Abstract
BackgroundUsing new molecular biology techniques, recent studies have implicated a common evolutionary pathway between lobular neoplasia, lobular carcinomas, and columnar cell lesions. Our aims were to assess the frequency of lobular neoplasia in a series of breast biopsies that were performed and examined in the same institution and to analyze the association between subtypes of lobular neoplasia and benign and malignant breast lesions.MethodsCases were selected after reviewing archived pathological reports in the Breast Pathology Laboratory, School of Medicine of Federal University of Minas Gerais (1999-2008). Cases of lobular neoplasia were reviewed and classified as atypical lobular hyperplasia, ductal involvement by cells of atypical lobular hyperplasia, lobular carcinoma in situ, and pleomorphic lobular carcinoma in situ. Coexistence of lobular neoplasia with other breast lesions, including columnar cell lesions, invasive ductal carcinoma and invasive lobular carcinoma, was evaluated. The association between lobular neoplasia and breast lesions was analyzed by Fisher's exact test and chi-square test for linear trend.ResultsWe analyzed 5650 breast specimens, selecting 135 breast specimens (2.4%) that had a diagnosis of lobular neoplasia, corresponding to 106 patients. Hematoxylin and eosin-stained slides were available for 84 cases, 5 of which were excluded because they contained only "indeterminate" in situ lesions. Of the 79 remaining cases, columnar cell lesions were present in 78.5%, primarily with columnar cell changes without atypia (67.7%). Invasive carcinoma was present in 45.6% of cases of lobular neoplasia--a similar frequency (47.2%) as invasive ductal carcinoma and invasive lobular carcinoma. We noted a significant linear trend (p < 0.03) of a higher frequency of invasive carcinomas that were concomitant with lobular carcinoma in situ compared with atypical lobular hyperplasia. Invasive lobular carcinomas were associated with lobular carcinoma in situ in 33% of cases, compared with 2.8% of atypical lobular hyperplasia cases.ConclusionsOur findings confirm a frequent association between lobular neoplasia and columnar cell lesions, the majority of which lacked atypia. We also observed a greater frequency of invasive carcinoma, more commonly invasive lobular carcinoma, associated with more developed forms of lobular neoplasia (lobular carcinoma in situ).
Highlights
Using new molecular biology techniques, recent studies have implicated a common evolutionary pathway between lobular neoplasia, lobular carcinomas, and columnar cell lesions
We accessed the archives of the Breast Pathology Laboratory (BPL) of the School of Medicine of Federal University of Minas Gerais from August 1999 to December 2008, selecting all breast specimens with diagnoses of atypical lobular hyperplasia (ALH), DIAL, Lobular carcinoma in situ (LCIS), and pleomorphic LCIS
hematoxylin and eosin (H&E)-stained slides were available for 84 patients, slides for 5 of whom were excluded because they contained only indeterminate in situ lesions
Summary
Using new molecular biology techniques, recent studies have implicated a common evolutionary pathway between lobular neoplasia, lobular carcinomas, and columnar cell lesions. Our aims were to assess the frequency of lobular neoplasia in a series of breast biopsies that were performed and examined in the same institution and to analyze the association between subtypes of lobular neoplasia and benign and malignant breast lesions. Lobular carcinoma in situ (LCIS) was first described by Foote and Stewart in 1941, designated as such due to its cytological similarities with invasive lobular carcinoma (ILC): cuboidal and regular and harboring discohesive cells, often containing cytoplasmic vacuoles. LCIS was originally considered a precursor of invasive carcinoma due to its frequent association with invasive lobular carcinoma [1]. Subsequent epidemiological studies demonstrated that the risk of developing invasive lesions was not as high as expected, progressing slowly and forming in the ipsilateral and contralateral breast [2]. Other studies confirmed the indolent nature of LCIS; clinically, LCIS was considered a risk marker for invasive breast cancer. Due to its indolent behavior, Haagensen et al proposed replacing the term “lobular carcinoma” with “lobular neoplasia” to decrease the impact of the malignancy and the link to mortality that is associated with the term “carcinoma” [2]
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