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Presented by Hind Nassar, M.D. and prepared by Rui Zheng, M.D., Ph.D.]
Case 4: 50 year old woman with a breast mass.
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1. Question
Week 458: Case 4
50 year old woman with a breast mass. She underwent a core biopsy (diagnosed as DCIS) followed by an excisional biopsy (shown here)images/1alex/11082010case4image1.jpg
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images/1alex/11082010case4image5.jpgCorrect
Answer: Lobular carcinoma in situ, pleomorphic type
Histology:
Discussion: The atypical proliferation is intraductal and involves the lobular units as well; it consists of pleomorphic cells with apocrine features. The lesion is negative for E-Cadherin on immunostain and therefore would be classified as pleomorphic apocrine LCIS. Due to the atypia, the LCIS is pleomorphic type (there is also a minor component of classical type LCIS in the adjacent breast). Pleomorphic LCIS can be associated with central necrosis and calcifications and misdiagnosed as DCIS. There is no clear data regarding prognosis and management of these cases. What is certain is that if found on core biopsy, an excision biopsy should be performed to R/O invasion. When found on excisional biopsy/mastectomy it is in general treated like DCIS (no data to support or disagree with this management)
Incorrect
Answer: Lobular carcinoma in situ, pleomorphic type
Histology:
Discussion: The atypical proliferation is intraductal and involves the lobular units as well; it consists of pleomorphic cells with apocrine features. The lesion is negative for E-Cadherin on immunostain and therefore would be classified as pleomorphic apocrine LCIS. Due to the atypia, the LCIS is pleomorphic type (there is also a minor component of classical type LCIS in the adjacent breast). Pleomorphic LCIS can be associated with central necrosis and calcifications and misdiagnosed as DCIS. There is no clear data regarding prognosis and management of these cases. What is certain is that if found on core biopsy, an excision biopsy should be performed to R/O invasion. When found on excisional biopsy/mastectomy it is in general treated like DCIS (no data to support or disagree with this management)
