Biomarker profile of invasive lobular carcinoma: pleomorphic versus classic subtypes, clinicopathological characteristics and prognosis analyses

Nuclear morphological characterisation of lobular carcinoma variants: a morphometric study

BACKGROUND AND AIMS

Lobular carcinoma (LC) of the breast exhibits diverse morphology and clinical behaviour. The pleomorphic variant (pLC) displays distinct cytonuclear features and aggressiveness compared to the classic variant (cLC). However, diagnosing pLC remains subjective. This study aims to refine LC's cytonuclear features, focusing on pLC.

METHODS

Whole slide images of 59 LCs, including both in situ (LCIS) and invasive (ILC) lesions, were analysed. Nuclear measurements, including nuclear size and variability, were scored using QuPath image analysis software. For comparison, selected features were scored in normal cells (n = 10) and pleomorphism score-matched invasive breast carcinoma (IBC) of NST type (n = 33). Additional visual assessment of the pleomorphic ILC (pILC) cohort (n = 90) was conducted for cytomorphological features characterisation.

RESULTS

pILC demonstrated larger nuclear area and higher nuclear variability with abundance of cytoplasm than cILC. Compared to lymphocytes, pILC demonstrated a median area ranging from 2.7 to 4.7 times larger. Cut-off values for differentiating pILC from other ILC subtypes included median nuclear area > 48.2 μm2 and interquartile range (IQR) > 19.4, nuclear perimeter median > 25.2 μm and IQR > 5.3 and maximum diameter > 9.1 μm and IQR > 2.2. Multivariable logistic regression confirmed these parameters as independent predictors of pILC, with the maximum diameter being the most significant (P < 0.001). Visual assessment recognised two pILC subtypes: apocrine and non-apocrine. Apocrine variant showed nuclear roundness, pale vesicular chromatin patterns and prominent nucleoli, while non-apocrine variant exhibited greater nuclear size and shape variation.

CONCLUSIONS

Objective nuclear measurements, combined with cytoplasmic and architectural features, provide a robust framework for diagnosing LC subtypes, improving diagnostic accuracy and reproducibility.

Unique Molecular Alteration of Lobular Breast Cancer: Association with Pathological Classification, Tumor Biology and Behavior, and Clinical Management

Invasive lobular carcinoma (ILC), accounting for up to 15% of diagnosed breast cancers, has garnered significant attention due to the loss of the epithelial cell-cell adhesion molecule E-cadherin. This loss contributes to its distinct biological, morphological, and clinical characteristics compared to non-lobular breast cancers. The use of immunohistochemistry (IHC) for E-cadherin and/or the associated cadherin-catenin complex, such as p120-catenin and beta-catenin, in morphologically equivocal cases, has been increasingly adopted in pathology practice. This approach has substantially improved diagnostic accuracy, interobserver reproducibility, and the identification of new morphologic variants of ILC. ILCs exhibit unique tumor biology, which presents considerable challenges in clinical management, especially in preoperative imaging evaluation, surgical management, and neoadjuvant treatment. Recent advances in translational and clinical research have enhanced our understanding of ILC and have spurred the development of new clinical trials specifically targeting these cancers. This review highlights recent progress in various aspects of ILC, including its unique molecular alteration, pathological classification and diagnostic approach, tumor biology and behavior, key clinical management challenges, and ongoing clinical trials, as well as the role of artificial intelligence in diagnosing ILC radiologically and pathologically. The goal of this review is to provide an updated understanding of the tumor biology, clinical manifestations, and molecular landscape of ILC and to help refine current tumor classification and diagnosis, subsequently improving management strategies and overall outcomes for lobular carcinoma patients.

Heterogeneity of the Alpha-Smooth Muscle Actin Tumor Score in Breast Cancer Cells Significantly Affects Tumor Invasiveness, Recurrence, and Patient Survival

BACKGROUND

Alpha-smooth muscle actin (αSMA) has been widely investigated in malignancies, primarily concerning its expression in cancer-associated fibroblasts (CAFs) inside the tumor stroma. Microscopic examination indicates that αSMA expression is not confined to the tumor stromal compartment but is also present in a subset of tumor cells, and this expression correlates with an enhanced invasive phenotype of malignant cells from lung, liver, or ovarian malignancies. Information on actin expression in breast cancer (BC) cells is scarce, and its influence on clinicopathological characteristics remains ambiguous due to conflicting findings in the literature.

OBJECTIVE

To examine the αSMA tumor score in breast cancer cells utilizing digital image analysis (DIA) methodologies and to critically analyze the varying effects of αSMA tumor score values on clinicopathologic parameters, particularly focusing on tumor cell invasiveness, recurrence, and survival.

MATERIALS AND METHODS

Double immunostaining for CD34 and αSMA was conducted on 53 breast cancer cases that were thoroughly characterized in relation to clinicopathologic data. Double immunostaining for CD34 and αSMA demonstrated different distribution patterns of both markers in normal and breast cancer tissues. DIA data about αSMA tumor cell density, intensity, tumor score, and histological score were correlated with clinicopathological factors.

RESULTS

We delineated three unique breast cancer subgroups based on αSMA tumor scores: a 9.43% low-expressing subgroup (αSMA_TSlow, score 4), a 35.07% medium-expressing subgroup (αSMA_TSmed, scores 5 and 6), and a 55.5% high-expressing subgroup (αSMA_TShigh, scores 7 and 8). Stromal immature vessels and tertiary lymphoid structures (TLS) exhibited a strong correlation with αSMA_TSlow, whereas recurrence, perineural, and lymphovascular invasion strongly influenced the αSMA_TSmed and αSMA_TShigh subgroups. The αSMA_TSmed subgroup demonstrated the most heterogeneity with the influence of αSMA-expressing breast cancer cells on tumor size, nodal status, perineural and lymphovascular invasion, menopausal status, recurrence, and survival. Most of the cases from the αSMA_TSlow subgroup had Luminal B and Luminal B-HER2 phenotypes, while triple-negative breast cancer (TNBC) represented one-third of all cases in the αSMA_TShigh subgroup.

CONCLUSION

αSMA-expressing breast cancer cells variably affect malignant growth, invasion, and recurrence, highly contingent upon their density and expression intensity. The current investigation identified an αSMA_TSmed BC subgroup that appears to promote invasiveness, recurrence, and survival in breast cancer. Our data indicate that αSMA BC-expressing cells play a dual role in BC progression, contingent upon their percentage and expression intensity; however, further research is required to elucidate the factors and mechanisms responsible for their accumulation and/or transdifferentiation in malignant breast tissue.

Comparison of Clinicopathological Features of Pleomorphic and Invasive Lobular Breast Carcinomas

PURPOSE

Accounting for about 15% of invasive lobular carcinomas and 1% of breast carcinomas, pleomorphic lobular carcinoma is known to be a rare histological subtype of invasive lobular carcinoma. Yet, it is more aggressive and produces a worse prognosis than other breast cancers. Ultimately, the present study compares the clinicopathological features of pleomorphic and invasive lobular breast carcinomas.

METHODS

In the study, we retrospectively evaluated the data of 262 patients with histological subtypes of classical and pleomorphic lobular cancers having been recruited for surgical operations. After resorting to Kolmogorov-Smirnov and Shapiro-Wilk tests to check the normality of distribution, the categorical and continuous variables were compared between the groups using the chi-square test and independent samples t test, respectively. In all analyses, we considered a P-value of <.05 to be statistically significant.

RESULTS

Our findings revealed that the groups with lobular and pleomorphic groups significantly differed by Ki-67 value, estrogen receptor negativity, grade, multicentricity, multifocality, surgical margin positivity, completion mastectomy, and metachronous contralateral tumor (P < .05).

CONCLUSION

We discovered that pleomorphic type was associated with higher grades, estrogen receptor negativity, and Ki-67 expression. The incidence of metachronous breast cancer was high in the pleomorphic group, which may be a noteworthy finding to be considered in follow-ups. In addition, the high rates of multicentricity and multifocality of tumors in the pleomorphic group may be associated with increased surgical margin positivity and a higher likelihood of mastectomy. In a nutshell, our findings may guide patients and surgeons regarding the type of intervention and reconstruction options to be adopted in prospective surgeries.