J Breast Cancer.  2012 Sep;15(3):313-319. 10.4048/jbc.2012.15.3.313.

Invasive Pleomorphic Lobular Carcinoma of the Breast: Clinicopathologic Characteristics and Prognosis Compared with Invasive Ductal Carcinoma

• Jung SP
• Lee SK
• Kim S
• Choi MY
• Bae SY
• Kim J
• Kim M
• Kil WH
• Cho EY
• Choe JH
• Kim JH
• Kim JS
• Nam SJ
• Lee JE

• KMID: 2286457
• DOI: http://doi.org/10.4048/jbc.2012.15.3.313

Abstract

PURPOSE
Invasive pleomorphic lobular carcinoma (IPLC) is a very rare and distinct morphological variant of invasive lobular carcinoma (ILC), characterized by nuclear atypia and pleomorphism contrasted with the cytologic uniformity of ILC. This study evaluated clinicopathologic characteristics and prognosis of IPLC compared with invasive ductal carcinoma (IDC).
METHODS
We retrospectively reviewed the medical records of 35 patients with IPLC and 6,184 patients with IDC, not otherwise specified. We compared the clinicopathologic characteristics, relapse-free survival (RFS) and disease specific survival (DSS) of patients who were surgically treated between January 1997 and December 2010.
RESULTS
Patients with IPLC presented at an older age with larger tumor size, worse histologic grade, higher rates of N3 stage, more multifocal/multicentric tumors, and more nipple-areolar complex involvement than those of patients with IDC. During the follow-up period, the IPLC group experienced five cases (14.3%) of disease recurrence and three cases (8.6%) of disease specific mortality compared with 637 cases (10.4%) of recurrence and 333 cases (5.4%) of disease specific mortality in the IDC group. Univariate analysis using the Kaplan-Meier method revealed that the IPLC group showed a significantly poorer prognosis than that of the IDC group (RFS, p=0.008; DSS, p<0.001). However, after adjusting for clinicopathologic factors, a multivariate analysis showed no statistical differences in RFS (p=0.396) and DSS (p=0.168) between the IPLC and the IDC groups.
CONCLUSION
Our data suggest that patients with IPLC present with poor prognostic factors such as large tumor size, poor histologic grade and advanced stage at diagnosis. These aggressive clinicopathologic characteristics may result in poor clinical outcomes. Although our study could not link IPLC histology to poor prognosis, considering the aggressive characteristics of IPLC, early detection and considerate treatment, including proper surgical and adjuvant intervention, could be helpful for disease progression and survival.

Keyword

Breast; Lobular carcinoma; Prognosis

MeSH Terms

Aluminum Hydroxide
Breast
Carbonates
Carcinoma, Ductal
Carcinoma, Lobular
Disease Progression
Follow-Up Studies
Humans
Medical Records
Multivariate Analysis
Prognosis
Recurrence
Retrospective Studies
Aluminum Hydroxide
Carbonates

Figure

• 

  Figure 1 Microscopic morphology of invasive pleomorphic lobular carcinoma (IPLC). (A) IPLC image with E-cadherin staining (×400). Neoplastic cells were typically negative for E-cadherin staining. (B) IPLC image with H&E staining (×200). Note the diffuse infiltration of dissociated cancer cells arranged in single file. (C) IPLC image with H&E staining (×400). IPLC cells had enlarged nuclei and abundant eosinophilic granular C cytoplasm.

• 

  Figure 2 Univariate analysis curves for relapse-free survival (RFS) and disease-specific survival (DSS) of patients with invasive ductal carcinoma (IDC) and invasive pleomorphic lobular carcinoma (IPLC). (A) Univariate analysis curves for RFS of IDC and IPLC. (B) Univariate analysis curves for DSS of IDC and IPLC.

• 

  Figure 3 Multivariate analysis curves for relapse-free survival (RFS) and disease-specific survival (DSS) of patients with invasive ductal carcinoma (IDC) and invasive pleomorphic lobular carcinoma (IPLC). (A) Multivariate analysis curves for RFS of IDC and IPLC. (B) Multivariate analysis curves for DSS of IDC and IPLC.

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