Metastasis Of Invasive Lobular Carcinoma Research Articles

Gastrointestinal Metastases From Lobular Breast Carcinoma: A Literature Review.

Invasive lobular carcinoma (ILC) represents a rare subtype of breast carcinoma, originating from the lobule. Unlike ductal carcinoma, ILC does not express E-cadherin and thus can metastasize to uncommon sites. We aimed to investigate the clinicopathological characteristics of the rare subgroup of ILC patients with gastrointestinal (GI) metastases. A PubMed search was undertaken using the terms "Lobular Breast Carcinoma" AND "Gastrointestinal Metastasis." We identified 169 cases, with metachronous GI metastatic disease being approximately twice as common as synchronous GI metastases. The median age at initial diagnosis was 56.7 years (24-88). The majority of patients were hormonal receptor-positive and only a small minority was HER2-positive. The appearance of a gastrointestinal lesion was often the mode of revelation of ILC. Differential diagnosis from primary gastrointestinal cancer is sometimes challenging, especially in the case of signet-ring cell carcinoma. The median time from breast cancer diagnosis to GI metastases was 6.5 years (0-33). Most common metastatic sites include the stomach, colon, and rectum, in order of decreasing frequency, whereas metastases were found in every part of the digestive tract. In conclusion, metastases of ILC can arise in the gastrointestinal tract and they should be managed similarly to metastatic breast cancer.

Gallbladder metastasis from occult lobular breast carcinoma: A case report

Abstract Introduction: Bones, lungs, brain and liver are the most common metastatic sites of breast carcinoma, although invasive lobular carcinoma can give metastases to less common sites, such as the gastrointestinal tract and the female genital tract. Case presentation: We present the case of a 57-year-old female with colic abdominal pain that was sent to surgery for cholecystectomy. Histopathology revealed a poorly cohesive individual or in single file neoplastic cells infiltrating all layers of the gallbladder. Immunohistochemistry revealed these cells to be CK 116, CK7, GCDFP-15, ER and PR positive, and CK20, HER-2, S-100 and E-cadherin negative. PET/CT showed numerous lytic bone lesions, but ultrasound, mammography, MRI and PET/CT revealed no breast mass. Conclusion: Although rare and poorly understood, metastases of invasive lobular carcinoma to gallbladder do exist in a minor percentage of patients, presenting usually as exacerbated cholecystitis. The problem are silent cases and patients with no history of breast carcinoma. This case is unique in that even after the diagnosis of metastatic lobular breast carcinoma to the gallbladder, the primary tumour of the breast was not detected.

High-accuracy prediction of axillary lymph node metastasis in invasive lobular carcinoma using focal cortical thickening on magnetic resonance imaging.

Invasive lobular carcinoma (ILC) grows diffusely in a single-cell fashion, sometimes presenting only subtle changes in preoperative imaging; therefore, axillary lymph node (ALN) metastases of ILC are difficult to detect using magnetic resonance imaging (MRI). Preoperative underestimation of nodal burden occurs more frequently in ILC than in invasive ductal carcinoma (IDC), however, the morphological assessment for metastatic ALNs of ILC have not fully been investigated. We hypothesized that the high false-negative rate in ILC is caused by the discrepancy in the MRI findings of ALN metastases between ILC and IDC and aimed to identify the MRI finding with a strong correlation with ALN metastasis of ILC. This retrospective analysis included 120 female patients (mean ± standard deviation age, 57.2 ± 11.2years) who underwent upfront surgery for ILC at a single center between April 2011 and June 2022. Of the 120 patients, 35 (29%) had ALN metastasis. Using logistic regression, we constructed prediction models based on MRI findings: primary tumor size, focal cortical thickening (FCT), cortical thickness, long-axis diameter (LAD), and loss of hilum (LOH). The area under the curves were 0.917 (95% confidence interval [CI] 0.869-0.968), 0.827 (95% CI 0.758-0.896), 0.754 (95% CI 0.671-0.837), and 0.621 (95% CI 0.531-0.711) for the FCT, cortical thickness, LAD, and LOH models, respectively. FCT may be the most relevant MRI finding for ALN metastasis of ILC, and although its prediction model may lead to less underestimation of the nodal burden, rigorous external validation is required.

Orbital metastasis of invasive lobular carcinoma of the breast

We herein report a case of orbital metastasis from the breast cancer in a 58-year-old woman presenting with visual disturbance and bilateral periorbital swelling. She had undergone radical mastectomy for right breast cancer 9 years previously and been receiving hormone therapy for bone metastasis of breast cancer for the past 4 years. Computed tomography and magnetic resonance imaging revealed an ill-defined mass in the bilateral orbits, whereas an excisional biopsy confirmed metastasis of invasive lobular carcinoma (ILC) of the breast. The appearance of eye symptoms in patients who have a history of breast cancer, especially ILC should be investigated, with a consideration of orbital metastasis.

Characterization of Stromal Tumor-infiltrating Lymphocytes and Genomic Alterations in Metastatic Lobular Breast Cancer.

Invasive lobular carcinoma (ILC) represents the second most common histologic breast cancer subtype after invasive ductal carcinoma (IDC). While primary ILC has been extensively studied, metastatic ILC has been poorly characterized at the genomic and immune level. We retrospectively assembled the multicentric EuroILC series of matched primary and metastatic samples from 94 patients with estrogen receptor (ER)-positive ILC. Stromal tumor-infiltrating lymphocytes (sTILs) were assessed by experienced pathologists. Targeted sequencing and low pass whole-genome sequencing were conducted to detect mutations and copy-number aberrations (CNAs). We compared the frequencies of the alterations in EuroILC with those from patients with ER-positive metastatic ILC (n = 135) and IDC (n = 563) from MSK-IMPACT. Low sTIL levels were observed in ILC metastases, with higher levels in the mixed nonclassic histology. Considering ILC metastases from EuroILC and MSK-IMPACT, we observed that >50% of tumors harbor genomic alterations that have previously been associated with endocrine resistance. A matched primary/metastasis comparison in EuroILC revealed mutations (AKT1, ARID1A, ESR1, ERBB2, or NF1) and CNAs (PTEN or NF1 deletion, CYP19A1 amplification) associated with endocrine resistance that were private to the metastasis in 22% (7/32) and 19% (4/21) of patients, respectively. An increase in CDH1, ERBB2, FOXA1, and TBX3 mutations, in CDH1 deletions and a decrease in TP53 mutations was observed in ILC as compared with IDC metastases. ILC metastases harbor genomic alterations that may potentially explain endocrine resistance in a large proportion of patients, and present genomic differences as compared with IDC metastases.

Correlation of p16 Expression on Cancer and Stromal Cells With Clinicopathologic and Immunohistochemical Features of Lobular Breast Carcinoma.

Cancer-associated fibroblasts, play a central role in the tumor-stroma interaction and promote tumorigenesis. However, it is still unclear how these processes are regulated. The aim of this study is to investigate p16 expression in cancer and stromal cells of invasive lobular carcinoma (ILC). Clinicopathologic parameters and immunohistochemical stains for estrogen receptor (ER), progesterone receptor, E-cadherin, and human epidermal growth factor receptor 2 of 70 ILC cases were retrieved. In addition, immunohistochemical were performed for p53, p16, and cyclin D1. The p16 expression in cancer and stromal cells were correlated with different clinicopathologic parameters. Of the 70 cases, 8 cases were p16- cancer and stromal cells, 14 cases p16- cancer and p16+ stromal cells, 14 cases p16+ cancer and p16- stromal cells, and 34 cases p16+ cancer and stromal cells. Thirty-one of the 59 cases showed axillary lymph node metastases. Nodal involvement, recurrence, and metastasis of ILC with p16+ cancer cells and p16- stromal cells were more frequent compared with other groups. ILC with p16+ cancer and p16- stromal cells were frequently negative for ER, progesterone receptor, and cyclin D1, p53 positive and triple negative compared with other groups. There was no recurrence and metastasis in ILC with p16- cancer and p16+ stromal cells. ILC with p16+ cancer and stromal cells were significantly node negative and were positive for ER and cyclin D1 compared with other groups. ILC with p16+ cancer and p16- stromal cells were characterized by frequent nodal involvement, recurrence, and metastatic propensity. These results suggest that p16, has novel anticancer properties capable of suppressing cancer cell migration and invasion and pharmacologic restoration of p16 level in stromal fibroblasts may be exploited as therapeutic strategy to prevent nodal or distant metastasis.

2626 A Curious Case of Gastric Outlet Obstruction!

INTRODUCTION: The average lifetime risk of a woman developing breast cancer is 12%. Invasive lobular carcinoma (ILC), the second most common histologic type attributes to 10–15% of breast cancer diagnoses. Compared to invasive ductal carcinoma, ILC has a higher chance to metastasize liver, ovaries and even the gastrointestinal tract. We present a unique case of gastric outlet obstruction (GOO) as the initial presentation of metastatic ILC. Histologically, it can be challenging to delineate ILC from primary gastric adenocarcinoma. This was a rare case where the diagnosis was made via the comparison of the endoscopic biopsy with the patient’s previous lymph node pathology. CASE DESCRIPTION/METHODS: 75-year-old female with history of type 2 diabetes mellitus, and lobular carcinoma treated with a bilateral mastectomy and Anastrozole hormone therapy for 8 years presented with confusion and non-bilious, non-bloody vomiting for two weeks. Vitals indicated orthostatic hypotension and abdominal exam revealed a tender epigastrium without rigidity or guarding. Laboratory findings demonstrated severe contraction alkalosis. Abdominal CT with contrast depicted wall thickening in the second and third portion of the duodenum. Endoscopy revealed an infiltrative circumferential mass that stemmed from the antrum extending through to the proximal duodenum causing GOO. The morphological features of the duodenal mass were consistent with biopsy findings of the patient’s previous sentinel lymph node and mastectomy specimen. The diagnosis was further confirmed with immunostains, which were positive for estrogen receptor and mammoglobin, and negative for progesterone receptor and E-cadherin. Patient received robotic gastrojejunostomy tube placement. Her nutritional status improved and was started on chemotherapy. She had a complete metastatic workup which was unrevealing. DISCUSSION: ILC can metastasize later in life to the brain, ovaries and gastrointestinal tract. Isolated duodenal metastasis is limited to only a few case reports. It is theorized in the literature that lack of expression of the adhesion molecule, E-cadherin, may facilitate ILC’s permeation into tissues. This may contribute to metastasis of ILC with a predilection to gastrointestinal and gynecological sites, which generally occurs after a mean duration of 7 years. Our case is rare in that, the patient presented with GOO as the only initial manifestation of duodenal metastasis within 8 years of treatment of ILC without any other evidence metastatic spread.

The Breast in the End: Metastatic Lobular Breast Cancer Found in the Rectum

Breast cancer is the most common malignancy among women. Common areas of metastasis include the bones, lungs, pleura, liver, and brain while metastasis to the gastrointestinal tract is rare. Often times, metastasis present years after the primary diagnosis. Here, we report a case of rectal metastasis of invasive lobular carcinoma (ILC) diagnosed four years after her primary diagnosis. A 60-year old female with a history of stage IIB ILC (PR-positive, ER-positive, and HER-2 negative) status-post left mastectomy and adjuvant chemotherapy in 2013, presented with a complaint of constipation and rectal bleeding in October 2017. Colonoscopy revealed a large friable, ulcerated rectal mass extending from the anal sphincter to 10 cm in. Pathology demonstrated metastatic ILC and not a primary colon cancer. She is currently undergoing treatment with Faslodex, Ibrance, and Navelbine. Although ILC only accounts for 5-10% of breast cancer, it disproportionately has greater GI metastasis compared to invasive ductal carcinoma. It is hypothesized that ILC's invasiveness is due to the lack of E-cadherin expression. Due to the rarity of rectal metastasis, treatment remains tailored to each patient. In a patient with a history of breast cancer (regardless of the time that has elapsed since primary diagnosis), clinicians should have a high index of suspicion for systemic recurrence in patients presenting with new GI complaints. Disease-free years does not rule-out GI metastatic disease from breast cancer. From the 31 reported cases, metastasis to the rectum can present on initial diagnosis or may take as long as 28 years.

Population-based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node-positive invasive lobular carcinoma of the breast

Preoperative staging of the axilla is important to allow decisions regarding neoadjuvant treatment and the management of the axilla. Invasive lobular carcinoma metastases are difficult to detect because of the infiltrative pattern of the nodal spread. In this study the sensitivity of preoperative axillary staging between invasive lobular (ILC) and ductal (IDC) carcinoma was compared. All women diagnosed with pure ILC or IDC in the West of Scotland in 2012-2014 were identified from a database maintained prospectively within the Managed Clinical Network. Pretreatment axillary ultrasound imaging (AUS), core biopsy and fine-needle aspiration cytology (FNAC) results were compared between ILC and IDC. Some 602 women with ILC and 4199 with IDC had undergone axillary surgery, of whom 209 and 1402 respectively had nodal metastases. Pretreatment AUS sensitivity was significantly lower in ILC than in IDC (32·1 versus 50·1 per cent respectively, P < 0·001; OR 0·47, 95 per cent c.i. 0·34 to 0·64). Core biopsy had equally high sensitivity of 86 per cent in both subtypes; however, FNAC was significantly less sensitive in both ILC (55 per cent; P = 0·003) and IDC (75·6 per cent; P = 0·006). Multivariable analysis revealed that cT3-4 status and symptomatic presentation were both significant in predicting nodal metastasis in patients with ILC and false-negative AUS findings (OR 3·77, 95 per cent c.i. 1·69 to 8·42, P = 0·001; and OR 1·92, 1·24 to 2·98, P = 0·003, respectively). AUS is inferior in detecting axillary node metastasis in ILC compared with IDC. Women with cT3-4 lobular carcinoma may benefit from ultrasound-guided axillary biopsy regardless of the ultrasonographic appearance of the nodes.

Pancreatic metastasis from invasive pleomorphic lobular carcinoma of the breast: a rare case report

BackgroundInvasive pleomorphic lobular carcinoma (PLC) is an aggressive subtype of invasive lobular carcinoma of the breast, which has its own histopathological and biological features. The metastatic patterns for PLC are distinct from those of invasive ductal carcinoma. In addition, pancreatic metastasis from PLC is extremely rare.Case presentationWe report a rare case of a 48-year-old woman presenting with clinical gastrointestinal symptoms and pancreatic metastasis of PLC. The pancreatic tumor was composed of pleomorphic tumor cells arranged in the form of solid sheets and nests and as single files, with frequent mitotic figures, nucleolar prominence, high nuclear to cytoplasmic ratio and loss of cohesion. The malignant cells were positive for p120 (cytoplasmic) and GATA3 and negative for estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, E-cadherin, gross cystic disease fluid protein 15 and mammaglobin, which indicated a lobular carcinoma phenotype of the breast.ConclusionsTo the best of our knowledge, this is one of the few reported cases in the literature of pancreatic metastasis of invasive lobular carcinoma of the breast, of which the definitive diagnosis was obtained only after surgery. Rare metastasis sites should be considered, particularly, when a patient has a medical history of PLC.

Appendicitis caused by the metastasis of HER2-positive breast cancer.

The appropriate therapy for metastatic breast cancer must be selected based on the immunohistochemical phenotype of the cancer. However, biopsy for metastatic lesions is difficult. We herein report a patient with incidental appendicitis caused by a metastatic breast cancer which was successfully treated with effective therapy chosen based on the pathological diagnosis obtained on resection. The patient was a 56-year-old female with right breast cancer and an immunohistochemical status of estrogen receptor (ER) (+), progesterone receptor (PgR) (+), human epidermal growth factor receptor 2 (HER2) (3+), and Ki67 40 %. She received epirubicin and cyclophosphamide therapy followed by docetaxel and trastuzumab, and total mastectomy with axillary dissection was performed. Thereafter, she received postmastectomy radiation, adjuvant trastuzumab, and adjuvant hormone therapy with letrozole. One year and 8 months after the operation, she developed right hydronephrosis and swollen para-aortic lymph nodes and her hormone therapy was changed to fulvestrant therapy. However, she additionally developed left hydronephrosis and multiple bone metastases, and pertuzumab, trastuzumab, and docetaxel therapy was started. After six cycles, her disease became well-controlled, and maintenance with pertuzumab and trastuzumab was introduced. However, after another 7 months, she developed new vertebral metastasis and acute appendicitis and laparoscopic appendectomy was performed. A pathological investigation of the resected appendix revealed some clusters of atypical cells in the subserosa and muscle layer, which showed an immunohistochemical status of ER (+), PgR (−), HER2 (3+), and E-cadherin (−). These findings led to the diagnosis as appendiceal metastasis of invasive lobular carcinoma (ILC) from the breast. Thereafter, she received trastuzumab-DM1 and her disease was well-controlled again. Appendicitis caused by breast cancer is very rare. However, ILC sometimes develops metastases in the abdominal cavity; an appendiceal tumor should therefore be included in the differential diagnosis. A pathological diagnosis of metastatic tumor could be very useful for selecting the effective therapy.

Solitary uterine metastasis of invasive lobular carcinoma after adjuvant endocrine therapy: a case report

IntroductionSolitary uterine metastases from extragenital cancers are very rare. Breast cancer is the most frequent primary site of metastasis to the uterine corpus, with invasive lobular carcinoma more likely to spread to gynecologic organs than invasive ductal carcinoma.Case presentationA 62-year-old postmenopausal Japanese woman was diagnosed with uterine leiomyomata more than 20 years ago and had been managed conservatively until menopause. Seven years prior to her presentation, she was diagnosed with breast cancer and underwent a partial resection of her right breast for stage IIA invasive lobular carcinoma. She underwent adjuvant chemotherapy, radiotherapy, and five years of anastrozole hormonal therapy. She presented with a growing uterine mass. Her tumor marker levels were markedly increased over the course of her follow-up, but a systemic examination revealed only a solitary uterine tumor. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. A histopathological examination, including detailed immunohistochemistry, confirmed metastatic invasive lobular carcinoma, infiltrating both her uterine myometrium and fibroid tissue.ConclusionWe report a very rare metastatic pattern of invasive lobular carcinoma and demonstrate that gross cystic disease fluid protein-15 and mammaglobin are useful in the diagnosis of metastatic breast cancer.

Gastric metastasis of ectopic breast cancer mimicking axillary metastasis of primary gastric cancer.

Ectopic breast tissue has the ability to undergo all the pathological changes of the normal breast, including breast cancer. Gastrointestinal metastasis of breast cancer is rarely observed and it is very difficult to differentiate gastric metastases from primary gastric cancer. We present a case of 52-year-old female, who suffered from abdominal pain. Physical examination showed a palpable mass in the left anterior axilla and computerized tomography revealed gastric wall thickening with linitis plastica. When gastroscopic biopsy showed no signs of malignancy, excisional biopsy was performed in the left axilla. Histological examination revealed invasive lobular carcinoma of the breast, consistent with ectopic breast cancer. Further gastroscopic submucosal biopsies and immunohistochemical studies revealed gastric metastases of invasive lobular carcinoma. Axillary ectopic breast tissue carcinomas can mimic axillary lymphadenopathies. Additionally, gastric metastasis of breast cancer is an uncommon but possible condition. To the best of our knowledge, this is the first report of ectopic breast cancer with gastric metastasis.

Abstract A083: Neutrophils promote metastasis of invasive lobular carcinoma

Abstract The multistep process of metastasis is highly dependent on the intrinsic mutations that accumulate in cancer cells. However, recent experimental evidence has shown that these mutations are not sufficient to facilitate metastatic disease. Cues from the tumor microenvironment are also required. In order to understand how systemic changes might affect metastasis formation, we profiled the cellular and molecular alterations in various organs of K14cre;EcdF/F;p53F/F mammary tumor-bearing mice – a model of invasive lobular breast cancer. Among all immune cells, increased neutrophil accumulation was the most pronounced. To test the functional importance of neutrophils in the metastatic process, we utilized our recently described model of spontaneous metastasis. This model is based on the transplantation of K14cre;EcdF/F;p53F/F tumor pieces into wild-type recipient mice, and subsequent surgical removal of the primary tumor, permitting us to investigate neutrophil function in both the neoadjuvant and adjuvant settings. Interestingly, mice treated with neutrophil-depleting antibodies in the neoadjuvant setting displayed a profound reduction in pulmonary metastasis, whereas metastases in the adjuvant group were equivalent to controls. These data indicate that neutrophils play a prominent role during the very early stages of the metastatic cascade. Our preliminary data suggest that these tumor-educated neutrophils can suppress the activation of T cells, as one mechanism by which they may promote metastasis. In addition, cytokine analysis of K14cre;EcdF/F;p53F/F mammary tumors demonstrated an increase in the IL17 pathway when compared to wild-type mammary glands. Subsets of T cells are known producers of IL17 and this pathway regulates neutrophil expansion indirectly. In accordance with this, K14cre;EcdF/F;p53F/F mice lacking the adaptive immune system displayed reduced IL17 levels and reduced circulating neutrophils. Current efforts are underway to determine whether T cells play a role in the pro-metastatic function of neutrophils. Together, these findings indicate that neutrophils are crucial for the establishment of breast cancer metastasis. Citation Format: Seth B. Coffelt, Chris W. Doornebal, Kelly Kersten, Metamia Ciampricotti, Cheei-Sing Hau, Kim Vrijland, Jorieke Weiden, Jos Jonkers, Karin E. de Visser. Neutrophils promote metastasis of invasive lobular carcinoma. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Breast Cancer Research: Genetics, Biology, and Clinical Applications; Oct 3-6, 2013; San Diego, CA. Philadelphia (PA): AACR; Mol Cancer Res 2013;11(10 Suppl):Abstract nr A083.

Invasive Lobular Carcinoma of the Breast with Metastasis to the Colon

Purpose: A 49-year-old woman was diagnosed with a 1.2 cm right breast mass in 2007. The patient elected against a biopsy at the time. In late 2009, she presented to GI office with a six week history of abdominal pain, weight loss, and hematochezia. Patient denied personal or family history of breast or colon cancer. A colonoscopy revealed a solitary 6 mm ulcer with a firm nodule in sigmoid colon. Histopathological findings were compatible with infiltrating carcinoma of the colon. MRI showed skeletal metastases in thoracolumbar spine and bilateral ribs, and a 1.4 cm lesion in the liver. CA15-3 was 371 U/ML and CA 27.29 was 124 U/ML. A PET scan revealed a 3.8 cm hyper-metabolic area in the right breast and bony metastases. Histological examination of breast biopsy showed for a low grade ER/PR positive and HER-2/neu negative invasive lobular carcinoma. She was diagnosed with colonic metastasis of invasive lobular carcinoma of the breast. A mastectomy was recommended, however the patient initially refused. A bilateral oophorectomy revealed invasive lobular carcinoma. Patient ultimately agreed to a modified radical right mastectomy in September 2010. The primary tumor was 5.5 cm in diameter, grade 6/9 with lymphovascular and perineural invasion. All surgical margins were negative. She had metastases to 10 out of 13 axillary lymph nodes. Patient had stage IV, T4 N3a M1 invasive lobular carcinoma of breast. She was treated with tamoxifen, radiation therapy, and monthly zolendronic acid. As of June 2011, PET continues to show stable osseous metastatic disease. Metastatic gastrointestinal tumors originating from Invasive lobular carcinoma (ILC) are unusual, and colonic metastases are especially rare. The clinical manifestations are variable and may range from non-specific complaints to acute GI symptoms. It is imperative to differentiate between metastatic breast cancer and primary colon cancer as treatment strategies differ. As seen in our case, careful correlation of both endoscopic histology and primary breast cancer histology was essential. Therefore, a high index of clinical suspicion with early endoscopy in those with vague symptoms and history of breast cancer is recommended.Figure: No Caption available.

122P Breast Cancer Metastases to the Gynecological Organs and Peritoneum: A Single Institution Experience

ABSTRACT The aim of this paper is to analyze characteristics of breast cancer (BC) that has metastasized to the gynecological organs as first metastatic sites. Patients and methods From February 2009 to December 1st 2011, 13 consecutive pts were registered with BC metastases to the gynecological organs/ peritoneum, synchronously with BC or as a first metastatic site (Table I). Results Median age at the BC diagnosis was 49 yrs. Histological type was invasive lobular carcinoma (ILC) in 77% and invasive ductal carcinoma (IDC) in 23% BC. Grade 3 was registered in 3 BC (23%), all ILC type. Nodal status was known in 10 pts, with metastases in median 3 nodes (0-18); 85% BC were ER +; HER 2 status was known in 10/13 BC (77%) and there were no HER2 3+. Median DFI was 99 months. Majority of pts had metastases to the both ovaries (77%), 4 pts (31%) were diagnosed synchronously with BC and metastases to the gynecological organs. One pt was first diagnosed with ovarian ILC metastases, radically operated, and after 11 months initially occult primary BC became detectable. Two pts had metastases in the uterus and 1 in peritoneum only. In 12 pts, metastases were histologicaly confirmed and in 1 pt only cytology of the ascites could be obtained. Majority of metastases were ILC. NED stage after metastases surgical removal was achieved in 5/13 pts (38,5%). Conclusion In this small subgroup of BC pts with peculiar metastases to gynecological organs and or peritoneum, the main BC characteristics were predominant ILC histology, hormone receptor positivity, absence of HER2 3 + , and either synchronous presentation of metastases in the gynecological organs or quite opposite, long DFI (med 8 yrs; range 6-15yrs). NED stage was achieved in 38% of pts by surgical removal of gynecological metastases. Therefore, it can be speculated that this subgroup of pts has indolent BC metastases that potentially could be cured by surgery. However, because of short median follow, survival has not been analyzed. Disclosure All authors have declared no conflicts of interest.

Modified Alcian Blue Enhances the Intraoperative Diagnosis of Sentinel Lymph Node Metastasis in Invasive Lobular Carcinoma: A Prospective Study

Abstract Context.—The sensitivity of an intraoperative diagnosis of sentinel lymph node metastasis of invasive lobular carcinoma using conventional staining is low. Objective.—To develop a fast, modified, Alcian blue stain to decrease the intraoperative false-negative results in testing for metastatic invasive lobular carcinoma. Design.—Modified Alcian blue was optimized. Patients who had invasive lobular carcinoma on needle biopsy were candidates for this study. Touch preparations from every sentinel lymph node were prospectively prepared in the same manner, one stained with modified Alcian blue and one with conventional staining. These slides were independently interpreted. Results.—A total of 121 sentinel lymph nodes from 31 patients with invasive lobular carcinoma were studied. There were 11 patients (35.5%) who had at least one positive lymph node test result. There were a total of 18 positive lymph node results (14.9%). Although 10 sentinel lymph nodes with abnormalities were detected in 7 patients ...

Modified Alcian Blue Enhances the Intraoperative Diagnosis of Sentinel Lymph Node Metastasis in Invasive Lobular Carcinoma: A Prospective Study

The sensitivity of an intraoperative diagnosis of sentinel lymph node metastasis of invasive lobular carcinoma using conventional staining is low. To develop a fast, modified, Alcian blue stain to decrease the intraoperative false-negative results in testing for metastatic invasive lobular carcinoma. Modified Alcian blue was optimized. Patients who had invasive lobular carcinoma on needle biopsy were candidates for this study. Touch preparations from every sentinel lymph node were prospectively prepared in the same manner, one stained with modified Alcian blue and one with conventional staining. These slides were independently interpreted. A total of 121 sentinel lymph nodes from 31 patients with invasive lobular carcinoma were studied. There were 11 patients (35.5%) who had at least one positive lymph node test result. There were a total of 18 positive lymph node results (14.9%). Although 10 sentinel lymph nodes with abnormalities were detected in 7 patients with conventional staining, modified Alcian blue detected 15 sentinel lymph node abnormalities in 10 patients. Modified Alcian blue increased the sensitivity compared with conventional staining from 63.6% to 90.9% (calculated based on the number of patients) and from 55.6% to 83.3% (calculated based on number of sentinel lymph nodes). The staining process takes approximately 11 minutes. Modified Alcian blue stain is a relatively rapid, cheap, highly sensitive, and specific method of detecting metastatic invasive lobular carcinoma. This method can be used in conjunction with conventional staining methods used intraoperatively.

Invasive lobular carcinoma of the breast presenting as retroperitoneal fibrosis: a case report

IntroductionInvasive lobular carcinoma of the breast represents approximately 6.3% of mammary malignancies. Distant metastasis of invasive lobular carcinoma to the peritoneum or retroperitoneum has been reported fairly frequently.Case presentationWe report the case of a 59-year-old Caucasian-Canadian woman with invasive lobular carcinoma of the breast presenting with retroperitoneal fibrosis and bilateral ureteral obstruction. Intra-operative pathology consultation did not reveal malignancy. The diagnosis, however, was confirmed on permanent sections by histological appearance in addition to immunohistochemistry. To the best of our knowledge, this is the first reported case of invasive lobular carcinoma of the breast presenting with retroperitoneal fibrosis.ConclusionIn a case of unexplained ureteric obstruction and retroperitoneal fibrosis, more comprehensive physical examination and additional ancillary studies may be warranted to rule out malignancy as an underlying etiology. This case also emphasizes that intra-operative frozen section consultation cannot always be fully relied upon to exclude a malignancy as the etiology of retroperitoneal fibrosis. Moreover, in permanent histopathology sections, immunohistochemistry testing can be of value to rule out metastatic disease where the morphology is not salient. There is a need for a thorough physical examination of patients with retroperitoneal fibrosis, including the breast and gynecological organs.

Unusual Sonographic Finding of Metastatic Invasive Lobular Carcinoma to the Contralateral Breast

Invasive lobular carcinoma (ILC) is the second most common breast cancer after invasive ductal carcinoma (IDC), accounting for 5% to 14% of all breast cancers.1 Like other primary breast cancers, ILC can metastasize to a contralateral breast via lymphatic or hematogenous dissemination. However, contralateral breast cancer metastasis is a rare event. A variety of sonographic findings of metastases from extramammary malignancies have been reported, 2 but those from contralateral breast cancer are little known. We report an unusual sonographic finding of contralateral metastases of ILC in a patient with advanced breast cancer and systemic metastases.