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WHO Classification of Tumours
Lobular carcinoma, NOS
Breast


Definition

Lobular carcinoma of the breast is an invasive adenocarcinoma arising from the lobules. It often presents as an irregular and poorly circumscribed tumour. The classical type of invasive lobular carcinoma (ILC) is characterized by non-cohesive cells individually scattered or arranged in single-file linear cords in a background of fibrous stroma. Mitoses are typically infrequent. In addition to this classical form, several variants have been described. The solid type consists of sheets of uniform small cells. In the alveolar variant, the neoplastic cells form globular aggregates. The pleomorphic variant is characterized by a higher degree of cellular atypia and pleomorphism and may show apocrine or histiocytoid differentiation.
Approximately 70-95% of cases are ER (estrogen-receptor) positive and 60-70% are PR (progesteron-receptor) positive

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Sastre-Garau X, Jouve M, Asselain B, Vincent-Salomon A, Beuzeboc P, Dorval T, Durand JC, Fourquet A, Pouillart P (1996)
Infiltrating lobular carcinoma of the breast. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns.
Cancer 77: 113-20




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Zafrani B, Aubriot MH, Mouret E, De Crémoux P, De Rycke Y, Nicolas A, Boudou E, Vincent-Salomon A, Magdelénat H, Sastre-Garau X (2000)
High sensitivity and specificity of immunohistochemistry for the detection of hormone receptors in breast carcinoma: comparison with biochemical determination in a prospective study of 793 cases.
Histopathology 37: 536-45



. 80-100% of ILC show complete loss of E-cadherin expression
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Moll R, Mitze M, Frixen UH, Birchmeier W (1993)
Differential loss of E-cadherin expression in infiltrating ductal and lobular breast carcinomas.
Am J Pathol 143: 1731-42




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Gamallo C, Palacios J, Suarez A, Pizarro A, Navarro P, Quintanilla M, Cano A (1993)
Correlation of E-cadherin expression with differentiation grade and histological type in breast carcinoma.
Am J Pathol 142: 987-93




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Oka H, Shiozaki H, Kobayashi K, Inoue M, Tahara H, Kobayashi T, Takatsuka Y, Matsuyoshi N, Hirano S, Takeichi M (1993)
Expression of E-cadherin cell adhesion molecules in human breast cancer tissues and its relationship to metastasis.
Cancer Res 53: 1696-701



.
Invasive lobular carcinoma accounts for 5-15% of invasive breast tumours

Click to access Pubmed
Sastre-Garau X, Jouve M, Asselain B, Vincent-Salomon A, Beuzeboc P, Dorval T, Durand JC, Fourquet A, Pouillart P (1996)
Infiltrating lobular carcinoma of the breast. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns.
Cancer 77: 113-20



. It affects predominantly women >40 years of age (mean age 63 years
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Winchester DJ, Chang HR, Graves TA, Menck HR, Bland KI, Winchester DP (1998)
A comparative analysis of lobular and ductal carcinoma of the breast: presentation, treatment, and outcomes.
J Am Coll Surg 186: 416-22



). Patients typically present with a palpable mass. Compared with invasive duct carcinoma, NOS , ILC metastasizes more frequently to bone, gastro-intestinal tract, uterus, meninges, and ovary, and less frequently to the lungs. Treatment depends on tumour stage; conservative treatment has been found to be appropriate
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Bouvet M, Ollila DW, Hunt KK, Babiera GV, Spitz FR, Giuliano AE, Strom EA, Ames FC, Ross MI, Singletary SE (1997)
Role of conservation therapy for invasive lobular carcinoma of the breast.
Ann Surg Oncol 4: 650-4




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Peiro G, Bornstein BA, Connolly JL, Gelman R, Hetelekidis S, Nixon AJ, Recht A, Silver B, Harris JR, Schnitt SJ (2000)
The influence of infiltrating lobular carcinoma on the outcome of patients treated with breast-conserving surgery and radiation therapy.
Breast Cancer Res Treat 59: 49-54




Click to access Pubmed
Sastre-Garau X, Jouve M, Asselain B, Vincent-Salomon A, Beuzeboc P, Dorval T, Durand JC, Fourquet A, Pouillart P (1996)
Infiltrating lobular carcinoma of the breast. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns.
Cancer 77: 113-20




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Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003