Abstract
The biologic nature, diagnostic features and therapeutic management of patients with lobular carcinoma in its in situ and invasive forms are discussed. Although recorded studies emphasize that patients with lobular carcinoma in situ are "at risk" for the development of invasive cancer, it has not been unequivocally demonstrated whether such an event represents a persistence of cancer due to inadequate excision or a de novo lesion. In support of the latter is the contention that lobular carcinoma exhibits a propensity for multicentricity and bilaterality. The recognition that the histologic types of the subsequent invasive cancers are not universally lobular invasive might also be cited in this regard. This information also bears upon views purporting a stepwise development of lobular invasive carcinoma from its in situ analog. Analysis of our own material fails to confirm any significant association between invasive lobular carcinoma and multicentric lesions. The diagnostic difficulty in distinguishing lobular hyperplasia from in situ lobular carcinoma and the inadvisability of frozen sections for this purpose is noted. Although the results of some electron microscopic studies of the in situ lesion challenge the propriety of its "pure in situ" nature; this criticism does not appear valid from both a pathological as well as pragmatic standpoints. The various schemes have been proposed concerning the surgical management of patients with lobular carcinoma in situ are presented and discussed. Certain biologic principles prompt consideration of segmental mastectomy and axillary node sampling as an alternative, commodious form of treatment for such lesions. There does not appear to be any unique reason to invoke any different treatment regimen for lobular invasive carcinoma than has been utilized for other invasive breast cancers.
Full text
PDF








Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Andersen J. A. Lobular carcinoma in situ of the breast with ductal involvement. Frequency and possible influence on prognosis. Acta Pathol Microbiol Scand A. 1974 Sep;82(5):655–662. doi: 10.1111/j.1699-0463.1974.tb03590.x. [DOI] [PubMed] [Google Scholar]
- Andersen J. A. The basement membrane and lobular carcinoma in situ of the breast. Acta Pathol Microbiol Scand A. 1975 Mar;83(2):245–250. doi: 10.1111/j.1699-0463.1975.tb01381.x. [DOI] [PubMed] [Google Scholar]
- Ashikari R., Huvos A. G., Urban J. A., Robbins G. F. Infiltrating lobular carcinoma of the breast. Cancer. 1973 Jan;31(1):110–116. doi: 10.1002/1097-0142(197301)31:1<110::aid-cncr2820310115>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
- Atkins H., Hayward J. L., Klugman D. J., Wayte A. B. Treatment of early breast cancer: a report after ten years of a clinical trial. Br Med J. 1972 May 20;2(5811):423–429. doi: 10.1136/bmj.2.5811.423. [DOI] [PMC free article] [PubMed] [Google Scholar]
- BERG J. W., ROBBINS G. F. 20 YEAR FOLLOW-UPS OF BREAST CANCER. Acta Unio Int Contra Cancrum. 1963;19:1575–1577. [PubMed] [Google Scholar]
- Benfield J. R., Fingerhut A. G., Warner N. E. A multidiscipline view of lobular breast carcinoma. Am Surg. 1972 Feb;38(2):115–116. [PubMed] [Google Scholar]
- Benfield J. R., Fingerhut A. G., Warner N. E. Lobular carcinoma of the breast-1969. A therapeutic proposal. Arch Surg. 1969 Aug;99(2):129–140. doi: 10.1001/archsurg.1969.01340140001001. [DOI] [PubMed] [Google Scholar]
- Carter D., Yardley J. H., Shelley W. M. Lobular carcinoma of the breast an ultrastructural comparison with certain duct carcinomas and benign lesions. Johns Hopkins Med J. 1969 Jul;125(1):25–32. [PubMed] [Google Scholar]
- Dall'Olmo C. A., Ponka J. L., Horn R. C., Jr, Riu R. Lobular carcinoma of the breast in situ. Are we too radical in its treatment? Arch Surg. 1975 May;110(5):537–542. doi: 10.1001/archsurg.1975.01360110083015. [DOI] [PubMed] [Google Scholar]
- Donegan W. L., Perez-Mesa C. M. Lobular carcinoma--an indication for elective biopsy of the second breast. Ann Surg. 1972 Aug;176(2):178–187. doi: 10.1097/00000658-197208000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Farrow J. H. Clinical considerations and treatment of in situ lobular breast cancer. Am J Roentgenol Radium Ther Nucl Med. 1968 Mar;102(3):652–656. doi: 10.2214/ajr.102.3.652. [DOI] [PubMed] [Google Scholar]
- Farrow J. H. Current concepts in the detection and treatment of the earliest of the early breast cancers. Cancer. 1970 Feb;25(2):468–477. doi: 10.1002/1097-0142(197002)25:2<468::aid-cncr2820250226>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
- Fechner R. E. Epithelial alterations in the extralobular ducts of breasts with lobular carcinoma. Arch Pathol. 1972 Feb;93(2):164–171. [PubMed] [Google Scholar]
- Fechner R. E. Histologic variants of infiltrating lobular carcinoma of the breast. Hum Pathol. 1975 May;6(3):373–378. doi: 10.1016/s0046-8177(75)80099-2. [DOI] [PubMed] [Google Scholar]
- Fechner R. E. Infiltrating lobular carcinoma without lobular carcinoma in situ. Cancer. 1972 Jun;29(6):1539–1545. doi: 10.1002/1097-0142(197206)29:6<1539::aid-cncr2820290618>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
- Fisher E. R., Gregorio R. M., Fisher B., Redmond C., Vellios F., Sommers S. C. The pathology of invasive breast cancer. A syllabus derived from findings of the National Surgical Adjuvant Breast Project (protocol no. 4). Cancer. 1975 Jul;36(1):1–85. doi: 10.1002/1097-0142(197507)36:1<1::aid-cncr2820360102>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
- Foote F. W., Stewart F. W. Lobular carcinoma in situ: A rare form of mammary cancer. Am J Pathol. 1941 Jul;17(4):491–496.3. doi: 10.3322/canjclin.32.4.234. [DOI] [PMC free article] [PubMed] [Google Scholar]
- GODWIN J. T. Chronology of lobular carcinoma of the breast; report of a case. Cancer. 1952 Mar;5(2):259–266. doi: 10.1002/1097-0142(195203)5:2<259::aid-cncr2820050210>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
- Gad A., Azzopardi J. G. Lobular carcinoma of the breast: a special variant of mucin-secreting carcinoma. J Clin Pathol. 1975 Sep;28(9):711–716. doi: 10.1136/jcp.28.9.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gershon-Cohen J., Berger S. M. Breast cancer with microcalcifications: diagnostic difficulties. Radiology. 1966 Oct;87(4):613–622. doi: 10.1148/87.4.613. [DOI] [PubMed] [Google Scholar]
- Giordano J. M., Klopp C. T. Lobular carcinoma in situ: incidence and treatment. Cancer. 1973 Jan;31(1):105–109. doi: 10.1002/1097-0142(197301)31:1<105::aid-cncr2820310114>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
- Hutter R. V., Foote F. W., Jr Lobular carcinoma in situ. Long term follow-up. Cancer. 1969 Nov;24(5):1081–1085. doi: 10.1002/1097-0142(196911)24:5<1081::aid-cncr2820240534>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
- Hutter R. V., Snyder R. E., Lucas J. C., Foote F. W., Jr, Farrow J. H. Clinical and pathologic correlation with mammographic findings in lobular carcinoma in situ. Cancer. 1969 Apr;23(4):826–839. doi: 10.1002/1097-0142(196904)23:4<826::aid-cncr2820230417>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
- Kermarec J., Plouvier S., Duplay H., Daniel R. Tumeur mammaire à cellules myo-épithéliales. Etude ultrastructurale. Arch Anat Pathol (Paris) 1973 Sep;21(3):225–231. [PubMed] [Google Scholar]
- Kramer W. M., Rush B. F., Jr Mammary duct proliferation in the elderly. A histopathologic study. Cancer. 1973 Jan;31(1):130–137. doi: 10.1002/1097-0142(197301)31:1<130::aid-cncr2820310117>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
- Leis H. P., Jr, Mersheimer W. L., Black M. M., De Chabon A. The second breast. N Y State J Med. 1965 Oct 1;65(19):2460–2468. [PubMed] [Google Scholar]
- Lewison E. F., Finney G. G., Jr Lobular carcinoma in situ of the breast. Surg Gynecol Obstet. 1968 Jun;126(6):1280–1286. [PubMed] [Google Scholar]
- Lewison E. F. Lobular carcinoma in situ of the breast. Am Surg. 1965 Dec;31(12):787–789. [PubMed] [Google Scholar]
- MILLER H. W., Jr, KAY S. Infiltrating lobular carcinoma of the female mammary gland. Surg Gynecol Obstet. 1956 Jun;102(6):661–667. [PubMed] [Google Scholar]
- McDivitt R. W., Hutter R. V., Foote F. W., Jr, Stewart F. W. In situ lobular carcinoma. A prospective follow-up study indicating cumulative patient risks. JAMA. 1967 Jul 10;201(2):82–86. doi: 10.1001/jama.201.2.82. [DOI] [PubMed] [Google Scholar]
- Murad T. M., Scharpelli D. G. The ultrastructure of medullary and scirrhous mammary duct carcinoma. Am J Pathol. 1967 Feb;50(2):335–360. [PMC free article] [PubMed] [Google Scholar]
- Murad T. M. Ultrastructure of ductular carcinoma of the breast (in situ and infiltrating lobular coarinoma). Cancer. 1971 Jan;27(1):18–28. doi: 10.1002/1097-0142(197101)27:1<18::aid-cncr2820270105>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
- NEWMAN W. In situ lobular carcinoma of the breast: report of 26 women with 32 cancers. Ann Surg. 1963 Apr;157:591–599. doi: 10.1097/00000658-196304000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Newman W. Lobular carcinoma of the female breast. Report of 73 cases. Ann Surg. 1966 Aug;164(2):305–314. doi: 10.1097/00000658-196608000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ozzello L., Sanpitak P. Epithelial-stromal junction of intraductal carcinoma of the breast. Cancer. 1970 Dec;26(6):1186–1198. doi: 10.1002/1097-0142(197012)26:6<1186::aid-cncr2820260603>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
- Ozzello L. Ultrastructure of intra-epithelial carcinomas of the breast. Cancer. 1971 Dec;28(6):1508–1515. doi: 10.1002/1097-0142(197112)28:6<1508::aid-cncr2820280625>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
- Rosen P. P., Menendez-Botet C. J., Nisselbaum J. S., Urban J. A., Miké V., Fracchia A., Schwartz M. K. Pathological review of breast lesions analyzed for estrogen receptor protein. Cancer Res. 1975 Nov;35(11 Pt 1):3187–3194. [PubMed] [Google Scholar]
- Schäfer A., Bässler R. Vergleichende elektronenmikroskopische Untersuchungen am Drüsenspithel und am sog. lobulären Carcinom der Mamma. Virchows Arch A Pathol Pathol Anat. 1969;346(3):269–286. [PubMed] [Google Scholar]
- Snyder R. E. Mammography and lobular carcinoma in situ. Surg Gynecol Obstet. 1966 Feb;122(2):255–260. [PubMed] [Google Scholar]
- Steinbrecher J. S., Silverberg S. G. Signet-ring cell carcinoma of the breast. The mucinous variant of infiltrating lobular carcinoma? Cancer. 1976 Feb;37(2):828–840. doi: 10.1002/1097-0142(197602)37:2<828::aid-cncr2820370231>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
- Tobon H., Price H. M. Lobular carcinoma in situ. Some ultrastructural observations. Cancer. 1972 Oct;30(4):1082–1091. doi: 10.1002/1097-0142(197210)30:4<1082::aid-cncr2820300430>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
- Toker C. Small cell dysplasia and in-situ carcinoma of the mammary ducts and lobules. J Pathol. 1974 Sep;114(1):47–52. doi: 10.1002/path.1711140109. [DOI] [PubMed] [Google Scholar]
- Urban J. A. Bilaterality of cancer of the breast. Biopsy of the opposite breast. Cancer. 1967 Nov;20(11):1867–1870. doi: 10.1002/1097-0142(196711)20:11<1867::aid-cncr2820201111>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
- Visfeldt J., Scheike O. Male breast cancer. I. Histologic typing and grading of 187 Danish cases. Cancer. 1973 Oct;32(4):985–990. doi: 10.1002/1097-0142(197310)32:4<985::aid-cncr2820320433>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
- Warner N. E. Lobular carcinoma of the breast. Cancer. 1969 Apr;23(4):840–846. doi: 10.1002/1097-0142(196904)23:4<840::aid-cncr2820230418>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
- Wheeler J. E., Enterline H. T., Roseman J. M., Tomasulo J. P., McIlvaine C. H., Fitts W. T., Jr, Kirshenbaum J. Lobular carcinoma in situ of the breast. Long-term followup. Cancer. 1974 Sep;34(3):554–563. doi: 10.1002/1097-0142(197409)34:3<554::aid-cncr2820340313>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]




