Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY.
Department of Pathology, Rhode Island Hospital and the Warren Alpert School of Medicine of Brown University, Providence, RI.
Clin Breast Cancer. 2018 Aug;18(4):e449-e454. doi: 10.1016/j.clbc.2017.10.004. Epub 2017 Oct 7.
Pleomorphic lobular carcinoma in situ (PLCIS) is a variant of LCIS with high-grade morphologic features. The number of case series studying PLCIS is limited, and clinical management of patients with PLCIS is controversial. We report a breast core biopsy (BCBx) series of PLCIS.
We reviewed 37 cases of PLCIS with or without microinvasion diagnosed by BCBx. PLCIS was defined as dyscohesive cells showing acinar expansion and loss of immunohistochemical membranous expression of e-cadherin or beta-catenin with nuclear pleomorphism with at least 2- to 3-fold variation in nuclear size, membrane irregularities, and variably prominent nucleoli. Clinical information and findings on excision were evaluated.
Thirty-one (84%) patients presented with mammographic calcifications, 4 (11%) presented with ultrasound findings, 1 (3%) presented with magnetic resonance imaging enhancement, and 1 (3%) with combined imaging abnormality. The mean patient age was 62.3 years. Nineteen patients (51%) had a family history of breast cancer. Microinvasion was present on BCBx in 9 (24%) of the 37 patients. Excision, available in 34 patients, demonstrated invasive carcinoma in 24 (65%), which was multifocal in 11 (46%). Twenty-three patients with PLCIS without microinvasion on BCBx, and without known history of ipsilateral invasive cancer, underwent excision; 14 of these patients demonstrated invasive carcinoma, representing an upgrade to invasive carcinoma of 60%.
We report the largest BCBx series of PLCIS and confirm its aggressive biology and frequent association with multifocal invasive lobular carcinoma, as well as frequent presentation in patients with a family history of breast cancer. Our results support excision to negative margins.
多形性小叶原位癌（PLCIS）是一种具有高级形态特征的 LCIS 变体。研究 PLCIS 的病例系列数量有限，对 PLCIS 患者的临床管理存在争议。我们报告了一组经乳腺核心活检（BCBx）诊断的 PLCIS。
我们回顾了 37 例经 BCBx 诊断为 PLCIS 伴或不伴微浸润的病例。PLCIS 的定义为细胞黏附分子（E-钙黏蛋白或β-连环蛋白）免疫组化膜表达缺失的黏附性差的细胞，表现为腺样扩张，细胞核多形性，核大小有 2-3 倍变化，膜不规则，核仁明显。评估了切除的临床信息和发现。
31 例（84%）患者有乳腺 X 线摄影钙化，4 例（11%）有超声表现，1 例（3%）有磁共振成像增强，1 例（3%）有联合影像异常。患者平均年龄为 62.3 岁。19 例（51%）有乳腺癌家族史。37 例患者中，9 例（24%）在 BCBx 上有微浸润。34 例可切除的患者中，24 例（65%）显示浸润性癌，其中 11 例（46%）为多灶性。23 例 BCBx 无微浸润且同侧无浸润性癌病史的 PLCIS 患者行切除术；其中 14 例患者有浸润性癌，浸润性癌升级率为 60%。
我们报告了最大的 BCBx 系列 PLCIS，并证实其具有侵袭性生物学特征，常与多灶性浸润性小叶癌相关，常发生于有乳腺癌家族史的患者。我们的结果支持阴性切缘切除。
