病变实际风险的难度。需要更大队列的长期随访数据来确定PLCIS患者的标准化管理和结局。
