Pleomorphic Lobular Carcinoma In Situ (PLCIS) on Breast Core Needle Biopsies

Department of Pathology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
The American journal of surgical pathology (Impact Factor: 5.15). 09/2008; 32(11):1721-6. DOI: 10.1097/PAS.0b013e31817dc3a6
Source: PubMed


Pleomorphic lobular carcinoma in situ (PLCIS) is a more recently characterized entity that mimics high-grade ductal carcinoma in situ (DCIS). PLCIS is sometimes treated similar to high-grade DCIS, but no consensus has been reached for the most appropriate treatment. The aim of this study is to evaluate the histologic and immunohistologic profile of pure PLCIS on core needle biopsies and present follow-up clinical data. We reviewed 12 cases of pure PLCIS diagnosed on core needle biopsies of the breast along with subsequent surgical resections. Histologically, all cases showed dyscohesive cells with grade 3 nuclei, prominent nucleoli, and moderate to abundant eosinophilic cytoplasm. A panel of immunohistochemical stains to study this entity included E-cadherin, P120 catenin, estrogen receptor, progesterone receptors, HER2/neu, and Ki-67 (MIB-1). Residual PLCIS was found on excisional biopsies in 83% (10/12) cases. Invasive lobular carcinoma was found in 25% (3/12) cases. The lobular nature of all cases was confirmed by negative E-cadherin and cytoplasmic-dominant staining with P120 catenin. PLCIS was positive for estrogen receptor in 92% (11/12); progesterone receptor in 50% (6/12), and Her2/neu was positive in 25% (3/12). A moderate to high proliferation activity was observed with MIB (Ki-67) staining in 92% (11/12) cases. We conclude that PLCIS has a lobular immunostaining pattern for P120 catenin and E-cadherin indicating disruption of the E-cadherin/P120 catenin complex. This entity has aggressive parameters similar to high-grade DCIS including grade 3 nuclei, high Ki-67 (MIB-1) index, and HER2/neu positivity. PLCIS has a significant association with other high-risk lesions and invasive lobular carcinoma.

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Available from: Mamatha Chivukula, Oct 02, 2015
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    ABSTRACT: Pleomorphic lobular carcinoma in situ (PLCIS) is a recently described variant of lobular carcinoma in situ. Although classic lobular carcinoma in situ (LCIS) is seen as a risk factor and non-obligate precursor for the development of invasive breast cancer, PLCIS is considered an even greater high-risk lesion. When patients are diagnosed with PLCIS on core biopsy, the recommendation is to perform an excisional biopsy of the affected area. Re-excision is not commonly recommended for patients with classic LCIS at or near a margin after breast conserving therapy, whereas excision with negative margins is recommended for patients with PLCIS. This review gives an overview of the biologic rationale for complete excision with negative margins for patients diagnosed with PLCIS, reviews historical data and clinical studies relevant to patients with PLCIS, and provides molecular rationale that supports treating patients with PLCIS more aggressively than patients with classic LCIS, and similar to intermediate-grade ductal carcinoma in situ (DCIS).
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