33 Special Types of Invasive Breast Carcinoma: Diagnostic Criteria ...
33 Special Types of Invasive Breast Carcinoma: Diagnostic Criteria ...
33 Special Types of Invasive Breast Carcinoma: Diagnostic Criteria ...
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Page et al. (15) described a pleomorphic variant that has the infiltrating pattern <strong>of</strong><br />
classic infiltrating lobular carcinoma, but with more pleomorphic nuclei, and tendency<br />
for the tumor cells to aggregate. Dixon et al. (6-8) listed this pleomorphic variant in<br />
their mixed category, which also included infiltrating lobular carcinomas that display<br />
various combinations <strong>of</strong> classical, solid, and/or alveolar patterns. Also, DiCostanzo et<br />
al. (9) studied the mixed variant <strong>of</strong> infiltrating lobular carcinoma, but their study only<br />
included cases <strong>of</strong> infiltrating lobular carcinoma with classical cytologic features (small<br />
and uniform cells), and thus excluded breast carcinomas with pleomorphic nuclei.<br />
Eusebi et al. (16) presented a series <strong>of</strong> 10 patients with pleomorphic infiltrating<br />
lobular carcinoma with prominent apocrine differentiation. Six <strong>of</strong> these patients died<br />
<strong>of</strong> their disease within 42 months <strong>of</strong> diagnosis. Three other patients developed distant<br />
metastases or suffered recurrences <strong>of</strong> their cancers within a short period <strong>of</strong> time. In<br />
contrast, only two <strong>of</strong> 22 control patients with classic infiltrating lobular carcinoma<br />
died <strong>of</strong> their disease after 48 months <strong>of</strong> follow up. The authors concluded that<br />
pleomorphic infiltrating lobular carcinoma was a very aggressive variant <strong>of</strong> infiltrating<br />
lobular carcinoma. All <strong>of</strong> their cases <strong>of</strong> pleomorphic infiltrating lobular carcinoma had<br />
the linear, single-file, and targetoid invasive pattern <strong>of</strong> classic infiltrating lobular<br />
carcinoma; but, the cytologic features were considered pleomorphic to a degree that<br />
contrasted with classic infiltrating lobular carcinoma and highlighted the difficulty <strong>of</strong><br />
distinguishing pleomorphic infiltrating lobular carcinoma from infiltrating duct<br />
carcinoma. Furthermore, the tumor cells in their 10 cases <strong>of</strong>ten had eosinophilic,<br />
slightly granular, and/or foamy cytoplasm, and all immunoreacted with gross cystic<br />
disease fluid protein-15 (GCDFP-15), a known apocrine marker (16). In this same<br />
study, 22 classic infiltrating lobular carcinomas failed to react with GCDFP-15.<br />
Weidner et al. & Cha et. al. (18,21) showed that pleomorphic infiltrating lobular<br />
carcinoma had a significantly shorter relapse-free survival rate than classical<br />
infiltrating lobular carcinoma (p30 months). Patients with<br />
pleomorphic infiltrating lobular carcinoma and no lymph node involvement were four<br />
times more likely to experience recurrence than node-negative patients with classical<br />
infiltrating lobular carcinoma. Likewise, those with positive lymph nodes and<br />
pleomorphic histology were 30 times more likely to experience recurrence. Although<br />
there appeared to be a trend toward decreased overall survival for those patients with<br />
-16-
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