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Presented by Pedram Argani, M.D. and prepared by Lynette S. Nichols, M.D.
Case 6: The patient is a 34-year old female who undergoes breast biopsy.
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1. Question
Week 133: Case 6
The patient is a 34-year old female who undergoes breast biopsy.images/Lyn’s/2p-6a.jpg
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images/Lyn’s/2p-6e.jpgCorrect
Answer: Lobular carcinoma in situ, florid
Histology: This is a lesion, which grows within the larger ducts outside of the terminal duct lobular units of the breast. It features central “comedo-type” necrosis. The cells filling the ducts are monomorphous with clear cytoplasm and well-defined cell borders, but have a vaguely signet ring cell-like appearance. The tumor cells show loss of expression of E-cadherin, favoring their classification as lobular carcinoma in situ (LCIS). Because this lesion distends ducts and has central necrosis, it has been called “florid LCIS”.
Discussion: The lesion shows cytologic uniformity and expansile growth in large ducts, which eliminates usual duct hyperplasia and atypical duct hyperplasia. Duct carcinoma in situ is suggested by the growth in large ducts, well-defined cell borders, and central necrosis, but the focal signet-ring cell cytology and absence of E-cadherin expression favors classification as LCIS.
This is an example of a lesion that might be described as carcinoma in situ with indeterminate features. While the absence of E-cadherin expression and the cytology is typical of LCIS, the growth pattern and presence of necrosis is more typical of DCIS. Florid LCIS, along with “pleomorphic LCIS,” are characterized by absence of E-cadherin labeling, which suggests that they are more closely related to LCIS than to DCIS. However, most observers suggest that these lesions be treated like DCIS, in that they should be re-excised if present at a surgical margin. This is because there is little clinical outcome data available for these forms of LCIS.
Incorrect
Answer: Lobular carcinoma in situ, florid
Histology: This is a lesion, which grows within the larger ducts outside of the terminal duct lobular units of the breast. It features central “comedo-type” necrosis. The cells filling the ducts are monomorphous with clear cytoplasm and well-defined cell borders, but have a vaguely signet ring cell-like appearance. The tumor cells show loss of expression of E-cadherin, favoring their classification as lobular carcinoma in situ (LCIS). Because this lesion distends ducts and has central necrosis, it has been called “florid LCIS”.
Discussion: The lesion shows cytologic uniformity and expansile growth in large ducts, which eliminates usual duct hyperplasia and atypical duct hyperplasia. Duct carcinoma in situ is suggested by the growth in large ducts, well-defined cell borders, and central necrosis, but the focal signet-ring cell cytology and absence of E-cadherin expression favors classification as LCIS.
This is an example of a lesion that might be described as carcinoma in situ with indeterminate features. While the absence of E-cadherin expression and the cytology is typical of LCIS, the growth pattern and presence of necrosis is more typical of DCIS. Florid LCIS, along with “pleomorphic LCIS,” are characterized by absence of E-cadherin labeling, which suggests that they are more closely related to LCIS than to DCIS. However, most observers suggest that these lesions be treated like DCIS, in that they should be re-excised if present at a surgical margin. This is because there is little clinical outcome data available for these forms of LCIS.