|Year : 2012 | Volume
| Issue : 2 | Page : 320-322
Pleomorphic variant of lobular carcinoma breast: A rare case report with review of the literature
Amit Gupta1, Naveen Sharma1, Ashesh Kumar Jha1, Akansha Gandhi2, Usha Rani Singh2
1 Department of Surgery, University College of Medical Sciences and Associated Guru TegBahadur Hospital, New Delhi, India
2 Department of Pathology, University College of Medical Sciences and Associated Guru TegBahadur Hospital, New Delhi, India
|Date of Web Publication||26-Jul-2012|
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Source of Support: None, Conflict of Interest: None
Pleomorphic carcinoma is a poorly described entity whose phenotype is not well recognized as within the morphological spectrum of breast carcinoma. The purpose of this report is to describe the clinicopathological features of this tumour with review of the literature. We report a case of invasive pleomorphic lobular carcinoma with coexisting classic lobular carcinoma in situ.
Keywords: Breast carcinoma, lobular, pleomorphic variant
|How to cite this article:|
Gupta A, Sharma N, Jha AK, Gandhi A, Singh UR. Pleomorphic variant of lobular carcinoma breast: A rare case report with review of the literature. J Can Res Ther 2012;8:320-2
|How to cite this URL:|
Gupta A, Sharma N, Jha AK, Gandhi A, Singh UR. Pleomorphic variant of lobular carcinoma breast: A rare case report with review of the literature. J Can Res Ther [serial online] 2012 [cited 2020 Jul 12];8:320-2. Available from: http://www.cancerjournal.net/text.asp?2012/8/2/320/99005
| > Introduction|| |
Pleomorphic lobular carcinoma (PLC) of the breast is a rare and aggressive variant ofinvasive lobular carcinoma, accounting for 0.67% of all breast carcinomas and less than 5% of lobular carcinoma.  Unlike the classic variant, the tumor cells of the pleomorphic variant of ILC (invasive lobular carcinoma) are larger, have abundant eosinophilic cytoplasm with large pleomorphic hyperchromatic nuclei that show prominent nucleoli. IPLC (invasive pleomorphic lobular carcinoma) has been identified as a distinct entity from classic ILC and is reported to be associated with a more aggressive clinical behavior than classic ILC. We report a case of invasive pleomorphic lobular carcinoma with coexisting classic lobular carcinoma in situ which is a rare presentation.
| > Case Report|| |
A 34-year-old lady presented with complaint of painless, progressively increasing lump in left breast for last 3 months. A well-defined palpable mass was identified in the upper outer quadrant of the left breast. No additional abnormalities were appreciated in both breasts. No peripheral adenopathy was appreciated. Medical, surgical and family history were noncontributory. Mammography reported well-defined asymmetric density in the left breast (BIRADS-4). An ultrasound breast revealed a hypoechoic mass with irregular margins measuring 1.8 × 2.0 × 1.5 cm. Tru-cut biopsy from the breast lump reported invasive lobular carcinoma. Metastatic workup was negative. She was staged cT2N0M0. She underwent left modified radical mastectomy (as per choice). Histopathology from left breast lump specimen revealed firm grey white, circumscribed mass measuring 2.0 × 1.5 cm in size. Cut surface was white with a few small areas of necrosis. On microscopic exam lesion was an invasive carcinoma with highly atypical tumor cells infiltrating in a trabecular and cord-like pattern [Figure 1]. Ductformation was not present. The tumor cells had a prominent apocrine differentiation. The cells were large with relatively abundant eosinophilic cytoplasm, enlarged nuclei with vesicular chromatin and prominent nucleoli. Mitotic figures varied from 1-3 per high-power field [Figure 2]. No lymphovascular invasion was seen. Axillary lymph nodes were negative for metastases. Immunohistochemical findings reported ER, PgR, and HER2 negative.
|Figure 1: LCIS with cancerization of duct (H&E, 200x). Uniform small cells having high N:C ratio filling the acini along with simultaneous involvement of a duct|
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| > Discussion|| |
Invasive lobular carcinoma is a distinct type of breast carcinoma based on its typical histological pattern. These tumors arise from the lobular and terminal duct epithelium. It occurs throughout the entire age range of breast carcinoma in adult women and usually constitutes 10% of carcinomas. Besides the classical invasive lobular other variant forms are seen. Pleomorphic lobular carcinoma, (PLC) which was defined in 1992, in the female breast has a poorer prognosis than its classical counterpart.  Pleomorphic lobular carcinoma most often occurs in postmenopausal women, the mean age being 58.9 years (age range 24-94 years).  Middleton et al. observed that the largest tumour they encountered was 25 cm.  The tumor cells in PLC show similar dissociated, linear and single-file growth pattern together with targetoid distribution around benign ducts as seen in invasive lobular carcinoma (ILC). However, the cells are pleomorphic to a degree that contrasts with the cytological uniformity of classic ILC. , The histopathological diagnosis of classic ILC is seldom difficult and experienced pathologists concur in the vast majority of cases. However, variant forms of ILC have more diverse appearance. The distinctive features of PLC from ILC is the occurrence of a significant proportion of the tumour cell nuclei showing grade 2 to 3 features by the Scarf-Bloom- Richardson grading system combined with the single-file growth pattern that is typical of the latter. The cytologic features of PLC are a hybrid between the appearances of lobular and ductal carcinoma.  On microscopic examination, lobular carcinoma in situ (LCIS) is characterized by complete obliteration of the acini by small cells having the high N:C ratio and minimal cytoplasm and inconspicuous nucleoli. They are only slightly larger than lymphocytes. These typical cells should obliterate all acini of a lobule and distend at least half of the acini to fulfil the definition of LCIS. Invasive lobular carcinoma is characterized by invasion of the stroma by these cells that are typically discohesive and invade in single files, eliciting only minimal stromal response or desmoplasia. Subsequent invasive ca in LCIS can be either ductal or lobular, but percentage of lobular is higher than in breast cancer patients generally. The pleomorphic variant has more anisokaryosis and the cells have more abundant cytoplasm. It has been associated with worse prognosis. Immunohistochemical staining for E-cadherin may help in diagnosis. , In comparisonwith classical invasive lobular carcinoma, pleomorphic lobular carcinoma shows significantly higher Ki67 index, lower estrogen receptor and progesterone receptor expression, and higher incidence of HER2 gene amplification. Both classical invasive lobular and pleomorphic lobular carcinoma exhibit loss of 16q and gain of 1q, in the majority of the cases.  Pleomorphic lobular carcinoma is a extremely aggressive tumor and is known to recur. Since grading of lobular carcinoma is intricate identification of the pleomorphic subtype is useful in identifying a lethal variant.  Its behavior is assessed on the basis of the tumor size at presentation and the occurrence of nodal metastases. It is important to diagnose PLC, as ILCs in general, are more often multifocal and bilateral. PLC has a prognosis worse than either IDC or classic ILC and hence is described as the lethal variant. This was a unique case as invasive pleomorphic lobular carcinoma was coexisting with classic lobular carcinoma in situ that is a rare presentation.
| > Conclusion|| |
Pleomorphic lobular carcinoma of the breast has been recognized as a histological variant of infiltrating lobular carcinoma (ILC) with poor prognosis. In contrast to the usual situation of a positive ER/PR and over expression of Her2/neu, a pleomorphic variant of lobular carcinoma can be triple negative, thereby adding to the challenges in the management approach of this aggressive tumor.
| > References|| |
|1.||Rosen PP. Rosen's breast pathology. 2 nd ed. Philadelphia: Lippincott Williams and Wilkins; 2001. p. 627-52. |
|2.||Eusebi V, Magalhaes F, Azzopardi JG. Pleomorphic lobular carcinoma of the breast: An aggressive tumour showing apocrine differentiation. Hum Pathol 1992;23:655-62. |
|3.||Middleton LP, Palacios DM, Bryant BR, Krebs P, Otis CN, Merino MJ. Pleomorphic lobular carcinoma: Morphology, immunochemistry and molecular analysis. Am J Surg Pathol 2000;24:1650-6. |
|4.||Robinson IA, McKee G, Jackson PA, Cook MG, Kissin MW. Lobular carcinoma of the breast: Cytological features supporting the diagnosis of lobular cancer. Diagn Cytopathol 1995;13:196-201. |
|5.||Bassett LW, Fu KL, Fu YS, Cardall SY, Lopez JK. Diagnosis of Diseases of the Breast. 2 nd ed. Philadelphia, USA: Saunders 2005. p. 483-517. |
|6.||Weidner N, Semple JP. Pleomorphic variant of invasive lobular carcinoma of the breast. Hum Pathol 1992;23:1167-71. |
|7.||Wahed A, Connelly J, Reese T. E-cadherin expression in pleomorphic lobular carcinoma: An aid to differentiation from ductal carcinoma. Ann Diagn Pathol 2002;6:349-51. |
|8.||Palacios J, Sarrió D, García-Macias MC, Bryant B, Sobel ME, Merino MJ. Frequent E-cadherin gene inactivation by loss of heterozygosity in pleomorphic lobular carcinoma of the breast. Mod Pathol 2003;16:674-78. |
|9.||Chen YY, Hwang ES, Roy R, DeVries S, Anderson J, Wa C, et al. Genetic and phenotypic characteristics of pleomorphic lobular carcinoma in situ of the breast. Am J Surg Pathol 2009;33:1683-94. |
|10.||Turashvili G, Bouchalova K, Bouchal J, Kolar Z. Expression of E-cadherin and c-erbB-2/HER-2/neu oncoprotein in high-grade breast cancer. Cesk Patol 2007;43:87-92. |
|11.||Kini H, Pai R, Rau AR, Lobo FD, Augustine AJ, Ramesh BS. Pleomorphic lobular carcinoma of the breast - A diagnostic dilemma. J Cytol 2007;24:193-5. |
[Figure 1], [Figure 2]