Invasive lobular carcinoma ILC , sometimes called infiltrating lobular carcinoma, is the second most common type of breast cancer after invasive ductal carcinoma cancer that begins in the milk-carrying ducts and spreads beyond it. According to the American Cancer Society, more than , women in the United States find out they have invasive breast cancer each year. Lobular means that the cancer began in the milk-producing lobules, which empty out into the ducts that carry milk to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. Over time, invasive lobular carcinoma can spread to the lymph nodes and possibly to other areas of the body.
Br J Radiol. Metastatic, or stage 4, breast cancer means the cancer has spread to other parts of the body. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. Domagala W, Markiewski M, Kubiak R, Bartkowiak J, Osborn M: Immunohistochemical profile of invasive lobular carcinoma of the breast: predominantly vimentin and p53 protein negative, cathepsin D Lovers moon oestrogen receptor lobulr. Pleomorphic Lobular Carcinoma. Infiltrating lobular carcinoma of breast Surg. Fechner RE: Infiltrating lobular carcinoma without lobular carcinoma in situ. Overall survival OS was defined as the interval between the diagnostic biopsy and death from any cause, death being scored as an event, and patients who were still alive were censored at the time of last follow-up. The background stroma is densely fibrotic and contains foci of periductal and perivenous elastosis.
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Br J Cancer. Emphasis on recent aspects of management. On the other hand, the number of patients with ILC who received adjuvant chemotherapy was significantly lower Find support from others who are living with breast cancer. How the results of your Infiltrating lobular carcinoma of breast will affect libular therapy is best discussed with your doctor. Breast cancer rarely spreads to the colon, but it can happen. Early stage breast cancers carry a higher survival rate than advanced stages. The treatment approaches usually have low complications 5. Ductal carcinoma in situ Ductal carcinoma in situ DCIS is characterized by cancerous cells that are confined to the lining of carcimoma milk ducts and have not Infiltrating lobular carcinoma of breast through the duct walls into surrounding breast tissue. Lobular carcinoma of the breast in situ and infiltrating. Medullary carcinoma may occur at any age, but it typically affects women in their late 40s Infiktrating early Truecelebs naked pictures.
- Because it is less common than infiltrating ductal carcinoma IDC , few data have been reported that address the biologic features of ILC in the context of their clinical outcome.
- Metrics details.
- Lobular breast cancer, also called invasive lobular carcinoma ILC , occurs in the breast lobes or lobules.
- Invasive lobular carcinoma is a cancerous development commencing at the lobules of the breast.
- Breast cancer is classified into different types based on how the cells look under a microscope.
- Breast cancers that have spread into surrounding breast tissue are known as invasive breast cancer.
Metrics details. Because it is less common than infiltrating ductal carcinoma IDC , few data have been reported that address the biologic features of ILC in the context of their clinical outcome. In the present study we undertook an extensive comparison of ILC and IDC using a large database to provide a more complete and reliable assessment of their biologic phenotypes and clinical behaviors.
The clinical and biological features of patients with ILC were compared with those of 45, patients with IDC not otherwise specified. The median follow-up period was 87 months. In comparison with IDC, ILC was significantly more likely to occur in older patients, to be larger in size, to be estrogen and progesterone receptor positive, to have lower S-phase fraction, to be diploid, and to be HER-2, p53, and epidermal growth factor receptor negative.
The 5-year disease-free survival was The 5-year overall survival was Despite the fact that the biologic phenotype of ILC is quite favorable, these patients do not have better clinical outcomes than do patients with IDC. At present, management decisions should be based on individual patient and tumor biologic characteristics, and not on lobular histology.
Carcinoma of the breast is a histologically heterogeneous disease. Data from a recent epidemiologic study [ 3 ] indicate that for unknown causes the incidence of this type of breast cancer is increasing, especially among postmenopausal women.
The morphologic features of lobular carcinoma differ from those of ductal carcinoma. ILC is characterized by small, round cells that are bland in appearance and have scant cytoplasm, which infiltrate the stroma in single file and surround benign breast tissues in a targeted manner [ 1 , 4 ].
Infiltration typically does not destroy anatomic structures or incite a substantial connective tissue response.
By virtue of their distinctive growth pattern and biology, lobular carcinomas often fail to form distinct masses that can easily be diagnosed by palpation or mammography. This can make early diagnosis challenging [ 5 , 6 ] and breast conservation approaches more difficult. Lobular carcinomas may have a substantially increased propensity for multifocal and multicentric distribution and for bilaterality [ 5 , 7 — 11 ].
Metastatic spread with an uncommon pattern of involvement has been reported [ 12 , 13 ]. Because it is substantially less common than infiltrating ductal carcinoma IDC , knowledge about the clinical outcome of lobular carcinoma has been based on studies including relatively small numbers of patients. Reported prognosis varies and has been reported to be worse [ 14 , 15 ], no different [ 16 — 19 ], or better [ 20 ] than that with IDC.
This reported variability might be due to relatively small numbers of cases in each analysis. In addition, few data have been reported on the biologic features of lobular carcinomas within the context of their clinical outcome. We therefore undertook an extensive comparison of ILC and IDC using a large database to provide a more complete and reliable assessment of their biologic phenotypes and clinical behaviors, which might yield information useful for clinical decision making or for further exploring the biologic nature of this disease.
The Breast Center at Baylor College of Medicine maintains databases of breast cancer patients whose biopsy or mastectomy specimens were sent to central laboratories for steroid receptor assays. These patients were diagnosed and treated at more than academic and community institutions throughout the USA. Histologic diagnoses were made by pathologists at community hospitals and were not reviewed centrally.
Follow-up information was obtained from tumor registries, by direct review of medical records conducted by data managers, or by data collection forms completed at the office of the referring physicians. These databases contain information on 50, patients with early breast cancer who were diagnosed between and Among them, 8. Patients with special histologic types tubular, mucinous, and medullary were excluded, as were those with gross distant metastases at diagnosis.
Histologic grade was not analyzed in the present study because in most cases this information was not available. The patient information contained in this report was obtained from two data repositories maintained by the Breast Center at Baylor College of Medicine. Estrogen receptor ER levels were measured using the dextran-coated charcoal method as previously described [ 21 ]. From to , [ 3 H]estradiol was used as a labeled ligand.
During the same period, progesterone receptor PgR levels were measured by sucrose density gradient [ 22 ]. In , the standard multipoint dextran-coated charcoal assay was modified to incorporate [ I]estradiol and [ 3 H]R in a single assay, allowing simultaneous determination of levels of both ER and PgR [ 23 ]. DNA ploidy and S-phase fraction were evaluated using flow cytometry, as previously described [ 24 — 26 ]. HER-2 status was determined using Western blotting [ 27 ].
This cutoff has been in use at the Nichols Institute since and its use is in accordance with published studies [ 28 , 29 ]. Descriptive statistics are reported as frequencies or medians. Overall survival OS was defined as the interval between the diagnostic biopsy and death from any cause, death being scored as an event, and patients who were still alive were censored at the time of last follow-up.
OS after first recurrence was calculated from the date of first recurrence, death being scored as an event, and patients who were still alive were censored at the time of last follow-up. Disease-free survival DFS was also calculated from the date of first diagnostic biopsy, with first recurrences, local or distant, being scored as an event, and with censoring of other patients at the time of last follow-up or death.
Local recurrence was defined as tumor arising in the treated breast, chest wall or axilla. Multivariate analyses of DFS and OS, with stepwise variables selection, were conducted using Cox proportional hazard regression models.
Analyses were performed using SAS Version 8. From a total of 50, patients with early breast cancer in the Baylor College of Medicine Breast Cancer databases, we identified patients 8. The median follow-up time was 87 months range 0— months. Table 1 summarizes the clinical and biologic tumor characteristics according to histologic type. ILCs were slightly larger on average Despite this difference in tumor size, there was no difference in the frequency of axillary node involvement.
Despite the larger tumor size, ILCs had more favorable biologic characteristics Table 1. The proportion of ER-positive tumors was PgR was expressed in The detail of coding in the database was not sufficient to permit further distinction between brain, spinal cord, and meningeal metastases, and therefore the incidence of leptomeningeal disease could not be determined. ILC was three times more likely to metastasize to the peritoneum, gastrointestinal tract, and ovaries 6.
Information on contralateral breast tumors was also available on the subset of patients in whom sites of breast cancer distant from the primary could be assessed. Contralateral breast cancers in this group were more frequent among those with ILC Both local and systemic therapy for breast cancer differed according to histologic type Table 3. Patients with ILC were slightly less likely to undergo lumpectomy 9.
Probably because of the higher hormone receptor content, adjuvant endocrine therapy was more frequently given to patients with ILC On the other hand, the number of patients with ILC who received adjuvant chemotherapy was significantly lower The 5-year DFS was This modest difference is not clinically or biologically significant.
However, although ILC patients experienced recurrence less frequently than did IDC patients during the first few years after diagnosis, the two DFS curves converged after longer follow-up Fig. The 5-year overall survival OS after the first recurrence was Multivariate analyses were performed using Cox regression models to determine whether ILC was an independent prognostic factor for recurrence and death Table 4.
Data were available for all of these variables in 33, patients. From these variables, the factors that remained independently associated with recurrence, as well as with survival, were as follows: lymph node status, tumor size, age, S-phase, PgR status, and ER status.
Once adjustment based on these six parameters was made, histologic type did not emerge as an important prognostic factor. Thus, the lack of prognostic significance related to ILC versus IDC in univariate analyses is confirmed by the results of the multivariate analyses.
The distributions of metastases were also different. Despite a substantially less aggressive biologic phenotype, recurrence and survival were very similar between ILC and IDC patients. To our knowledge this is the largest published report on ILC that comprehensively evaluates biologic characteristics and clinical outcomes. The incidence of ILC observed in the present study 8. In addition, the large number of patients, the multi-institutional nature of the study population, and the median follow-up period of more than 7 years strengthen the reliability of the results and permit extrapolation of the findings to routine clinical practice.
Several studies showed that patients with ILC are on average older at presentation than are IDC patients [ 18 , 19 , 34 ]. Consistent with these data, in the present study the median ages at diagnosis were This older age at diagnosis in those with ILC could be due to a low proliferative rate or greater difficulties in detecting ILC.
The lack of a desmoplastic reaction may make the lesion impalpable and invisible, both clinically and mammographically, deferring the identification and probably explaining why lobular carcinomas were larger at diagnosis than IDCs. However, despite the slightly larger size of ILCs, the rate of lymph node involvement was the same in each group.
The uniform appearance of bland tumor cells that lack cellular atypia and often have a low mitotic rate make the lobular carcinoma cells more difficult to detect in metastatic lymph nodes. Thus, particular attention should be given to histologic examination of axillary nodes in resection specimens of lobular carcinomas because nodal metastases are more often missed with ILCs, and false-negative results are more frequently reported compared with ductal carcinomas [ 35 ].
By contrast, the peritoneum, ovary, and gastrointestinal system were much more likely to be involved in advanced ILC. Entries for gastrointestinal involvement in the database represent peritoneal and parenchymal involvement. This database could not clearly distinguish between brain, spinal cord, or leptomeningeal metastases in its classification of CNS involvement.
It has been reported that ILC more often involves the meninges and spinal fluid [ 13 , 36 — 38 ] but we were unable to address this issue directly because of limitations in the database. The factors that account for this distinct metastatic pattern are unclear. The difference could be due to a cell size or shape with physical properties that favor certain areas with microanatomy that is more conducive to stopping or trapping these types of cells.
Alternatively, the microenvironment of the ovary or peritoneum may provide growth and survival factors that favor ILC cells over IDC cells. Additional molecular or biologic differences might account for this peculiar pattern of metastasis.
It has been demonstrated that loss of expression of the cell—cell adhesion molecule E-cadherin in ILC may decrease adhesiveness of cells and facilitate this type of infiltration [ 19 , 39 , 40 ].
Indeed, the findings of this study support a different molecular biology of ILC. In our dataset the incidence of contralateral breast cancer in women with ILC was nearly double that in women with IDC. This finding could make a compelling case for the use of tamoxifen to prevent contralateral breast cancer in women with lobular primaries.
Because only a few small and scattered studies have addressed the biologic features of ILC, one of the main objectives of the present study was to characterize more comprehensively its biologic phenotype. This report definitively confirms and extends the findings of some previous studies [ 11 , 12 , 17 , 43 — 45 ] indicating that lobular carcinomas are significantly more likely to be steroid receptor positive than are IDCs.
These results also demonstrate that lobular carcinomas are more likely to have low S-phase fractions and to be diploid.
Treatment plan. Author information Article notes Copyright and License information Disclaimer. More study is needed on these specific subtypes. This type of cancer is called invasive ductal carcinoma IDC. Close Select A Hope Lodge. If your doctor knows that your tumor is made up of one of these special types of breast cancer, he or she may recommend different treatment. From a total of 50, patients with early breast cancer in the Baylor College of Medicine Breast Cancer databases, we identified patients 8.
Infiltrating lobular carcinoma of breast. Invasive (infiltrating) ductal carcinoma (IDC)
Invasive Lobular Carcinoma: Symptoms, Diagnosis, and More
Follow us:. Infiltrating Lobular Carcinoma. Hormone replacement therapy after menopause may increase the risk of ILC. The size of ILC ranges from grossly inapparent lesions that may diffusely involve the breast to discrete, firm, gray-white masses with irregular borders.
Frequently, it creates an ill-defined thickening or fullness in a portion of the breast which feels different than the surrounding tissue. It is also difficult to appreciate on mammograms due to its growth characteristics.
Breast MRI is superior to ultrasound and mammography in visualizing the tumor. Microscopically, ILC is consists of a uniform population of small to medium-sized tumor cells that exhibit lack of cohesion. In a classical case of ILC, they grow in slender strands or single files Indian file or in a concentric fashion around ducts or lobules harboring lobular carcinoma-in-situ LCIS.
The background stroma is densely fibrotic and contains foci of periductal and perivenous elastosis. A lymphocytic infiltrate is frequently present. The lack of E-Cadherin is due to biallelic loss of expression of a tumor suppressor gene CDH1 on chromosome 16q. E-Cadherin is a calcium-dependent transmembrane protein that plays a key role in cell-cell adhesion. As a result, the tumors like ILC that lack E-Cadherin are discohesive and frequently consist of single cells infiltrating through the breast parenchyma.
Lobular Carcinoma. Inflammation in Lobular CA. Perineural invasion in Lobular CA. Pleomorphic Lobular Carcinoma. Histiocytoid Carcinoma. All rights reserved.