Difference between revisions of "Lobular carcinoma in situ"

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<noinclude>{{Top
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
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{{Fixation - standard}}
 
{{Fixation - standard}}
 
[[File:Histopathology of lobular carcinoma in situ.jpg|thumb|]]
 
[[File:Histopathology of lobular carcinoma in situ.jpg|thumb|]]
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<noinclude>
 
==Presentations==
 
==Presentations==
 
*[[Breast biopsy or excision]]
 
*[[Breast biopsy or excision]]
 
*[[Mastectomy]]
 
*[[Mastectomy]]
 
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</noinclude>
 
==Microscopic evaluation==
 
==Microscopic evaluation==
 
Lobular carcinoma in situ (LCIS) typically display monomorphic, loosely cohesive, slightly enlarged and evenly spaced cells that fill acini.<ref name=PathologyOutlinesLCIS>{{cite web|url=http://www.pathologyoutlines.com/topic/breastmalignantlcis.html|title=Breast - Noninvasive lobular neoplasia - LCIS classic|author=Sucheta Srivastava}} Topic Completed: 1 September 2017. Minor changes: 21 June 2020</ref>
 
Lobular carcinoma in situ (LCIS) typically display monomorphic, loosely cohesive, slightly enlarged and evenly spaced cells that fill acini.<ref name=PathologyOutlinesLCIS>{{cite web|url=http://www.pathologyoutlines.com/topic/breastmalignantlcis.html|title=Breast - Noninvasive lobular neoplasia - LCIS classic|author=Sucheta Srivastava}} Topic Completed: 1 September 2017. Minor changes: 21 June 2020</ref>
 
Cells have indistinct cell borders, pale cytoplasm, and uniform small nuclei with evenly distributed chromatin and inconspicuous nucleoli.<ref name=PathologyOutlinesLCIS/>
 
Cells have indistinct cell borders, pale cytoplasm, and uniform small nuclei with evenly distributed chromatin and inconspicuous nucleoli.<ref name=PathologyOutlinesLCIS/>
  
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===Differential diagnosis===
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The main differential diagnosis is '''[[ductal carcinoma in situ]] (DCIS)'''.
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<gallery mode=packed heights=190>
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File:DCIS - Intraductal carcinoma of the breast.jpg|In '''DCIS''', the cells are cohesive and have high grade atypia.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/breastmalignantlcis.html|title=Breast - Noninvasive lobular neoplasia - LCIS classic (Differential diagnosis section)|author=Sucheta Srivastava, M.D.}} Topic Completed: 1 September 2017. Minor changes: 17 May 2021</ref>
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File:Histopathology of DCIS with lobular cancerization.jpg|LCIS typically fills smaller lobules rather than ducts, but '''DCIS can display lobular cancerization''' as shown at bottom of image.{{MH}}
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</gallery>
 
When unsure, perform immunohistochemistry for E-cadherin and p120:
 
When unsure, perform immunohistochemistry for E-cadherin and p120:
 
<gallery mode=packed>
 
<gallery mode=packed>
File:Immunohistochemistry for E-cadherin in lobular carcinoma in situ.jpg|thumb|'''E-cadherin''' is '''negative''' in '''lobular''' carcinoma in situ.
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File:Immunohistochemistry for E-cadherin in lobular carcinoma in situ.jpg|thumb|'''E-cadherin''' is '''negative''' in '''lobular''' carcinoma in situ (LCIS).
File:Immunohistochemistry for p120 in lobular carcinoma in situ.jpg|'''p120''' has a '''cytoplasmic''' staining in '''lobular''' carcinoma in situ.
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File:Immunohistochemistry for p120 in lobular carcinoma in situ.jpg|'''p120''' has a '''cytoplasmic''' staining in '''lobular''' carcinoma in situ (LCIS).
 
</gallery>
 
</gallery>
In contrast, both '''E-cadherin''' (left image below) and '''p120''' (right) have a '''membranous''' staining pattern in [[ductal carcinoma in situ|'''ductal''' carcinoma in situ]]:
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In contrast, both E-cadherin (left image below) and p120 (right) have a '''membranous''' staining pattern in [[ductal carcinoma in situ|'''ductal''' carcinoma in situ]] (DCIS).
 
<gallery mode=packed>
 
<gallery mode=packed>
 
Immunohistochemistry for E-cadherin in ductal carcinoma in situ.jpg
 
Immunohistochemistry for E-cadherin in ductal carcinoma in situ.jpg
 
Immunohistochemistry for p120 in ductal carcinoma in situ.jpg
 
Immunohistochemistry for p120 in ductal carcinoma in situ.jpg
 
</gallery>
 
</gallery>
{{Bottom}}
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===Biomarkers===
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{{Estrogen and progesterone receptors in breast cancers}}
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===Microscopic report===
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It should contain:<ref>{{cite web|url=https://surgpathcriteria.stanford.edu/breast/lcis/printable.html|title=Lobular Carcinoma in Situ of the Breast|website=Surgical Pathology Criteria|accessdate=2021-12-14}}</ref>
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*Type of resection or biopsy, and location
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*Results of any supplementary studies performed
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*Extent
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However, grading and staging is not applicable.
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(Margins of excision are not relevant)
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<noinclude>
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{{Reporting}}
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{{Bottom}}</noinclude>

Revision as of 19:54, 2 December 2022

Author: Mikael Häggström [note 1]

Fixation

Generally 10% neutral buffered formalin.

Histopathology of lobular carcinoma in situ.jpg

Presentations

Microscopic evaluation

Lobular carcinoma in situ (LCIS) typically display monomorphic, loosely cohesive, slightly enlarged and evenly spaced cells that fill acini.[1] Cells have indistinct cell borders, pale cytoplasm, and uniform small nuclei with evenly distributed chromatin and inconspicuous nucleoli.[1]

Differential diagnosis

The main differential diagnosis is ductal carcinoma in situ (DCIS).

When unsure, perform immunohistochemistry for E-cadherin and p120:

In contrast, both E-cadherin (left image below) and p120 (right) have a membranous staining pattern in ductal carcinoma in situ (DCIS).

Biomarkers

Generally perform immunohistochemistry for estrogen and progesterone receptors and calculate the percentage of positive tumor cells.

Microscopic report

It should contain:[3]

  • Type of resection or biopsy, and location
  • Results of any supplementary studies performed
  • Extent

However, grading and staging is not applicable. (Margins of excision are not relevant)

  See also: General notes on reporting


Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. 1.0 1.1 Sucheta Srivastava. Breast - Noninvasive lobular neoplasia - LCIS classic. Topic Completed: 1 September 2017. Minor changes: 21 June 2020
  2. Sucheta Srivastava, M.D.. Breast - Noninvasive lobular neoplasia - LCIS classic (Differential diagnosis section). Topic Completed: 1 September 2017. Minor changes: 17 May 2021
  3. . Lobular Carcinoma in Situ of the Breast. Surgical Pathology Criteria. Retrieved on 2021-12-14.

Image sources