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Djerroudi L, El Sabeh-Ayoun A, Benoist C, Pierron G, Masliah-Planchon J, Fuhrmann L, Kieffer Y, Carton M, Ramtohul T, Callens C, Renault V, Bidard FC, Mechta-Grigoriou F, Vincent-Salomon A. Molecular and Clinical Portrait of HER2-low Invasive Lobular Carcinomas. Mod Pathol 2024; 37:100463. [PMID: 38428737 DOI: 10.1016/j.modpat.2024.100463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
Invasive lobular carcinomas (ILCs) have a low frequency of ERBB2 amplification, therefore restricting the use of conventional anti-HER2 therapies for this histologic special type. Conversely, ILCs with low HER2 overexpression may represent a broader target for the use of emerging antibody drug conjugate therapies targeting HER2, since these treatments have proven effective in HER2-low breast cancers. Very scarce data about HER2-low ILCs have been so far published, although these tumors could have different prevalence and histomolecular specificities compared with invasive breast carcinoma of no special type (IBC-NST). Our aims in that context were to decipher the clinicopathological and molecular features of a large series of HER2-low ILCs. Comparative evaluation of HER2-low prevalence was done based on a retrospective series of 7970 patients from Institut Curie, with either primary invasive lobular (N = 1103) or no special type (N = 6867) invasive carcinoma. Clinicopathological and molecular analyses of HER2-zero, HER2-low, and HER2-positive ILCs were performed on a subgroup of 251 patients who underwent surgery for a primary ILC between 2005 and 2008. The mutational profile of these 251 cases was determined from RNAseq data. Compared with HER2-negative IBC-NSTs, the HER2-negative ILCs were found to display a higher frequency of HER2-zero cases (59.4% vs 53.7%) and a lower frequency of HER2-low (40.6% vs 46.3%) (P < .001). Clinicopathological features associated with HER2-low status (vs HER2-zero) in ILC were older age, postmenopausal status, nonclassic ILC histological types, higher grade, proliferation, and estrogen receptor expression levels. Survival curve analysis showed a significantly lower risk of local recurrence for HER2-low (vs HER2-zero) ILCs, but no association was found between HER2 status and either breast cancer-specific survival or distant metastasis-free interval. ERBB3 was the unique mutated gene exclusively associated with HER2-low ILCs yet being mutated at a low frequency (7.1%) (false discovery rate < 0.05). In conclusion, HER2-low ILCs exhibit their own particularities, both on clinical-pathological and molecular levels. Our findings call for larger multicenter validation studies.
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MESH Headings
- Humans
- Female
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/therapy
- Carcinoma, Lobular/drug therapy
- Receptor, ErbB-2/genetics
- Receptor, ErbB-2/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/genetics
- Breast Neoplasms/therapy
- Middle Aged
- Aged
- Retrospective Studies
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/analysis
- Adult
- Mutation
- Aged, 80 and over
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Affiliation(s)
- Lounes Djerroudi
- Institut Curie, PSL University, Department of Diagnostic and Theranostic Medicine, Paris, France; Institut Curie, Stress and Cancer laboratory, Inserm U830, PSL University, Paris, France.
| | - Ahmad El Sabeh-Ayoun
- Institut Curie, PSL University, Department of Diagnostic and Theranostic Medicine, Paris, France
| | - Camille Benoist
- Institut Curie, PSL University, Clinical Bioinformatics, Paris, France
| | - Gaelle Pierron
- Institut Curie, PSL University, Department of Diagnostic and Theranostic Medicine, Paris, France
| | - Julien Masliah-Planchon
- Institut Curie, PSL University, Department of Diagnostic and Theranostic Medicine, Paris, France
| | - Laetitia Fuhrmann
- Institut Curie, PSL University, Department of Diagnostic and Theranostic Medicine, Paris, France
| | - Yann Kieffer
- Institut Curie, Stress and Cancer laboratory, Inserm U830, PSL University, Paris, France
| | - Matthieu Carton
- Department of Statistics, Institut Curie, PSL University, Paris, France
| | - Toulsie Ramtohul
- Department of Radiology, Institut Curie, PSL University, Paris, France
| | - Celine Callens
- Institut Curie, PSL University, Department of Diagnostic and Theranostic Medicine, Paris, France
| | - Victor Renault
- Institut Curie, PSL University, Clinical Bioinformatics, Paris, France
| | - François-Clément Bidard
- Department of Medical Oncology, Institut Curie, Université Versailles Saint Quentin, Saint Cloud, France
| | | | - Anne Vincent-Salomon
- Institut Curie, PSL University, Department of Diagnostic and Theranostic Medicine, Paris, France
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Pouptsis A, Cano Gimeno J, Martinez Rubio C, Bañuls Marrades M, Olivan Sasot P. Metastatic Occult Primary Lobular Breast Cancer: A Case Report. Cureus 2024; 16:e58586. [PMID: 38689671 PMCID: PMC11057946 DOI: 10.7759/cureus.58586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
Breast cancer is the most common malignancy diagnosed in women. Invasive lobular breast cancer (ILC) is the second most common histologic subtype after invasive ductal carcinoma. Metastatic occult primary breast cancer, although rare, is a well-known clinical entity that usually presents with axillary lymphadenopathy without a detectable breast tumour. A perimenopausal woman in her 50s presented with abdominal pain, fatigue, and weight loss. Imaging showed peritoneal carcinomatosis with ascites, ovarian masses, and a lesion in the ascending colon. Gastric and colon biopsies showed infiltration from lobular breast cancer. Diagnostic workup, including mammography, breast ultrasound, and breast MRI, showed no evidence of breast pathology or axillary lymphadenopathy. First-line treatment with goserelin, letrozole, and palbociclib commenced with clinical improvement and radiological response. This case illustrates the challenges faced by clinicians in the diagnosis and treatment of lobular breast cancer without an identifiable primary lesion or axillary lymphadenopathy.
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Affiliation(s)
- Athanasios Pouptsis
- Department of Medical Oncology, Hospital Universitario de la Ribera, Valencia, ESP
| | - Julia Cano Gimeno
- Department of Radiology, Hospital Universitario de la Ribera, Valencia, ESP
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Liu C, Ma G, Xu X, Song S, Yang Z. Can 18F-FES PET Improve the Evaluation of 18F-FDG PET in Patients With Metastatic Invasive Lobular Carcinoma? Clin Nucl Med 2024; 49:301-307. [PMID: 38427956 DOI: 10.1097/rlu.0000000000005085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
PURPOSE Invasive lobular carcinoma (ILC) exhibits a low affinity for 18F-FDG. The estrogen receptor (ER) is commonly expressed in ILCs, suggesting a potential benefit of targeting with the ER probe 18F-FES in this patient population. The objective of this study was to evaluate the diagnostic performance of 18F-FES imaging in patients with metastatic ILC and compare it with that of 18F-FDG. METHODS We conducted a retrospective analysis of 20 ILC patients who underwent concurrent 18F-FES and 18F-FDG PET/CT examinations in our center. 18F-FES and 18F-FDG imaging were analyzed to determine the total count of tracer-avid lesions in nonbone sites and their corresponding organ systems, assess the extent of anatomical regions involved in bone metastases, and measure the SUVmax values for both tracers. RESULTS Among 20 ILC patients, 65 nonbone lesions were found to be distributed in 13 patients, and 16 patients were diagnosed with bone metastasis, which was distributed in 54 skeletal anatomical regions. The detection rate of 18F-FDG in nonbone lesions was higher than that of 18F-FES (57 vs 37, P < 0.001). 18F-FES demonstrated a superior ability to detect nonbone lesions in 4 patients, whereas 18F-FDG was superior in 5 patients (P > 0.05). Among 9/16 patients with bone metastasis, 18F-FES demonstrated a significant advantage in the detection of bone lesions compared with 18F-FDG (P = 0.05). Furthermore, patients with only 18F-FES-positive lesions (12/12) were administered endocrine regimens, whereas patients lacking 18F-FES uptake (2/3) predominantly received chemotherapy. CONCLUSIONS 18F-FES is more effective than 18F-FDG in detecting bone metastasis in ILC, but it does not demonstrate a significant advantage in nonbone lesions. Additionally, the results of examination with 18F-FES have the potential to guide patient treatment plans.
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Cavaller L, Goupille C, Arbion F, Vilde A, Body G, Ouldamer L. Metastatic profiles and survival differences between infiltrating ductal carcinoma and infiltrating lobular carcinoma in invasive breast cancer. J Gynecol Obstet Hum Reprod 2024; 53:102740. [PMID: 38311000 DOI: 10.1016/j.jogoh.2024.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND In this study, we conducted a comprehensive evaluation of metastatic profiles and survival outcomes in patients with infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma (ILC) treated at our university hospital center. METHODS We collected and analyzed data from all patients diagnosed with invasive breast cancer at our center between January 1, 2007, and 31 December 2014. We specifically compared three subgroups: patients with IDC, patients with ILC and patients with mixed carcinoma, which is a combination of IDC and ILC. RESULTS Among the 1963 patients treated for invasive breast cancer in our center during the study period, 1435 had IDC, 466 had ILC, and 59 had mixed carcinoma. The incidence of patients with at least one positive axillary lymph node differed significantly: 40 % for IDC, 36 % for ILC, and 45 % for mixed carcinoma (p = 0.001). However, there was no significant difference in the mean number of positive nodes (p = 0.1633). The occurrence of distant metastases was lower in patients with ILC (p = 0.04), particularly in the case of brain metastases (p = 0.01), although there was no difference in bone or visceral metastatic sites. Patients with ILC exhibited a longer mean time to metastasis from the initial diagnosis of invasive breast carcinoma. Overall survival (p = 0.0525) and survival without locoregional recurrence (p = 0.026) were significantly different. Specifically, the 5-year overall survival rates for IDC, ILC, and mixed carcinoma were approximately 95 %. Distance metastatic-free survival at 5 years was 85 % for IDC, 91 % for ILC, and 87 % for mixed carcinoma (p = 0.00506). CONCLUSION Our findings indicate variations in the distribution of distant metastatic sites among patients with IDC, ILC, and mixed carcinoma, as well as differences in survival outcomes. This study sheds light on the unique characteristics and clinical implications associated with these two distinct subtypes of invasive breast cancer.
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Affiliation(s)
- L Cavaller
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France
| | - C Goupille
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit, 1069 Tours, France
| | - F Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - A Vilde
- Department of Radiology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit, 1069 Tours, France
| | - L Ouldamer
- Department of Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044 Tours, France; François-Rabelais University, Tours, France; INSERM unit, 1069 Tours, France.
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Van Baelen K, Van Cauwenberge J, Maetens M, Beck G, Camden A, Chase MC, Fraser V, Freeney S, Hutcheson L, Levine JK, Lien T, Terveer R, Turner C, Senkus E, Jankowitz RC, Vandecaveye V, Floris G, Neven P, Wildiers H, Sawyer E, Vincent-Salomon A, Derksen PWB, Desmedt C. Reporting on invasive lobular breast cancer in clinical trials: a systematic review. NPJ Breast Cancer 2024; 10:23. [PMID: 38509112 PMCID: PMC10954721 DOI: 10.1038/s41523-024-00627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
Invasive lobular breast cancer (ILC) differs from invasive breast cancer of no special type in many ways. Evidence on treatment efficacy for ILC is, however, lacking. We studied the degree of documentation and representation of ILC in phase III/IV clinical trials for novel breast cancer treatments. Trials were identified on Pubmed and clinicaltrials.gov. Inclusion/exclusion criteria were reviewed for requirements on histological subtype and tumor measurability. Documentation of ILC was assessed and ILC inclusion rate, central pathology and subgroup analyses were evaluated. Inclusion restrictions concerning tumor measurability were found in 39/93 manuscripts. Inclusion rates for ILC were documented in 13/93 manuscripts and varied between 2.0 and 26.0%. No central pathology for ILC was reported and 3/13 manuscripts had ILC sub-analyses. ILC is largely disregarded in most trials with poor representation and documentation. The current inclusion criteria using RECIST v1.1, fall short in recognizing the unique non-measurable metastatic infiltration of ILC.
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Affiliation(s)
- Karen Van Baelen
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Josephine Van Cauwenberge
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Marion Maetens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Gabriela Beck
- European Lobular Breast Cancer Consortium, Utrecht, the Netherlands
| | - Ann Camden
- Lobular Breast Cancer Alliance inc., Plymouth, MA, USA
| | | | | | - Siobhan Freeney
- European Lobular Breast Cancer Consortium, Utrecht, the Netherlands
- Lobular Ireland, Dublin, Ireland
| | | | | | - Tone Lien
- European Lobular Breast Cancer Consortium, Utrecht, the Netherlands
| | - Rian Terveer
- European Lobular Breast Cancer Consortium, Utrecht, the Netherlands
- Borstkankervereniging Nederland, Utrecht, the Netherlands
| | - Claire Turner
- European Lobular Breast Cancer Consortium, Utrecht, the Netherlands
- Lobular Breast Cancer UK, Manchester, UK
| | - Elzbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Rachel C Jankowitz
- Division of Hematology/Oncology, Abramsom Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Division of Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Elinor Sawyer
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, Guy's Cancer Centre, King's College London, London, UK
| | - Anne Vincent-Salomon
- Department of Pathology, Institut Curie, Paris Sciences Lettres University, Paris, France
| | - Patrick W B Derksen
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium.
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6
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Cheng M, Jia Z, Zhang G, Wang Y, Li S, Yang S, Li C, Geng C. Gastric metastasis from breast cancer: five cases and a single-institutional review. J Int Med Res 2024; 52:3000605241233988. [PMID: 38483129 PMCID: PMC10943725 DOI: 10.1177/03000605241233988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/29/2024] [Indexed: 03/18/2024] Open
Abstract
Gastric metastasis from breast cancer has a high rate of misdiagnosis and missed diagnosis. Data of patients who had gastric metastasis from breast cancer were retrieved from our hospital between 2014 and 2020. The gastric metastasis from breast cancer incidence was 0.04% (5/14,169 cases of breast cancer). Four patients had invasive lobular carcinoma, and the other patient had invasive ductal carcinoma. The time from the initial diagnosis of breast cancer to the appearance of gastric metastasis ranged from 0 to 12 years. One patient's endoscopic presentation was similar to mucosal-associated lymphoid tissue lymphoma and presented with gastric mucosal congestion and edema, widened wrinkles, mixed color fading, and redness. The initial pathological diagnosis of this patient was mucosal-associated lymphoid tissue lymphoma, and breast cancer was finally confirmed by immunohistochemistry. Hormonal receptors were highly expressed in four patients with primary and metastasis lesions and were negative in one patient. Human epidermal growth factor receptor 2 was negative in all patients. Mammaglobin and GATA3 were positive in all patients. In conclusion, the gastric metastasis of breast cancer incidence rate is low, and misdiagnosis can lead to insufficient or excessive treatment. Multiple biopsies and immunohistochemistry should be performed to diagnose gastric metastasis of breast cancer.
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Affiliation(s)
- Meng Cheng
- Breast Center, The 4th Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
- Key Laboratory in Hebei Province for Molecular Medicine of Breast Cancer, Shijiazhuang, Hebei Province, P.R. China
| | - Zhanli Jia
- Pathology Department, The 4th Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Guoyu Zhang
- Breast Center, The 4th Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Yingnan Wang
- Gastroenterology Department, The 4th Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Sainan Li
- Breast Center, The 4th Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
- Key Laboratory in Hebei Province for Molecular Medicine of Breast Cancer, Shijiazhuang, Hebei Province, P.R. China
| | - Shan Yang
- Breast Center, The 4th Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
- Key Laboratory in Hebei Province for Molecular Medicine of Breast Cancer, Shijiazhuang, Hebei Province, P.R. China
| | - Chunxiao Li
- Breast Center, The 4th Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
| | - Cuizhi Geng
- Breast Center, The 4th Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China
- Key Laboratory in Hebei Province for Molecular Medicine of Breast Cancer, Shijiazhuang, Hebei Province, P.R. China
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Gronewold M, Grote I, Bartels S, Christgen H, Kandt LD, Brito MJ, Cserni G, Daemmrich ME, Fogt F, Helmke BM, ter Hoeve N, Lang‐Schwarz C, Vieth M, Wellmann A, Kuehnle E, Kulik U, Riedel G, Reineke‐Plaass T, Lehmann U, Koorman T, Derksen PWB, Kreipe H, Christgen M. Microenvironment-induced restoration of cohesive growth associated with focal activation of P-cadherin expression in lobular breast carcinoma metastatic to the colon. J Pathol Clin Res 2024; 10:e12361. [PMID: 38618992 PMCID: PMC10796744 DOI: 10.1002/2056-4538.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 04/16/2024]
Abstract
Invasive lobular carcinoma (ILC) is a special breast cancer type characterized by noncohesive growth and E-cadherin loss. Focal activation of P-cadherin expression in tumor cells that are deficient for E-cadherin occurs in a subset of ILCs. Switching from an E-cadherin deficient to P-cadherin proficient status (EPS) partially restores cell-cell adhesion leading to the formation of cohesive tubular elements. It is unknown what conditions control EPS. Here, we report on EPS in ILC metastases in the large bowel. We reviewed endoscopic colon biopsies and colectomy specimens from a 52-year-old female (index patient) and of 18 additional patients (reference series) diagnosed with metastatic ILC in the colon. EPS was assessed by immunohistochemistry for E-cadherin and P-cadherin. CDH1/E-cadherin mutations were determined by next-generation sequencing. The index patient's colectomy showed transmural metastatic ILC harboring a CDH1/E-cadherin p.Q610* mutation. ILC cells displayed different growth patterns in different anatomic layers of the colon wall. In the tunica muscularis propria and the tela submucosa, ILC cells featured noncohesive growth and were E-cadherin-negative and P-cadherin-negative. However, ILC cells invading the mucosa formed cohesive tubular elements in the intercryptal stroma of the lamina propria mucosae. Inter-cryptal ILC cells switched to a P-cadherin-positive phenotype in this microenvironmental niche. In the reference series, colon mucosa infiltration was evident in 13 of 18 patients, one of which showed intercryptal EPS and conversion to cohesive growth as described in the index patient. The large bowel is a common metastatic site in ILC. In endoscopic colon biopsies, the typical noncohesive growth of ILC may be concealed by microenvironment-induced EPS and conversion to cohesive growth.
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Affiliation(s)
- Malte Gronewold
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | - Isabel Grote
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | - Stephan Bartels
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | | | - Leonie D Kandt
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | | | - Gàbor Cserni
- Department of PathologyUniversity of SzegedSzegedHungary
| | | | - Franz Fogt
- Pennsylvania Hospital – Penn Pathology and Laboratory MedicinePhiladelphiaPAUSA
| | | | - Natalie ter Hoeve
- Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Michael Vieth
- Klinikum Bayreuth – Institut für PathologieBayreuthGermany
| | | | - Elna Kuehnle
- Clinic for Obstetrics and Gynecology the NeonatologyHannover Medical SchoolHannoverGermany
| | - Ulf Kulik
- Department of General, Visceral, and Transplant SurgeryHannover Medical SchoolHannoverGermany
| | - Gesa Riedel
- Department of Immunology and RheumatologyHannover Medical SchoolHannoverGermany
| | | | - Ulrich Lehmann
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | - Thijs Koorman
- Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Patrick WB Derksen
- Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Hans Kreipe
- Institute of PathologyHannover Medical SchoolHannoverGermany
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Rodrigues Alves N, Duarte AF, Ribeiro DF, Silva RS, Carvalho BA, Alpuim Costa D. Successful management of bilateral orbital metastases from invasive lobular breast cancer with abemaciclib and letrozole: a case report and literature review. Front Oncol 2024; 14:1286910. [PMID: 38322413 PMCID: PMC10845133 DOI: 10.3389/fonc.2024.1286910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
Breast cancer is a significant global health concern, contributing to substantial morbidity and mortality among women. Hormone receptor-positive (HR+)/HER2-negative (HER2-) breast cancer constitutes a considerable proportion of cases, and significant advancements have been made in its management. CDK4/6 inhibitors (CDK4/6is) are a new targeted therapy that has demonstrated efficacy in adjuvant, advanced and metastatic settings. The propensity of lobular breast carcinomas for estrogen-rich sites, such as periocular tissues and orbital fat, may explain their tendency for orbital metastases. Current treatment strategies for these cases are predominantly palliative, and the prognosis remains poor. This article presents a unique case of a 51-year-old female with progressive right periorbital edema, pain, and limited ocular motility. An imaging work-up showed bilateral intra and extraconal orbital infiltration, which was biopsied. The histopathologic analysis disclosed mild chronic inflammatory infiltrate with thickened fibrous tissue and moderately differentiated lobular carcinoma cells, positive for GATA3 and CK7 markers, with 100% of tumor nuclei expressing estrogen receptors (ER+). A systemic evaluation showed a multicentric nodular formation in both breasts. Further diagnostic assessments unveiled an HR+/HER2- bilateral lobular breast carcinoma with synchronous bilateral orbital metastases. Systemic treatment was initiated with abemaciclib 150mg twice daily and letrozole 2.5mg once a day. However, this regimen was interrupted due to toxicity. After two weeks, treatment was resumed with a reduced abemaciclib dose (100mg twice daily) alongside letrozole, with a reasonable tolerance. Nearly two years after the initial diagnosis of inoperable metastatic cancer, the patient remains on the same systemic treatment regimen with no signs of invasive disease. This case report is the first of a patient presenting with bilateral orbital metastases from bilateral lobular breast cancer, showing an impressive and sustained response to a first-line treatment regimen combining abemaciclib and letrozole. A literature review on bilateral orbital metastases from breast cancer is also presented.
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Affiliation(s)
- Nuno Rodrigues Alves
- Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- Department of Ophthalmology, Unidade Local de Saúde de São José, Lisbon, Portugal
| | - Ana Filipa Duarte
- Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- Department of Ophthalmology, Unidade Local de Saúde de São José, Lisbon, Portugal
- Department of Ophthalmology, Hospital CUF Descobertas, Lisbon, Portugal
| | | | - Rita Sousa Silva
- Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- Department of Ophthalmology, Unidade Local de Saúde de São José, Lisbon, Portugal
- Department of Ophthalmology, Hospital Lusíadas de Lisboa, Lisbon, Portugal
| | - Bruno Almeida Carvalho
- Department of Ophthalmology, Hospital CUF Descobertas, Lisbon, Portugal
- Deparment of Ophthalmology, Clínica de São João de Deus, Lisbon, Portugal
| | - Diogo Alpuim Costa
- Department of Haematology and Oncology, CUF Oncologia, Lisbon, Portugal
- Department of Medical Oncology, Hospital de Cascais, Cascais, Portugal
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
- Department of Medical Oncology, AIM Cancer Center, Lisbon, Portugal
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Sasaki A, Masuda S, Yoshioka T, Saito A, Motomura Y. Therapeutic Effects of CDK4/6 Inhibitors in Gastric and Colonic Metastases From Breast Cancer: A Case Report. Cureus 2024; 16:e52765. [PMID: 38389643 PMCID: PMC10882214 DOI: 10.7759/cureus.52765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Breast cancer often metastasizes to the lungs, bones, liver, and brain; however, gastric and colonic metastases from breast cancer are rare. Nevertheless, here, we present the case of a 50-year-old woman diagnosed with recurrent breast cancer, exhibiting gastric and colonic metastases that were detected when she experienced intermittent abdominal pain. The differentiation between primary gastric cancer and metastasis from breast cancer was made through immunohistochemical staining. The patient underwent treatment with palbociclib, a cyclin-dependent kinase (CDK)4/6 inhibitor, and anastrozole, with no significant adverse effects. Subsequent upper and lower endoscopic examinations following the initiation of these treatments revealed tumor shrinkage in both gastric and colonic metastases. This case report presents the first instance in which morphological changes in gastrointestinal metastasis induced by CDK4/6 inhibitors could be evaluated.
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Affiliation(s)
- Akinori Sasaki
- Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
| | - Shuko Masuda
- Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
| | - Tsubasa Yoshioka
- Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
| | - Akira Saito
- Pathology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
| | - Yasuaki Motomura
- Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
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10
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Batra H, Mouabbi JA, Ding Q, Sahin AA, Raso MG. Lobular Carcinoma of the Breast: A Comprehensive Review with Translational Insights. Cancers (Basel) 2023; 15:5491. [PMID: 38001750 PMCID: PMC10670219 DOI: 10.3390/cancers15225491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
The second most common breast carcinoma, invasive lobular carcinoma, accounts for approximately 15% of tumors of breast origin. Its incidence has increased in recent times due in part to hormone replacement therapy and improvement in diagnostic modalities. Although believed to arise from the same cell type as their ductal counterpart, invasive lobular carcinomas (ILCs) are a distinct entity with different regulating genetic pathways, characteristic histologies, and different biology. The features most unique to lobular carcinomas include loss of E-Cadherin leading to discohesion and formation of a characteristic single file pattern on histology. Because most of these tumors exhibit estrogen receptor positivity and Her2 neu negativity, endocrine therapy has predominated to treat these tumors. However novel treatments like CDK4/6 inhibitors have shown importance and antibody drug conjugates may be instrumental considering newer categories of Her 2 Low breast tumors. In this narrative review, we explore multiple pathological aspects and translational features of this unique entity. In addition, due to advancement in technologies like spatial transcriptomics and other hi-plex technologies, we have tried to enlist upon the characteristics of the tumor microenvironment and the latest associated findings to better understand the new prospective therapeutic options in the current era of personalized treatment.
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Affiliation(s)
- Harsh Batra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Jason Aboudi Mouabbi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Qingqing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Q.D.); (A.A.S.)
| | - Aysegul A. Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Q.D.); (A.A.S.)
| | - Maria Gabriela Raso
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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11
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Danzinger S, Pöckl K, Kronawetter G, Pfeifer C, Behrendt S, Gscheidlinger P, Harrasser L, Mühlböck H, Dirschlmayer W, Schauer C, Reitsamer R, Uher H, Schönau K, Delmarko I, Singer CF. Axillary lymph node status and invasive lobular breast cancer : Analysis of the Clinical Tumor Register of the AGO Austria. Wien Klin Wochenschr 2023; 135:463-471. [PMID: 37010596 PMCID: PMC10497662 DOI: 10.1007/s00508-023-02162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/10/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) represents the second most common type of invasive breast cancer (BC). Although ILC generally have good prognostic properties (positive estrogen receptor, ER, low tumor grade), they are generally diagnosed at a more advanced stage. The data on the axillary lymph node status in ILC compared to invasive ductal carcinoma (IDC) are considered controversial. Therefore, the aim of this study was to compare the pathological node stage (pN) between ILC and IDC in an Austria-wide register. METHODS Data of the Clinical Tumor Register (Klinisches TumorRegister, KTR) of the Austrian Association for Gynecological Oncology (AGO) were retrospectively analyzed. Patients with primary early BC, invasive lobular or ductal, diagnosed between January 2014 and December 2018, and primary surgery were included. A total of 2127 tumors were evaluated and compared in 2 groups, ILC n = 303, IDC n = 1824. RESULTS A total of 2095 patients were analyzed in the study. In the multivariate analysis, pN2 and pN3 were observed significantly more frequently in ILC compared with IDC (odds ratio, OR 1.93; 95% confidence interval, CI 1.19-3.14; p = 0.008 and OR 3.22; 95% CI: 1.47-7.03; p = 0.003; respectively). Other factors associated with ILC were tumor grades 2 and 3, positive ER, and pathological tumor stage (pT) 2 and pT3. In contrast, concomitant ductal carcinoma in situ, overexpression of the human epidermal growth factor receptor 2 (HER2), and a moderate and high proliferation rate (Ki67) were found less frequently in ILC. CONCLUSION The data show an increased risk of extensive axillary lymph node metastasis (pN2/3) in ILC.
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Affiliation(s)
- Sabine Danzinger
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Karin Pöckl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Gerit Kronawetter
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christian Pfeifer
- Department of Statistics, University of Innsbruck, Innsbruck, Austria
| | - Sandra Behrendt
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Patricia Gscheidlinger
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Lois Harrasser
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Helmut Mühlböck
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Walter Dirschlmayer
- Department of Obstetrics and Gynecology, Hospital Barmherzige Schwestern Ried, Ried im Innkreis, Austria
| | - Christian Schauer
- Department of Gynecology, Hospital Barmherzige Brüder Graz, Graz, Austria
| | - Roland Reitsamer
- Department of Gynecology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus Salzburg, Salzburg, Austria
| | - Heidemarie Uher
- Department of Surgery, Breast Health Center, Hospital Landstraße, Vienna, Austria
| | - Kristina Schönau
- Department of General, Visceral and Tumor Surgery, Breast Health Center, Hospital Ottakring, Vienna, Austria
| | - Irmgard Delmarko
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Christian F. Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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12
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Cosar R, Sut N, Topaloglu S, Tastekin E, Nurlu D, Ozler T, Şenödeyici E, Dedeli M, Chousein M, Cicin I. Classifying invasive lobular carcinoma as special type breast cancer may be reducing its treatment success: A comparison of survival among invasive lobular carcinoma, invasive ductal carcinoma, and no-lobular special type breast cancer. PLoS One 2023; 18:e0283445. [PMID: 37428725 DOI: 10.1371/journal.pone.0283445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/08/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE The literature contains different information about the prognosis of invasive lobular carcinoma of breast cancer (BC). We aimed to address the inconsistency by comparatively examining the clinical features and prognosis of invasive lobular carcinoma patients in our university and to report our experience by dividing our patients into various subgroups. PATIENTS AND METHODS Records of patients with BC admitted to Trakya University School of Medicine Department of Oncology between July 1999 and December 2021 were reviewed. The patients were divided into three groups (No-Special Type BC, Invasive Lobular Special Type BC, No-Lobular Special Type BC). Patient characteristics, treatment methods and oncological results are presented. Survival curves were generated using the Kaplan-Meier method. Statistical significance of survival among the selected variables was compared by using the log-rank test. RESULTS The patients in our study consisted of 2142 female and 15 male BC patients. There were 1814 patients with No-Special Type BC, 193 patients with Invasive Lobular Special Type BC, and 150 patients with No-Lobular Special Type BC. The duration of disease-free survival (DFS) was 226.5 months for the No-Special Type BC group, 216.7 months for the No-Lobular Special Type BC group, and 197.2 months for the Invasive Lobular Special Type BC group, whereas the duration of overall survival (OS) was 233.2 months for the No-Special Type BC group, 227.9 for the No-Lobular Special Type BC group, and 209.8 for the Invasive Lobular Special Type BC group. The duration of both DFS and OS was the lowest in the Invasive Lobular Special Type BC group. Multivariate factors that were significant risk factors for OS were Invasive Lobular Special Type BC histopathology (p = .045), T stage, N stage, stage, skin infiltration, positive surgical margins, high histological grade, and mitotic index. Modified radical mastectomy, chemotherapy, radiotherapy and use of tamoxifen and aromatase inhibitors for more than 5 years were significant protective factors for overall survival. CONCLUSION The histopathological subgroup with the worst prognosis in our study was Invasive Lobular Special Type BC. Duration of DFS and OS were significantly shorter in Invasive Lobular Special Type BC than No-Lobular Special Type BC group. The classification of Invasive Lobular BC under the title of Special Type BC should be reconsidered and a more accurate treatment and follow-up process may be required.
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Affiliation(s)
- Rusen Cosar
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Necdet Sut
- Department of Biostatistics, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Sernaz Topaloglu
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Ebru Tastekin
- Department of Pathology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Dilek Nurlu
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Talar Ozler
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | | | - Melisa Dedeli
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mert Chousein
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Irfan Cicin
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
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13
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Joshi U, Budhathoki P, Gaire S, Yadav SK, Shah A, Adhikari A, Choong G, Couzi R, Giridhar KV, Leon-Ferre RA, Boughey JC, Hieken TJ, Mutter R, Ruddy KJ, Haddad TC, Goetz MP, Couch FJ, Yadav S. Clinical outcomes and prognostic factors in triple-negative invasive lobular carcinoma of the breast. Breast Cancer Res Treat 2023; 200:217-224. [PMID: 37210429 PMCID: PMC10782581 DOI: 10.1007/s10549-023-06959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/21/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE Triple-negative invasive lobular carcinoma (TN-ILC) of breast cancer is a rare disease and the clinical outcomes and prognostic factors are not well-defined. METHODS Women with stage I-III TN-ILC or triple-negative invasive ductal carcinoma (TN-IDC) of the breast undergoing mastectomy or breast-conserving surgery between 2010 and 2018 in the National Cancer Database were included. Kaplan-Meier curves and multivariate Cox proportional hazard regression were used to compare overall survival (OS) and evaluate prognostic factors. Multivariate logistic regression was performed to analyze the factors associated with pathological response to neoadjuvant chemotherapy. RESULTS The median age at diagnosis for women with TN-ILC was 67 years compared to 58 years in TN-IDC (p < 0.001). There was no significant difference in the OS between TN-ILC and TN-IDC in multivariate analysis (HR 0.96, p = 0.44). Black race and higher TNM stage were associated with worse OS, whereas receipt of chemotherapy or radiation was associated with better OS in TN-ILC. Among women with TN-ILC receiving neoadjuvant chemotherapy, the 5-year OS was 77.3% in women with a complete pathological response (pCR) compared to 39.8% in women without any response. The odds of achieving pCR following neoadjuvant chemotherapy were significantly lower in women with TN-ILC compared to TN-IDC (OR 0.53, p < 0.001). CONCLUSION Women with TN-ILC are older at diagnosis but have similar OS compared to TN-IDC after adjusting for tumor and demographic characteristics. Administration of chemotherapy was associated with improved OS in TN-ILC, but women with TN-ILC were less likely to achieve complete response to neoadjuvant therapy compared to TN-IDC.
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Affiliation(s)
- Utsav Joshi
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Pravash Budhathoki
- Department of Internal Medicine, Bronxcare Health System, Bronx, NY, 10457, USA
| | - Suman Gaire
- Department of Internal Medicine, Mount Sinai Hospital Chicago, Chicago, IL, 60608, USA
| | - Sumeet K Yadav
- Department of Hospital Internal Medicine, Mayo Clinic, Mankato, MN, 56001, USA
| | - Anish Shah
- Department of Internal Medicine, Bronxcare Health System, Bronx, NY, 10457, USA
| | - Anurag Adhikari
- Department of Internal Medicine, Jacobi Medical Center, New York, NY, 10461, USA
| | - Grace Choong
- Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rima Couzi
- Department of Oncology, Johns Hopkins Hospital, Baltimore, MD, 21231, USA
| | | | | | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Tina J Hieken
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robert Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Tufia C Haddad
- Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Matthew P Goetz
- Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
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Chang‐Chieh L, Yen‐Chuan O, Min‐Che T, Wei‐Shiang H, Tang‐Yi T, Chao‐Yu H. Urinary bladder metastasis from suspected second primary breast cancer presenting with ambiguous lower urinary tract symptoms: A case report and literature review. Clin Case Rep 2023; 11:e7615. [PMID: 37384235 PMCID: PMC10293581 DOI: 10.1002/ccr3.7615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
Common urinary symptoms may arise from metastases from uncommon sites. In patients with a history of cancer, the focus should be on the currently affected organ and the status of the underlying malignancy.
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Affiliation(s)
- Liao Chang‐Chieh
- Department of Medical EducationTungs' Taichung Metro Harbor HospitalTaichung CityTaiwan, ROC
| | - Ou Yen‐Chuan
- Division of Urology, Department of SurgeryTungs' Taichung Metro Harbor HospitalTaichung CityTaiwan, ROC
| | - Tung Min‐Che
- Division of Urology, Department of SurgeryTungs' Taichung Metro Harbor HospitalTaichung CityTaiwan, ROC
| | - Hu Wei‐Shiang
- Division of Urology, Department of SurgeryTungs' Taichung Metro Harbor HospitalTaichung CityTaiwan, ROC
| | - Tsao Tang‐Yi
- Department of Anatomical PathologyTungs' Taichung Metro Harbor HospitalTaichung CityTaiwan, ROC
| | - Hsu Chao‐Yu
- Division of Urology, Department of SurgeryTungs' Taichung Metro Harbor HospitalTaichung CityTaiwan, ROC
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15
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Gilardi L, Airò Farulla LS, Curigliano G, Corso G, Leonardi MC, Ceci F. FDG and Non-FDG Radiopharmaceuticals for PET Imaging in Invasive Lobular Breast Carcinoma. Biomedicines 2023; 11:biomedicines11051350. [PMID: 37239021 DOI: 10.3390/biomedicines11051350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most frequent histological type of breast cancer (BC) and includes a heterogeneous spectrum of diseases with unique characteristics, especially the infiltrative growth pattern and metastatic spread. [18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is extensively used in oncology and BC patient evaluation. Its role in ILCs is considered suboptimal due to its low FDG avidity. Therefore, ILCs could benefit from molecular imaging with non-FDG tracers that target other specific pathways, contributing to precision medicine. This narrative review aims to summarize the current literature on the use of FDG-PET/CT in ILC and to discuss future opportunities given by the development of innovative non-FDG radiotracers.
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Affiliation(s)
- Laura Gilardi
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lighea Simona Airò Farulla
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of New Drugs and Early Drug Development, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | | | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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16
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Bonnin D, Ladoire S, Briot N, Bertaut A, Drouet C, Cochet A, Alberini JL. Performance of [18F]FDG-PET/CT Imaging in First Recurrence of Invasive Lobular Carcinoma. J Clin Med 2023; 12:jcm12082916. [PMID: 37109252 PMCID: PMC10144846 DOI: 10.3390/jcm12082916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Invasive lobular carcinoma accounts for 10 to 15% of all breast cancers. The first objective of this retrospective study was to assess the diagnostic performance of FDG-PET/CT scanning in women previously treated for invasive lobular carcinoma with suspected first recurrence. The secondary objectives were to evaluate the impact of PET/CT in a change in treatment and its prognostic value on specific survival. METHODS Patients in whom a PET/CT scan was performed from January 2011 to July 2019 in our Cancer Research Center were enrolled. Recurrence was suspected based on clinical symptoms, abnormal findings on conventional imaging, and/or elevated tumor markers. The diagnosis of recurrence was established by the oncologist after integration of all clinical, biological, histological, imaging, and follow-up data. Prognostic factors of recurrence as predicted by PET were determined using univariate logistic regression. KI67, mitotic index, or grade of mitosis were tested. Survival curves were compared using the log-rank test. Sixty-four patients (mean age: 60.3; SD = 12.4 years) were enrolled. The average time from initial diagnosis of the primary tumor to suspicion of recurrence was 5.2 ± 4.1 years. Forty-eight patients (75%) were judged to have recurrence by the oncologist: 7 local and 41 metastatic, with mainly bone (n = 24), lymph node (n = 14) and liver (n = 10) metastases. RESULTS Sensitivity, specificity, and positive and negative predictive values of PET/CT to predict recurrence were, respectively: 87%, 87%, 95%, and 70%. SUVmax at recurrence sites was generally high (mean: 6.4; SD = 2.9). False negative PET/CT results occurred with local (n = 2), peritoneal (n = 2), meningeal (n = 1), or bladder (n = 1) recurrences. In 40 patients with available histopathological data from suspected sites of recurrence, 30 PET/CT were true positive. In four patients, primary lung (n = 1) or gastric (n = 1) tumors or lymphomas (n = 2) were found. The detection of a recurrence resulted in a change in treatment in 44/48 patients (92%). No association between recurrence predicted by PET and biological biomarkers was found. Median specific survival appears shorter in patients with metastatic recurrence versus patients with local or no recurrence on PET/CT (p = 0.067). CONCLUSIONS FDG-PET/CT is an effective and reliable tool for the detection of invasive lobular carcinoma recurrence, although certain recurrence sites specific to this histological type can impair its diagnostic performance.
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Affiliation(s)
- David Bonnin
- Department of Nuclear Medicine, Georges Francois Leclerc Research Cancer Center, 21079 Dijon, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Georges Francois Leclerc Research Cancer Center; 21000 Dijon, France
- Research Center INSERM LNC-UMR1231, 21000 Dijon, France
| | - Nathalie Briot
- Department of Methodology and Biostatistics, Georges-Francois Leclerc Research Cancer Center, 21000 Dijon, France
| | - Aurélie Bertaut
- Department of Methodology and Biostatistics, Georges-Francois Leclerc Research Cancer Center, 21000 Dijon, France
| | - Clément Drouet
- Department of Nuclear Medicine, Georges Francois Leclerc Research Cancer Center, 21079 Dijon, France
| | - Alexandre Cochet
- Department of Nuclear Medicine, Georges Francois Leclerc Research Cancer Center, 21079 Dijon, France
- Laboratoire ICMUB, University Bourgogne, 21000 Dijon, France
| | - Jean-Louis Alberini
- Department of Nuclear Medicine, Georges Francois Leclerc Research Cancer Center, 21079 Dijon, France
- Laboratoire ICMUB, University Bourgogne, 21000 Dijon, France
- Centre Georges-Francois Leclerc, 1 rue du Pr Marion, 21079 Dijon CEDEX, France
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17
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Yang G, Zuo C, Lin Y, Zhou X, Wen P, Zhang C, Xiao H, Jiang M, Fujita M, Gao XD, Fu F. Comprehensive proteome, phosphoproteome and kinome characterization of luminal A breast cancer. Front Oncol 2023; 13:1127446. [PMID: 37064116 PMCID: PMC10102592 DOI: 10.3389/fonc.2023.1127446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundBreast cancer is one of the most frequently occurring malignant cancers worldwide. Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) are the two most common histological subtypes of breast cancer. In this study, we aimed to deeply explore molecular characteristics and the relationship between IDC and ILC subtypes in luminal A subgroup of breast cancer using comprehensive proteomics and phosphoproteomics analysis.MethodsCancer tissues and noncancerous adjacent tissues (NATs) with the luminal A subtype (ER- and PR-positive, HER2-negative) were obtained from paired IDC and ILC patients respectively. Label-free quantitative proteomics and phosphoproteomics methods were used to detect differential proteins and the phosphorylation status between 10 paired breast cancer and NATs. Then, the difference in protein expression and its phosphorylation between IDC and ILC subtypes were explored. Meanwhile, the activation of kinases and their substrates was also revealed by Kinase-Substrate Enrichment Analysis (KSEA).ResultsIn the luminal A breast cancer, a total of 5,044 high-confidence proteins and 3,808 phosphoproteins were identified from 10 paired tissues. The protein phosphorylation level in ILC tissues was higher than that in IDC tissues. Histone H1.10 was significantly increased in IDC but decreased in ILC, Conversely, complement C4-B and Crk-like protein were significantly decreased in IDC but increased in ILC. Moreover, the increased protein expression of Septin-2, Septin-9, Heterogeneous nuclear ribonucleoprotein A1 and Kinectin but reduce of their phosphorylation could clearly distinguish IDC from ILC. In addition, IDC was primarily related to energy metabolism and MAPK pathway, while ILC was more closely involved in the AMPK and p53/p21 pathways. Furthermore, the kinomes in IDC were primarily significantly activated in the CMGC groups.ConclusionsOur research provides insights into the molecular characterization of IDC and ILC and contributes to discovering novel targets for further drug development and targeted treatment.
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Affiliation(s)
- Ganglong Yang
- The Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi, China
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Chenyang Zuo
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Yuxiang Lin
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaoman Zhou
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Piaopiao Wen
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Chairui Zhang
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Han Xiao
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Meichen Jiang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Morihisa Fujita
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
| | - Xiao-Dong Gao
- The Key Laboratory of Carbohydrate Chemistry & Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi, China
- *Correspondence: Xiao-Dong Gao, ; Fangmeng Fu,
| | - Fangmeng Fu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian, China
- *Correspondence: Xiao-Dong Gao, ; Fangmeng Fu,
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18
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Mansikka I, Kinnunen I, Hirvonen J, Vainio P, Velhonoja J. Tumor-to-tumor metastasis to Warthin tumor presenting as an initial sign of breast carcinoma: A case report. Clin Case Rep 2023; 11:e6817. [PMID: 36619482 PMCID: PMC9817488 DOI: 10.1002/ccr3.6817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/30/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Metastases of distant primary tumors on the parotid gland are very rare. Tumor-to-tumor metastasis to salivary gland tumors is extremely rare. A case of a 69-year-old woman with a large left parotid gland mass with no previous salivary gland problems or cancer. Fine-needle aspiration (FNA) showed evidence of a Warthin tumor. A total left parotidectomy was performed. The final pathology report showed a Warthin tumor containing two metastases of adenocarcinoma. The immunohistochemistry of the metastases led to the diagnosis of primary breast cancer. A negative FNA does not rule out the possibility of a malignant parotid tumor or metastasis, and a parotid lump should be presumed to be a secondary tumor until proven otherwise if the patient has a history of any distant primary cancer. Our patient case serves as a reminder that a new distant primary cancer might be the cause of a parotid lump.
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Affiliation(s)
- Iisa Mansikka
- Department of Otorhinolaryngology and Head and Neck SurgeryTurku University Hospital and University of TurkuTurkuFinland
| | - Ilpo Kinnunen
- Department of Otorhinolaryngology and Head and Neck SurgeryTurku University Hospital and University of TurkuTurkuFinland
| | - Jussi Hirvonen
- Department of RadiologyTurku University Hospital and University of TurkuTurkuFinland
| | - Paula Vainio
- Department of PathologyTurku University Hospital and University of TurkuTurkuFinland
| | - Jarno Velhonoja
- Department of Otorhinolaryngology and Head and Neck SurgeryTurku University Hospital and University of TurkuTurkuFinland
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19
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Ferhatoğlu F, Aydiner A, Paksoy N. Evaluation of clinical features and risk factors related to late recurrence (>5 years) in patients with breast cancer. J Surg Med 2022; 6:986-990. [DOI: 10.28982/josam.7610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background/Aim: Over the years, disease-free survival (DFS) has been considerably prolonged with effective treatments in resectable breast cancer patients. However, a limited number of studies evaluating the predictive and prognostic factors of the disease in breast cancer patients who develop late recurrence are available. In this respect, we investigated clinicopathological features and risk factors affecting the survival of patients who developed breast cancer recurrence (BCR) after 60 months (late BCR).
Methods: In this retrospective cohort study, clinicopathological features and survival outcomes of 45 late BCR patients were evaluated. The demographic and medical data of the patients were obtained from the retrospective registry system of our center. Statistical analyses were performed to determine the risk factors affecting DFS.
Results: The median age of the cohort was 49 (24–78) years. Twenty-three postmenopausal patients were included in the study, and the mean age of menopause was 50 (43–55) years. Fourteen (31.1%) patients were stage 3 at diagnosis. In the adjuvant period, 80% of the patients underwent radiotherapy, and 79.5% underwent chemotherapy. The mean duration of adjuvant hormone therapy was 64 (69–129) months. Adjuvant ovarian suppression therapy was applied to 14 patients. The three most common sites of recurrence were bones (57.8%), locoregional (26.7%), and distant lymph nodes (26.7%). The median DFS of the cohort was 116.9 (3.7) months (109.6–124.1 months). Disease-related deaths occurred in only five patients, and the median overall survival (OS) could not be achieved. Based on a log-rank analysis, the median DFS was longer in patients whose adjuvant hormone therapy duration was 5–10 years and in those with bone or lymph node recurrence (P = 0.025 and P = 0.001, respectively). DFS was significantly shorter in patients with liver metastases (P = 0.005). Based on a chi-squared analysis, bone and lymph node metastases were higher in luminal A-like group (P = 0.030), and liver metastasis was lower (P = 0.039). Luminal biology did not affect late BCR (P = 0.075).
Conclusions: Prolonged adjuvant hormone therapy (5–10 years) delays breast cancer recurrence. However, luminal features are insufficient to predict recurrence as the recurrence period increases. In addition, different sites of metastases are associated with long-term survival and luminal subgroups.
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20
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Mouabbi JA, Raghavendra AS, Bassett RL Jr, Hassan A, Tripathy D, Layman RM. Histology-based survival outcomes in hormone receptor-positive metastatic breast cancer treated with targeted therapies. NPJ Breast Cancer 2022; 8:131. [PMID: 36539444 DOI: 10.1038/s41523-022-00499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
The addition of targeted therapies (TT) to endocrine therapy (ET) has improved the outcomes of patients with HR-positive, HER2-negative metastatic breast cancer (mBC). However, it is unknown whether patients with invasive lobular carcinoma (ILC) or mixed invasive ductal and lobular carcinoma (mixed) histologies experience the same magnitude of benefit from this therapy as those with invasive ductal carcinoma (IDC). We aim to determine whether patients with IDC, ILC, and mixed HR+/HER2- mBC derive similar benefit from the addition of cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6is), mammalian target of rapamycin inhibitor (mTORi), and phosphoinositide 3-kinase inhibitor (PI3Ki) to ET in HR+/HER2- mBC. We conducted an observational, population-based investigation using data from the MD Anderson prospectively collected database. We conducted a histology-based analysis of progression-free survival (PFS) and overall survival (OS) durations in 3784 patients with HR+/HER2- mBC who were treated with TT plus ET between January 1, 2010, and December 31, 2021. Out of the 3784 patients, 2975 were included in the final analysis. Of these, 2249 received CDK4/6is (81% IDC, 15% ILC, and 4% mixed), 1027 received everolimus (82% IDC, 14% ILC, and 4% mixed) and 49 received alpelisib (81% IDC and 19% ILC). The addition of targeted therapy to ET did not result in statistically significant differences in PFS or OS duration among patients with IDC, ILC, and mixed HR+/HER2- mBC. We concluded that for patients with HR+/HER2- mBC, the addition of TT to ET leads to a similar magnitude of benefit, irrespective of histology.
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21
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Kong D, Dong X, Qin P, Sun D, Zhang Z, Zhang Y, Hao F, Wang M. Asymptomatic uterine metastasis of breast cancer: Case report and literature review. Medicine (Baltimore) 2022; 101:e31061. [PMID: 36254025 PMCID: PMC9575808 DOI: 10.1097/md.0000000000031061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Uterine metastasis from breast cancer is extremely rare. Asymptomatic patients with cervical metastases from breast cancer are rarer and more likely to be missed. We present an asymptomatic patient with breast cancer metastasized to the uterus and share opinions on diagnosing and treating for this kind of cases. PATIENT CONCERNS We present the case of a 64-year-old woman who was diagnosed with both breast cancer and uterine fibroids after examination. She had no symptoms of gynecological disease during breast cancer treatment. A positron emission tomography/computed tomography (PET/CT) scan was performed during reexamination, revealing multiple metastases of the bone throughout the body and an abnormal hypermetabolic mass in the uterus. It was later confirmed as uterine metastasis by pathology. DIAGNOSIS A diagnosis of metastatic breast invasive lobular carcinoma was established after a uterine curettage. INTERVENTIONS AND OUTCOMES Treatment of the uterine metastasis included systemic chemotherapy, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO), postoperative radiotherapy, and postoperative chemotherapy. The patient eventually refused further treatment for personal reasons and died at home. LESSONS Breast cancer metastases to the uterus are very rare and further research is needed for their diagnosis and treatment. During reexamination of breast cancer patients, clinicians must be alert to metastasis to gynecologic organs. This is particularly important in hormone receptor-positive patients with asymptomatic distant metastasis.
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Affiliation(s)
- Dechen Kong
- Clinical School, Weifang Medical University, Weifang, China
| | - Xiaotong Dong
- Department of Pathology, Weifang People’s Hospital, Weifang, China
| | - Peiyan Qin
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Daqing Sun
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Zhengtao Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Yan Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Furong Hao
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
- Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang, China
| | - Mingchen Wang
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
- *Correspondence: Mingchen Wang, Department of Radiation Oncology, Weifang People’s Hospital, No.151, Guangwen Street, Weifang, China (e-mail: )
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22
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Van Baelen K, Geukens T, Maetens M, Tjan-Heijnen V, Lord CJ, Linn S, Bidard FC, Richard F, Yang WW, Steele RE, Pettitt SJ, Van Ongeval C, De Schepper M, Isnaldi E, Nevelsteen I, Smeets A, Punie K, Voorwerk L, Wildiers H, Floris G, Vincent-Salomon A, Derksen PWB, Neven P, Senkus E, Sawyer E, Kok M, Desmedt C. Current and future diagnostic and treatment strategies for patients with invasive lobular breast cancer. Ann Oncol 2022; 33:769-785. [PMID: 35605746 DOI: 10.1016/j.annonc.2022.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Invasive lobular breast cancer (ILC) is the second most common type of breast cancer after invasive breast cancer of no special type (NST), representing up to 15% of all breast cancers. DESIGN Latest data on ILC are presented, focusing on diagnosis, molecular make-up according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT) guidelines, treatment in the early and metastatic setting and ILC-focused clinical trials. RESULTS At the imaging level, magnetic resonance imaging-based and novel positron emission tomography/computed tomography-based techniques can overcome the limitations of currently used imaging techniques for diagnosing ILC. At the pathology level, E-cadherin immunohistochemistry could help improving inter-pathologist agreement. The majority of patients with ILC do not seem to benefit as much from (neo-)adjuvant chemotherapy as patients with NST, although chemotherapy might be required in a subset of high-risk patients. No differences in treatment efficacy are seen for anti-human epidermal growth factor receptor 2 (HER2) therapies in the adjuvant setting and cyclin-dependent kinases 4 and 6 inhibitors in the metastatic setting. The clinical utility of the commercially available prognostic gene expression-based tests is unclear for patients with ILC. Several ESCAT alterations differ in frequency between ILC and NST. Germline BRCA1 and PALB2 alterations are less frequent in patients with ILC, while germline CDH1 (gene coding for E-cadherin) alterations are more frequent in patients with ILC. Somatic HER2 mutations are more frequent in ILC, especially in metastases (15% ILC versus 5% NST). A high tumour mutational burden, relevant for immune checkpoint inhibition, is more frequent in ILC metastases (16%) than in NST metastases (5%). Tumours with somatic inactivating CDH1 mutations may be vulnerable for treatment with ROS1 inhibitors, a concept currently investigated in early and metastatic ILC. CONCLUSION ILC is a unique malignancy based on its pathological and biological features leading to differences in diagnosis as well as in treatment response, resistance and targets as compared to NST.
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Affiliation(s)
- K Van Baelen
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; Departments of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - T Geukens
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - M Maetens
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - V Tjan-Heijnen
- Medical Oncology Department, Maastricht University Medical Center (MUMC), School of GROW, Maastricht, The Netherlands
| | - C J Lord
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Linn
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Medical Oncology, Amsterdam, The Netherlands; Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F-C Bidard
- Department of Medical Oncology, Institut Curie, UVSQ/Paris-Saclav University, Paris, France
| | - F Richard
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - W W Yang
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - R E Steele
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S J Pettitt
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - C Van Ongeval
- Departments of Radiology, UZ Leuven, Leuven, Belgium
| | - M De Schepper
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; Pathology, UZ Leuven, Leuven, Belgium
| | - E Isnaldi
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - A Smeets
- Surgical Oncology, UZ Leuven, Leuven, Belgium
| | - K Punie
- General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - L Voorwerk
- Departments of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Tumour Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Wildiers
- General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - G Floris
- Pathology, UZ Leuven, Leuven, Belgium
| | | | - P W B Derksen
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Neven
- Departments of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - E Sawyer
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, Guy's Cancer Centre, King's College London, London, UK
| | - M Kok
- Departments of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Tumour Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Desmedt
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium.
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23
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Bhaludin BN, Tunariu N, Koh DM, Messiou C, Okines AF, McGrath SE, Ring AE, Parton MM, Sharma B, Gagliardi T, Allen SD, Pope R, Johnston SRD, Downey K. A review on the added value of whole-body MRI in metastatic lobular breast cancer. Eur Radiol 2022; 32:6514-6525. [PMID: 35384456 DOI: 10.1007/s00330-022-08714-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/01/2022]
Abstract
Invasive lobular breast carcinomas (ILC) account for approximately 15% of breast cancer diagnoses. They can be difficult to diagnose both clinically and radiologically, due to their infiltrative growth pattern. The pattern of metastasis of ILC is unusual, with spread to the serosal surfaces (pleura and peritoneum), retroperitoneum and gastrointestinal (GI)/genitourinary (GU) tracts and a higher rate of leptomeningeal spread than IDC. Routine staging and response assessment with computed tomography (CT) can be undertaken quickly and measurements can be reproduced easily, but this is challenging with metastatic ILC as bone-only/bone-predominant patterns are frequently seen and assessment of the disease status is limited in these scenarios. Functional imaging such as whole-body MRI (WBMRI) allows the assessment of bone and soft tissue disease by providing functional information related to differences in cellular density between malignant and benign tissues. A number of recent studies have shown that WBMRI can detect additional sites of disease in metastatic breast cancer (MBC), resulting in a change in systemic anti-cancer therapy. Although WBMRI and fluorodeoxyglucose-positron-emission tomography-computed tomography (FDG-PET/CT) have a comparable performance in the assessment of MBC, WBMRI can be particularly valuable as a proportion of ILC are non-FDG-avid, resulting in the underestimation of the disease extent. In this review, we explore the added value of WBMRI in the evaluation of metastatic ILC and compare it with other imaging modalities such as CT and FDG-PET/CT. We also discuss the spectrum of WBMRI findings of the different metastatic sites of ILC with CT and FDG-PET/CT correlation. KEY POINTS: • ILC has an unusual pattern of spread compared to IDC, with metastases to the peritoneum, retroperitoneum and GI and GU tracts, but the bones and liver are the commonest sites. • WBMRI allows functional assessment of metastatic disease, particularly in bone-only and bone-predominant metastatic cancers such as ILC where evaluation with CT can be challenging and limited. • WBMRI can detect more sites of disease compared with CT, can reveal disease progression earlier and provides the opportunity to change ineffective systemic treatment sooner.
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Affiliation(s)
- Basrull N Bhaludin
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK.
| | - Nina Tunariu
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK.,Institute of Cancer Research, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK.,Institute of Cancer Research, London, UK
| | - Christina Messiou
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK.,Institute of Cancer Research, London, UK
| | - Alicia F Okines
- Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Sophie E McGrath
- Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK
| | - Alistair E Ring
- Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK
| | - Marina M Parton
- Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Bhupinder Sharma
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Tanja Gagliardi
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Steven D Allen
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Romney Pope
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Stephen R D Johnston
- Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Kate Downey
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
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24
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Mouabbi JA, Hassan A, Lim B, Hortobagyi GN, Tripathy D, Layman RM. Invasive lobular carcinoma: an understudied emergent subtype of breast cancer. Breast Cancer Res Treat 2022; 193:253-264. [DOI: 10.1007/s10549-022-06572-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 12/22/2022]
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25
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Allen V, Coulombe J, Zhao H, Kreps LM, Cook DP, Pryce B, Clemons M, Vanderhyden BC, Gray DA, Addison CL. VIVA1: a more invasive subclone of MDA-MB-134VI invasive lobular carcinoma cells with increased metastatic potential in xenograft models. Br J Cancer 2022; 127:56-68. [PMID: 35318435 PMCID: PMC9276762 DOI: 10.1038/s41416-022-01778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/28/2022] [Accepted: 02/25/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) is the second most common type of breast cancer. As few tools exist to study ILC metastasis, we isolated ILC cells with increased invasive properties to establish a spontaneously metastasising xenograft model. METHODS MDA-MB-134VI ILC cells were placed in transwells for 7 days. Migrated cells were isolated and expanded to create the VIVA1 cell line. VIVA1 cells were compared to parental MDA-MB-134VI cells in vitro for ILC marker expression and relative proliferative and invasive ability. An intraductally injected orthotopic xenograft model was used to assess primary and metastatic tumour growth in vivo. RESULTS Similar to MDA-MB-134VI, VIVA1 cells retained expression of oestrogen receptor (ER) and lacked expression of E-cadherin, however showed increased invasion in vitro. Following intraductal injection, VIVA1 and MDA-MB-134VI cells had similar primary tumour growth and survival kinetics. However, macrometastases were apparent in 7/10 VIVA1-injected animals. Cells from a primary orthotopic tumour (VIVA-LIG43) were isolated and showed similar proliferative rates but were also more invasive than parental cells. Upon re-injection intraductally, VIVA-LIG43 cells had more rapid tumour growth with similar metastatic incidence and location. CONCLUSIONS We generated a new orthotopic spontaneously metastasising xenograft model for ER+ ILC amenable for the study of ILC metastasis.
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Affiliation(s)
- Victoria Allen
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, K1H 8M5, ON, Canada
| | - Josée Coulombe
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada
| | - Huijun Zhao
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada
| | - Lauren M Kreps
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, K1H 8M5, ON, Canada
| | - David P Cook
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, K1H 8M5, ON, Canada
| | - Benjamin Pryce
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, K1H 8M5, ON, Canada
| | - Mark Clemons
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, K1H 8M5, ON, Canada
| | - Barbara C Vanderhyden
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, K1H 8M5, ON, Canada
| | - Douglas A Gray
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, K1H 8M5, ON, Canada
| | - Christina L Addison
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, ON, Canada. .,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, K1H 8M5, ON, Canada. .,Department of Medicine, University of Ottawa, Ottawa, K1H 8M5, ON, Canada.
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26
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Abstract
Breast cancer is the most common malignant tumor in females. While most carcinomas are categorized as invasive carcinoma, no special type (NST), a diverse group of tumors with distinct pathologic and clinical features is also recognized, ranging in incidence from relatively more common to rare. So-called "special histologic type" tumors display more than 90% of a specific, distinctive histologic pattern, while a spectrum of tumors more often encountered in the salivary gland may also arise in the breast. Metaplastic carcinomas can present diagnostic challenges. Some uncommon tumors harbor pathognomonic genetic alterations. This article provides an overview of the key diagnostic points and differential diagnoses for this group of disparate lesions, as well as the salient clinical characteristics of each entity.
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Affiliation(s)
- Benjamin Yongcheng Tan
- Department of Anatomical Pathology, Singapore General Hospital, Level 10, Academia, 20 College Road, Singapore 169856, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Level 7, Diagnostics Tower, Academia, 20 College Road, Singapore 189856, Singapore.
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27
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Gómez-Cuadrado L, Bullock E, Mabruk Z, Zhao H, Souleimanova M, Noer PR, Turnbull AK, Oxvig C, Bertos N, Byron A, Dixon JM, Park M, Haider S, Natrajan R, Sims AH, Brunton VG. Characterisation of the Stromal Microenvironment in Lobular Breast Cancer. Cancers (Basel) 2022; 14:cancers14040904. [PMID: 35205651 PMCID: PMC8870100 DOI: 10.3390/cancers14040904] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 11/16/2022] Open
Abstract
Invasive lobular carcinoma (ILC) is the second most common histological subtype of breast cancer, and it exhibits a number of clinico-pathological characteristics distinct from the more common invasive ductal carcinoma (IDC). We set out to identify alterations in the tumor microenvironment (TME) of ILC. We used laser-capture microdissection to separate tumor epithelium from stroma in 23 ER + ILC primary tumors. Gene expression analysis identified 45 genes involved in regulation of the extracellular matrix (ECM) that were enriched in the non-immune stroma of ILC, but not in non-immune stroma from ER+ IDC or normal breast. Of these, 10 were expressed in cancer-associated fibroblasts (CAFs) and were increased in ILC compared to IDC in bulk gene expression datasets, with PAPPA and TIMP2 being associated with better survival in ILC but not IDC. PAPPA, a gene involved in IGF-1 signaling, was the most enriched in the stroma compared to the tumor epithelial compartment in ILC. Analysis of PAPPA- and IGF1-associated genes identified a paracrine signaling pathway, and active PAPP-A was shown to be secreted from primary CAFs. This is the first study to demonstrate molecular differences in the TME between ILC and IDC identifying differences in matrix organization and growth factor signaling pathways.
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Affiliation(s)
- Laura Gómez-Cuadrado
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK; (L.G.-C.); (E.B.); (Z.M.); (A.K.T.); (A.B.)
| | - Esme Bullock
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK; (L.G.-C.); (E.B.); (Z.M.); (A.K.T.); (A.B.)
| | - Zeanap Mabruk
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK; (L.G.-C.); (E.B.); (Z.M.); (A.K.T.); (A.B.)
| | - Hong Zhao
- Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 1A3, Canada; (H.Z.); (M.S.); (M.P.)
| | - Margarita Souleimanova
- Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 1A3, Canada; (H.Z.); (M.S.); (M.P.)
| | - Pernille Rimmer Noer
- Department of Molecular Biology and Genetics, University of Aarhus, DK-8000 Aarhus C, Denmark; (P.R.N.); (C.O.)
| | - Arran K. Turnbull
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK; (L.G.-C.); (E.B.); (Z.M.); (A.K.T.); (A.B.)
| | - Claus Oxvig
- Department of Molecular Biology and Genetics, University of Aarhus, DK-8000 Aarhus C, Denmark; (P.R.N.); (C.O.)
| | - Nicholas Bertos
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Adam Byron
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK; (L.G.-C.); (E.B.); (Z.M.); (A.K.T.); (A.B.)
| | - J. Michael Dixon
- Edinburgh Breast Unit, University of Edinburgh, Edinburgh EH4 2XU, UK;
| | - Morag Park
- Goodman Cancer Research Centre, McGill University, Montreal, QC H3A 1A3, Canada; (H.Z.); (M.S.); (M.P.)
| | - Syed Haider
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London SW3 6JB, UK; (S.H.); (R.N.)
| | - Rachael Natrajan
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London SW3 6JB, UK; (S.H.); (R.N.)
| | - Andrew H. Sims
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK; (L.G.-C.); (E.B.); (Z.M.); (A.K.T.); (A.B.)
| | - Valerie G. Brunton
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK; (L.G.-C.); (E.B.); (Z.M.); (A.K.T.); (A.B.)
- Correspondence:
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Huang P, Wu R, Juan Y, Ho H, Lin Y, Huang Y, Ng S, Lai C, Chao A, Lin G. Diagnostic Accuracy of Whole-Body Computed Tomography for Incidental Ovarian Tumors in Patients with Prior Breast Cancer. Diagnostics (Basel) 2022; 12:347. [PMID: 35204438 PMCID: PMC8870859 DOI: 10.3390/diagnostics12020347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 12/10/2022] Open
Abstract
Whole-body computed tomography (WBCT) serves as the first-line imaging modality for breast cancer follow-up. To investigate the imaging characteristics and diagnostic accuracy of WBCT for incidental ovarian tumors in patients with prior breast cancer, we retrospectively reviewed a consecutive cohort of 13,845 patients with breast cancer, of whom 149 had pathologically-proven ovarian lesions. We excluded patients with ovarian diagnosis before breast cancer, CT scan not including ovary, CT-pathology interval >30 days, and severe CT artifact. Among our 60 breast cancer patients (median age, 46 years) with pathologically proven ovarian lesions, 49 patients had benign diseases, seven had primary ovarian cancer and four had ovarian metastasis from breast cancer. The histologic types of breast cancer with ovarian metastases included invasive ductal carcinoma, lobular carcinoma and angiosarcoma. Cystic ovarian lesions identified on WBCT during the breast cancer follow-up are more likely to be benign, while solid-cystic lesions are likely to be primary ovarian cancers, and solid lesions may indicate ovarian metastasis. The diagnostic accuracy, sensitivity, specificity, and areas under the receiver operating characteristic curve of WBCT were 98.3%, 100.0%, 98.0%, and 0.99 (malignant vs. benign); 90.0%, 100.0%, 85.7%, and 0.93 (metastasis vs. primary ovarian cancer), respectively. The only false positive solid lesion was a Sertoli–Leydig tumor. In conclusion, WBCT may help diagnose incidental ovarian tumors in patients with prior breast cancers and guide disease management.
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Christgen M, Cserni G, Floris G, Marchio C, Djerroudi L, Kreipe H, Derksen PWB, Vincent-Salomon A. Lobular Breast Cancer: Histomorphology and Different Concepts of a Special Spectrum of Tumors. Cancers (Basel) 2021; 13:3695. [PMID: 34359596 DOI: 10.3390/cancers13153695] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Invasive lobular breast cancer (ILC) is a special type of breast cancer (BC) that was first described in 1941. The diagnosis of ILC is made by microscopy of tumor specimens, which reveals a distinct morphology. This review recapitulates the developments in the microscopic assessment of ILC from 1941 until today. We discuss different concepts of ILC, provide an overview on ILC variants, and highlight advances which have contributed to a better understanding of ILC as a special histologic spectrum of tumors. Abstract Invasive lobular breast cancer (ILC) is the most common special histological type of breast cancer (BC). This review recapitulates developments in the histomorphologic assessment of ILC from its beginnings with the seminal work of Foote and Stewart, which was published in 1941, until today. We discuss different concepts of ILC and their implications. These concepts include (i) BC arising from mammary lobules, (ii) BC growing in dissociated cells and single files, and (iii) BC defined as a morpho-molecular spectrum of tumors with distinct histological and molecular characteristics related to impaired cell adhesion. This review also provides a comprehensive overview of ILC variants, their histomorphology, and differential diagnosis. Furthermore, this review highlights recent advances which have contributed to a better understanding of the histomorphology of ILC, such as the role of the basal lamina component laminin, the molecular specificities of triple-negative ILC, and E-cadherin to P-cadherin expression switching as the molecular determinant of tubular elements in CDH1-deficient ILC. Last but not least, we provide a detailed account of the tumor microenvironment in ILC, including tumor infiltrating lymphocyte (TIL) levels, which are comparatively low in ILC compared to other BCs, but correlate with clinical outcome. The distinct histomorphology of ILC clearly reflects a special tumor biology. In the clinic, special treatment strategies have been established for triple-negative, HER2-positive, and ER-positive BC. Treatment specialization for patients diagnosed with ILC is just in its beginnings. Accordingly, ILC deserves greater attention as a special tumor entity in BC diagnostics, patient care, and cancer research.
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Danzinger S, Hielscher N, Izsó M, Metzler J, Trinkl C, Pfeifer C, Tendl-Schulz K, Singer CF. Invasive lobular carcinoma: clinicopathological features and subtypes. J Int Med Res 2021; 49:3000605211017039. [PMID: 34187216 PMCID: PMC8258769 DOI: 10.1177/03000605211017039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To analyze the characteristics of invasive lobular carcinoma (ILC) compared with invasive ductal carcinoma (IDC) and to investigate the impact of histology on axillary lymph node (ALN) involvement in luminal A subtype tumors. Methods We retrospectively analyzed patients diagnosed with ILC or IDC from 2012 to 2016 who underwent surgery. Patients constituted 493 primary early breast cancer cases (82 ILC; 411 IDC). Results Compared with IDC, ILC tumors were significantly more likely to be grade 2, estrogen receptor- (ER) positive (+), have a lower proliferation rate (Ki67 <14%), and a higher pathological T stage (pT2–4). The luminal A subtype was significantly more common in ILC compared with IDC. In a multivariate regression model, grade 2, ER+, progesterone receptor-positive, pT2, and pT3 were significantly associated with ILC. Additionally, with the luminal A subtype, ALN involvement (pathological node stage (pN)1–3) was significantly more frequent with ILC versus IDC. Conclusions Our data suggest that grade 2, positive hormone receptor status, and higher pathological T stage are associated with ILC. With the luminal A subtype, ALN involvement was more frequent with ILC versus IDC.
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Affiliation(s)
- Sabine Danzinger
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Nora Hielscher
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Miriam Izsó
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Johanna Metzler
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Carmen Trinkl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christian Pfeifer
- Department of Statistics, University of Innsbruck, Innsbruck, Austria
| | | | - Christian F Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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Yalla P, J P, Udupa KS, Kumar NA. Gastric Outlet Obstruction in a Breast Cancer Survivor: Evaluation and Treatment. Indian J Surg 2021; 83:552-555. [DOI: 10.1007/s12262-020-02611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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32
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Gerasimova-Chechkina E, Toner BC, Batchelder KA, White B, Freynd G, Antipev I, Arneodo A, Khalil A. Loss of Mammographic Tissue Homeostasis in Invasive Lobular and Ductal Breast Carcinomas vs. Benign Lesions. Front Physiol 2021; 12:660883. [PMID: 34054577 PMCID: PMC8153084 DOI: 10.3389/fphys.2021.660883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/09/2021] [Indexed: 12/24/2022] Open
Abstract
The 2D wavelet transform modulus maxima (WTMM) method is used to perform a comparison of the spatial fluctuations of mammographic breast tissue from patients with invasive lobular carcinoma, those with invasive ductal carcinoma, and those with benign lesions. We follow a procedure developed and validated in a previous study, in which a sliding window protocol is used to analyze thousands of small subregions in a given mammogram. These subregions are categorized according to their Hurst exponent values (H): fatty tissue (H ≤ 0.45), dense tissue (H ≥ 0.55), and disrupted tissue potentially linked with tumor-associated loss of homeostasis (0.45 < H < 0.55). Following this categorization scheme, we compare the mammographic tissue composition of the breasts. First, we show that cancerous breasts are significantly different than breasts with a benign lesion (p-value ∼ 0.002). Second, the asymmetry between a patient’s cancerous breast and its contralateral counterpart, when compared to the asymmetry from patients with benign lesions, is also statistically significant (p-value ∼ 0.006). And finally, we show that lobular and ductal cancerous breasts show similar levels of disruption and similar levels of asymmetry. This study demonstrates reproducibility of the WTMM sliding-window approach to help detect and characterize tumor-associated breast tissue disruption from standard mammography. It also shows promise to help with the detection lobular lesions that typically go undetected via standard screening mammography at a much higher rate than ductal lesions. Here both types are assessed similarly.
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Affiliation(s)
| | - Brian C Toner
- CompuMAINE Laboratory, University of Maine, Orono, ME, United States
| | | | - Basel White
- CompuMAINE Laboratory, University of Maine, Orono, ME, United States
| | - Genrietta Freynd
- Department of Pathology, Perm State Medical University Named After Academician E. A. Wagner, Perm, Russia
| | - Igor Antipev
- Department of Pathology, Perm State Medical University Named After Academician E. A. Wagner, Perm, Russia
| | - Alain Arneodo
- Laboratoire Ondes et Matière d'Aquitaine, Universite de Bordeaux, Bordeaux, France
| | - Andre Khalil
- CompuMAINE Laboratory, University of Maine, Orono, ME, United States.,Department of Chemical and Biomedical Engineering, University of Maine, Orono, ME, United States
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Yanagisawa W, Krishnan S, Fernandez A. A rare case of lobular breast cancer metastasizing to large bowel. Clin Case Rep 2021; 9:e04081. [PMID: 34084499 PMCID: PMC8142465 DOI: 10.1002/ccr3.4081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/24/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022] Open
Abstract
Lobular breast cancer metastasis to bowel is rare, however, when it occurs, the prognosis is poor. Possible benefits of investigation with screening endoscopy for gastrointestinal metastases are discussed in order to optimize prognosis for patients.
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Affiliation(s)
- Waka Yanagisawa
- Department of General SurgeryPrince of Wales HospitalSydneyNSWAustralia
- South East Regional HospitalBegaNSWAustralia
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Nehmeh WA, Derienne J, El Khoury L, Kassar S, Track-Smayra V, Noun R, Chakhtoura G. A 58-Year-Old Woman with Acute Gastric Perforation Due to Metastatic Ductal Carcinoma 18 Years Following Bilateral Mastectomy for Invasive Ductal Carcinoma of the Breast. Am J Case Rep 2021; 22:e927094. [PMID: 33828068 PMCID: PMC8042419 DOI: 10.12659/ajcr.927094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patient: Female, 58-year-old Final Diagnosis: Gastric perforation Symptoms: Abdominal pain • peritonitis Medication: — Clinical Procedure: Jejunostomy tube placement • laparoscopic surgery • open surgery Specialty: Surgery
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Affiliation(s)
- William A Nehmeh
- Department of Digestive Surgery, Hotel Dieu De France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Derienne
- Department of Digestive Surgery, Hotel Dieu De France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Léa El Khoury
- Department of Pathology, Hotel Dieu De France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Serge Kassar
- Department of Digestive Surgery, Hotel Dieu De France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Viviane Track-Smayra
- Department of Pathology, Hotel Dieu De France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hotel Dieu De France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hotel Dieu De France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Suman M, Dugué PA, Wong EM, Joo JE, Hopper JL, Nguyen-Dumont T, Giles GG, Milne RL, McLean C, Southey MC. Association of variably methylated tumour DNA regions with overall survival for invasive lobular breast cancer. Clin Epigenetics 2021; 13:11. [PMID: 33461604 PMCID: PMC7814464 DOI: 10.1186/s13148-020-00975-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background Tumour DNA methylation profiling has shown potential to refine disease subtyping and improve the diagnosis and prognosis prediction of breast cancer. However, limited data exist regarding invasive lobular breast cancer (ILBC). Here, we investigated the genome-wide variability of DNA methylation levels across ILBC tumours and assessed the association between methylation levels at the variably methylated regions and overall survival in women with ILBC. Methods Tumour-enriched DNA was prepared by macrodissecting formalin-fixed paraffin embedded (FFPE) tumour tissue from 130 ILBCs diagnosed in the participants of the Melbourne Collaborative Cohort Study (MCCS). Genome-wide tumour DNA methylation was measured using the HumanMethylation 450K (HM450K) BeadChip array. Variably methylated regions (VMRs) were identified using the DMRcate package in R. Cox proportional hazards regression models were used to assess the association between methylation levels at the ten most significant VMRs and overall survival. Gene set enrichment analyses were undertaken using the web-based tool Metaspace. Replication of the VMR and survival analysis findings was examined using data retrieved from The Cancer Genome Atlas (TCGA) for 168 ILBC cases. We also examined the correlation between methylation and gene expression for the ten VMRs of interest using TCGA data. Results We identified 2771 VMRs (P < 10−8) in ILBC tumours. The ten most variably methylated clusters were predominantly located in the promoter region of the genes: ISM1, APC, TMEM101, ASCL2, NKX6, HIST3H2A/HIST3H2BB, HCG4P3, HES5, CELF2 and EFCAB4B. Higher methylation level at several of these VMRs showed an association with reduced overall survival in the MCCS. In TCGA, all associations were in the same direction, however stronger than in the MCCS. The pooled analysis of the MCCS and TCGA data showed that methylation at four of the ten genes was associated with reduced overall survival, independently of age and tumour stage; APC: Hazard Ratio (95% Confidence interval) per one-unit M-value increase: 1.18 (1.02–1.36), TMEM101: 1.23 (1.02–1.48), HCG4P3: 1.37 (1.05–1.79) and CELF2: 1.21 (1.02–1.43). A negative correlation was observed between methylation and gene expression for CELF2 (R = − 0.25, P = 0.001), but not for TMEM101 and APC. Conclusions Our study identified regions showing greatest variability across the ILBC tumour genome and found methylation at several genes to potentially serve as a biomarker of survival for women with ILBC.
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Affiliation(s)
- Medha Suman
- Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Pierre-Antoine Dugué
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Ee Ming Wong
- Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - JiHoon Eric Joo
- Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - John L Hopper
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Tu Nguyen-Dumont
- Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Graham G Giles
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Roger L Milne
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Catriona McLean
- Anatomical Pathology, Alfred Health, The Alfred Hospital, Melbourne, VIC, 3181, Australia
| | - Melissa C Southey
- Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, 3010, Australia. .,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia. .,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia.
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Schumacher K, Inciardi M, O'Neil M, Wagner JL, Shah I, Amin AL, Balanoff CR, Larson KE. Is axillary imaging for invasive lobular carcinoma accurate in determining clinical node staging? Breast Cancer Res Treat 2021; 185:567-72. [PMID: 33389408 DOI: 10.1007/s10549-020-06047-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/05/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Preoperative evaluation of clinical N-stage (cN) is difficult in breast cancer patients with invasive lobular carcinoma (ILC). Our goal was to assess the predictive value of axillary imaging in ILC by comparing imaging cN and pathologic N-stage (pN). METHODS A single-institution retrospective review was performed for newly diagnosed stage I-III ILC patients undergoing preoperative breast imaging from 2011 to 2016. Clinicopathologic factors; mammogram, MRI, and ultrasound findings; and surgical pathology data were reviewed. Sub-analysis for pN2-N3 patients was performed to determine imaging sensitivity for patients with a larger nodal disease burden. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging modality. RESULTS Of the total 349 patients included, 70.5% were cN0, and 62% were pN0 (p = 0.03). For all patients, mammogram sensitivity was 7%, specificity 97%, PPV 50%, NPV 72%; ultrasound sensitivity was 26%, specificity 86%, PPV 52%, NPV 67%; MRI sensitivity was 7%, specificity 98%, PPV 80%, NPV 51%. For pN2/N3 patients, 38% were identified as cN0. Mammogram sensitivity was 10%; ultrasound 42%; MRI 65%. Pathology evaluation of N2/N3 patients indicated LN were replaced with ILC but maintained normal architecture. The average largest pathologic tumor deposit (1.5 ± 0.8 cm) correlated with average largest imaging LN size (1.4 ± 0.6 cm) (p = 0.58). CONCLUSION A statistically significant difference between clinical and pathologic N-stage exists for ILC patients. MRI was most sensitive for identification of pN2-N3 patients and should be considered part of routine axillary imaging evaluation for ILC patients.
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Kutasovic JR, McCart Reed AE, Sokolova A, Jayanthan J, Da Silva L, Simpson PT, Lakhani SR. Phenotypic drift in metastatic progression of breast cancer: A case report with histologically heterogeneous lesions that are clonally related. Clin Case Rep 2020; 8:2725-2731. [PMID: 33363813 PMCID: PMC7752647 DOI: 10.1002/ccr3.3257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/21/2020] [Accepted: 08/01/2020] [Indexed: 11/22/2022] Open
Abstract
Breast cancer metastasis to the stomach is rare; invasive lobular carcinoma has a predilection to spread to the gastrointestinal system and is morphologically similar to primary diffuse gastric carcinoma. This case highlights heterogeneous metastatic progression and that documentation of heterogeneity is important for informing future treatment strategies and prognostication.
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Affiliation(s)
- Jamie R. Kutasovic
- UQ Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneQldAustralia
| | - Amy E. McCart Reed
- UQ Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneQldAustralia
| | - Anna Sokolova
- UQ Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneQldAustralia
- Pathology QueenslandThe Royal Brisbane and Women’s HospitalBrisbaneQldAustralia
| | - Janani Jayanthan
- UQ Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneQldAustralia
| | - Leonard Da Silva
- UQ Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneQldAustralia
- Pathology QueenslandThe Royal Brisbane and Women’s HospitalBrisbaneQldAustralia
| | - Peter T. Simpson
- UQ Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneQldAustralia
| | - Sunil R. Lakhani
- UQ Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneQldAustralia
- Pathology QueenslandThe Royal Brisbane and Women’s HospitalBrisbaneQldAustralia
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Tille JC, Vieira AF, Saint-Martin C, Djerroudi L, Furhmann L, Bidard FC, Kirova Y, Tardivon A, Reyal F, Carton M, Vincent-Salomon A. Tumor-infiltrating lymphocytes are associated with poor prognosis in invasive lobular breast carcinoma. Mod Pathol 2020; 33:2198-207. [PMID: 32404955 DOI: 10.1038/s41379-020-0561-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/14/2022]
Abstract
The prognostic impact of tumor-infiltrating lymphocytes (TILs) within invasive lobular carcinoma (ILC) remains to be better characterized. In estrogen receptor (ER)-negative invasive ductal carcinomas of no special type (IDC-NST), TILs are associated with good prognosis. The aim of this study was to examine TILs in ILC, with particular focus on prognostic and clinicopathologic features. A cohort comprising 459 consecutive ILCs diagnosed in a single institution from 2005 to 2008 met the eligibility criteria for this study. The percentage of tumor area occupied by TILs was quantified by two breast pathologists and categorized into three groups: no TILs, ≤5%, >5%. Clinicopathologic features were tested by Fisher's exact tests or Chi2 tests. Overall survival (OS) and invasive disease-free survival (iDFS) were estimated by Kaplan-Meier and Cox proportional hazard statistics. There were 239 TIL-negative cases, 185 cases with ≤5% TILs, and 35 cases with >5% TILs. TILs were associated with younger age, larger tumors, lymph node involvement, poor Nottingham prognostic index, HER2 amplification, multinucleation, and prominent nucleoli (p < 0.05). Poor OS was significantly associated with increasing TILs in the univariate Cox proportional hazards model (p < 0.001) and Kaplan-Meier estimator (p < 0.05, log-rank test). Similar results were observed for iDFS (p = 0.004 for Cox univariate and p = 0.005 for log-rank test). Notably, TILs can identify a subset of ILC patients with poor OS independently of molecular subtype and lymph node metastases (multivariate Cox, p < 0.001, OS hazard ratio (HR) = 4.38 and HR = 6.15, for ≤5% and >5% TILs, respectively, vs. absence of TILs). Prominent nucleoli was the only nuclear feature associated with poor OS (p = 0.05) and iDFS (p = 0.05) in univariate Cox survival analysis. TILs represent a promising new morphologic biomarker associated with poor outcome of ILC, in contrast with that observed in ER-negative IDC-NST.
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Nelson B, Brizendine AM, Gietzen R, Venkatesan R. Case of HER2neu+ Invasive Pleomorphic Lobular Carcinoma With Response to Conventional Neoadjuvant Chemotherapy: A Viable Option for an Exceedingly Rare Breast Cancer Type. Cureus 2020; 12:e11108. [PMID: 33240704 PMCID: PMC7682532 DOI: 10.7759/cureus.11108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Invasive pleomorphic lobular carcinoma (IPLC) is an extremely rare form of breast cancer that accounts for less than 1% of all breast cancer cases. Due to this rarity, currently, there is a lack of an established standard of care for patients diagnosed with this form of breast cancer. In this case report, we present a 57-year-old female with a complex oncologic history diagnosed with clinical prognostic Stage IIA (ER 5%, PR 0%, HER2neu 3+) invasive pleomorphic lobular carcinoma of the left breast treated with neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab-based therapy (TCHP) followed by surgery. Surgical pathology revealed treatment-related changes with a definite response to neoadjuvant therapy. We report this case to highlight the response of this rare pathological entity to a standard neoadjuvant regimen such as docetaxel, carboplatin, trastuzumab, and pertuzumab.
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Affiliation(s)
- Blessie Nelson
- Department of Hematology and Medical Oncology, University of Texas Medical Branch, Galveston, USA
| | - Ashley M Brizendine
- Department of Hematology and Medical Oncology, University of Texas Medical Branch, Galveston, USA
| | - Rachelle Gietzen
- Department of Pathology, University of Texas Medical Branch, Galveston, USA
| | - Rohit Venkatesan
- Department of Hematology and Oncology, University of Texas MD Anderson Cancer Center, Galveston, USA
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Kaneko Y, Koi Y, Kajitani K, Ohara M, Daimaru Y. Asymptomatic solitary metastasis to the stomach from breast cancer: A case report. Mol Clin Oncol 2020; 13:75. [PMID: 33005409 PMCID: PMC7523290 DOI: 10.3892/mco.2020.2145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/01/2020] [Indexed: 12/20/2022] Open
Abstract
Distant metastases from breast cancer are frequently found in bones, lungs and the liver. Metastasis to the stomach is rare, and its clinical presentation remains unclear. The present report describes a case of isolated gastric metastasis from breast cancer identified by contrast-enhanced computed tomography (CT). A 45-year-old female patient underwent right mastectomy and axillary lymph node dissection after preoperative chemotherapy for right invasive lobular breast carcinoma T4bN2M0, stage IIIB. Postoperative radiotherapy and endocrine therapy with tamoxifen for 5 years were performed. CT for postoperative follow-up at 52 years old revealed thickening of the stomach wall. Although the patient was asymptomatic, erosive mucosa was observed on the gastric body during gastroscopy. The gastric lesion was immunohistochemically diagnosed as metastatic luminal disease from the breast cancer. Positron emission tomography/CT revealed no abnormal accumulation suggesting metastasis to other organs. Palbociclib and fulvestrant treatment were initiated for gastric metastasis. Invasive lobular breast carcinoma results in gastrointestinal metastasis, including the stomach, more frequently than invasive ductal breast carcinoma. However, most gastric metastases occur simultaneously with systemic metastases. Solitary metastasis to the stomach without symptoms as in this case has rarely been reported. The possibility of gastric metastasis should be considered among the differential diagnoses, even in the absence of symptoms, when gastrointestinal abnormalities are seen on CT in patients with a history of breast cancer.
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Affiliation(s)
- Yuki Kaneko
- Department of Breast Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Yumiko Koi
- Department of Breast Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Keiko Kajitani
- Department of Breast Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Masahiro Ohara
- Department of Breast Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Yutaka Daimaru
- Section of Pathological Research and Laboratory, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
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Abstract
Breast cancer is the leading cause of cancer death in women, and most breast cancer related deaths are due to metastasis. Urinary bladder metastasis from breast cancer is rarely reported in the literature. In this review, we examined the reported cases of breast cancer metastasizing to the urinary bladder, with the objective of identifying clues that could help physicians in diagnosing and planning further treatment. We performed a systematic review of the literature to analyze the clinical and pathological profile of this disease. We thoroughly examined and systematically reported data regarding epidemiology, the pattern of spread, signs and symptoms, pathology and hormonal status, diagnostic workup, management, and outcomes. Urinary bladder metastases from breast cancers are more common in invasive lobular carcinoma. In addition to asymptomatic presentations, most cases present with hematuria and voiding dysfunction. This review summarizes the insights into the incidence, clinical presentation, diagnostic workup, management, and prognosis of urinary bladder metastasis in patients with breast cancer.
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Affiliation(s)
- Uday Karjol
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, IND
| | - Pavan Jonnada
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, IND
| | | | - Ajay Chandranath
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, IND
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42
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Gomez M, Whitting K, Naous R. Lobular breast carcinoma metastatic to the endometrium in a patient under tamoxifen therapy: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20907208. [PMID: 32110411 PMCID: PMC7026837 DOI: 10.1177/2050313x20907208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/14/2020] [Indexed: 11/16/2022] Open
Abstract
Metastatic carcinomas to the uterus are rare and usually originate from nearby gynecologic sites, most commonly from the ovaries. Among non-gynecologic origins, breast tumors are the most frequent primaries, predominantly the lobular carcinoma type. A 69-year-old postmenopausal woman diagnosed with lobular breast carcinoma 5 years ago, status post modified radical mastectomy, and currently on tamoxifen therapy presented with post-menopausal bleeding. Subsequent endometrial biopsy confirmed the diagnosis of metastatic lobular breast carcinoma to the endometrium. Breast carcinomas rarely metastasize to the uterus, especially lobular carcinoma type. Abnormal uterine bleeding in a patient with known history of breast carcinoma and under tamoxifen therapy should prompt a complete diagnostic workup to rule out metastatic disease.
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Affiliation(s)
- Mariangela Gomez
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kerry Whitting
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Rana Naous
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
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43
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McCart Reed AE, Lal S, Kutasovic JR, Wockner L, Robertson A, de Luca XM, Kalita-de Croft P, Dalley AJ, Coorey CP, Kuo L, Ferguson K, Niland C, Miller G, Johnson J, Reid LE, Males R, Saunus JM, Chenevix-Trench G, Coin L, Lakhani SR, Simpson PT. LobSig is a multigene predictor of outcome in invasive lobular carcinoma. NPJ Breast Cancer 2019; 5:18. [PMID: 31263747 PMCID: PMC6597578 DOI: 10.1038/s41523-019-0113-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
Invasive lobular carcinoma (ILC) is the most common special type of breast cancer, and is characterized by functional loss of E-cadherin, resulting in cellular adhesion defects. ILC typically present as estrogen receptor positive, grade 2 breast cancers, with a good short-term prognosis. Several large-scale molecular profiling studies have now dissected the unique genomics of ILC. We have undertaken an integrative analysis of gene expression and DNA copy number to identify novel drivers and prognostic biomarkers, using in-house (n = 25), METABRIC (n = 125) and TCGA (n = 146) samples. Using in silico integrative analyses, a 194-gene set was derived that is highly prognostic in ILC (P = 1.20 × 10-5)-we named this metagene 'LobSig'. Assessing a 10-year follow-up period, LobSig outperformed the Nottingham Prognostic Index, PAM50 risk-of-recurrence (Prosigna), OncotypeDx, and Genomic Grade Index (MapQuantDx) in a stepwise, multivariate Cox proportional hazards model, particularly in grade 2 ILC cases (χ 2, P = 9.0 × 10-6), which are difficult to prognosticate clinically. Importantly, LobSig status predicted outcome with 94.6% accuracy amongst cases classified as 'moderate-risk' according to Nottingham Prognostic Index in the METABRIC cohort. Network analysis identified few candidate pathways, though genesets related to proliferation were identified, and a LobSig-high phenotype was associated with the TCGA proliferative subtype (χ 2, P < 8.86 × 10-4). ILC with a poor outcome as predicted by LobSig were enriched with mutations in ERBB2, ERBB3, TP53, AKT1 and ROS1. LobSig has the potential to be a clinically relevant prognostic signature and warrants further development.
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Affiliation(s)
- Amy E. McCart Reed
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Samir Lal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
- Present Address: Pfizer Oncology Research, San Diego, CA 92121 USA
| | - Jamie R. Kutasovic
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Leesa Wockner
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD 4006 Australia
| | - Alan Robertson
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Brisbane, QLD 4072 Australia
| | - Xavier M. de Luca
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Priyakshi Kalita-de Croft
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Andrew J. Dalley
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Craig P. Coorey
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Luyu Kuo
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Kaltin Ferguson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Colleen Niland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Gregory Miller
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
- Pathology Queensland, The Royal Brisbane & Women’s Hospital, Herston, QLD 4029 Australia
| | - Julie Johnson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Lynne E. Reid
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Renique Males
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | - Jodi M. Saunus
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
| | | | - Lachlan Coin
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Brisbane, QLD 4072 Australia
| | - Sunil R. Lakhani
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
- Pathology Queensland, The Royal Brisbane & Women’s Hospital, Herston, QLD 4029 Australia
| | - Peter T. Simpson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
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Thomas M, Kelly ED, Abraham J, Kruse M. Invasive lobular breast cancer: A review of pathogenesis, diagnosis, management, and future directions of early stage disease. Semin Oncol 2019; 46:121-132. [PMID: 31239068 DOI: 10.1053/j.seminoncol.2019.03.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 01/17/2023]
Abstract
Invasive lobular carcinoma (ILC) is the second most common type of invasive breast cancer after invasive ductal carcinoma (IDC). Invasive lobular carcinoma has unique clinical, pathologic, and radiographic features which suggest that it is a distinct clinical entity; however, it is treated with the same treatment paradigms as IDC. Information regarding the specific treatment of ILC, including response to standard therapy, is sparse. Neoadjuvant treatment considerations are of great importance in this space as ILC is often found at a locally advanced stage. In this review, we summarize the classic features of ILC and the available data regarding efficacy of both endocrine therapy and chemotherapy in curative treatment of breast cancer.
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Affiliation(s)
- Mathew Thomas
- Division of Breast Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erinn Downs Kelly
- Division of Breast Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jame Abraham
- Division of Breast Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Megan Kruse
- Division of Breast Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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45
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De Gruttola I, Adil MT, D’Souza L, Jambulingam P, Whitelaw D. Perforated gastric carcinomatosis following invasive lobular cancer of the breast. Clin Case Rep 2019; 7:999-1002. [PMID: 31110734 PMCID: PMC6509928 DOI: 10.1002/ccr3.2116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/17/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Current guidelines do not advocate a routine search for gastric metastasis in known patients of breast cancer. This makes it challenging to suspect them clinically as they progress over many years. Gastric carcinomatosis from primary invasive lobular cancer can perforate leading to life-threatening abdominal emergency necessitating surgery.
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Affiliation(s)
- Ivan De Gruttola
- Department of Upper GI and Bariatric SurgeryLuton and Dunstable University HospitalLutonUK
| | - Md Tanveer Adil
- Department of Upper GI and Bariatric SurgeryLuton and Dunstable University HospitalLutonUK
| | - Lorraine D’Souza
- Department of PathologyLuton and Dunstable University HospitalLutonUK
| | | | - Douglas Whitelaw
- Department of Upper GI and Bariatric SurgeryLuton and Dunstable University HospitalLutonUK
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46
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Ede C, Benn CA, Fearnhead K, Nayler S, Rayne S. Should all lobular breast carcinoma undergo staging gastrointestinal endoscopy? Breast J 2019; 25:340-342. [PMID: 30788875 DOI: 10.1111/tbj.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Chikwendu Ede
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol-Ann Benn
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kirstin Fearnhead
- Department of Anatomical pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Simon Nayler
- Department of Anatomical pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Rayne
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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47
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Wang G, Zhou C, Conklin C, Hayes MM, Villamil CF, Ostry A, Jones EC. Metastatic breast carcinoma to the urinary bladder-a report of 11 cases including a tumor to tumor metastasis. Virchows Arch 2019; 474:333-9. [PMID: 30607556 DOI: 10.1007/s00428-018-02515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/04/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
Metastatic breast carcinoma to the urinary bladder is rare. Eleven cases of metastatic breast carcinoma to the bladder are described in this report, including one case with a tumor to tumor metastasis. The patients ranged from 51 to 83 years of age. The time intervals between the diagnosis of primary breast cancer and the occurrence of bladder metastases ranged from 41 to 336 months. There were seven cases of invasive ductal carcinoma and four cases of invasive lobular carcinoma. In one case, a lobular carcinoma of the breast metastasized to a concurrent squamous cell carcinoma of the bladder. The immunophenotypic status of estrogen receptor and Her2 expression of the metastatic carcinomas were all concordant with the primary tumors. In nine patients with follow-up available, seven patients died of the disease ranging from 1 to 23 months after the diagnosis of the bladder metastasis and two patients were alive at 5 months of follow-up. To date, this report is the largest single series of patients with breast carcinoma metastatic to the bladder. It is the first reported instance of lobular carcinoma of the breast metastasizing to a squamous cell carcinoma of the bladder.
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DiPiro PJ, Tirumani SH, Cruz GP, Ramaiya NH, Lester SC, Shinagare AB. Lobular breast cancer: patterns of intraabdominal metastatic spread on imaging and prognostic significance. Abdom Radiol (NY) 2019; 44:362-369. [PMID: 30076430 DOI: 10.1007/s00261-018-1722-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To retrospectively review the frequency, patterns and intra-abdominal sites of metastatic invasive lobular breast cancer, and to correlate the findings with overall survival. MATERIALS AND METHODS From a pathology database search revealing 327 patients with metastatic lobular breast cancer at our institution from January 2004 through August 2014, imaging was available in 116 patients (age range, 31-87 years, mean age, 55). Simple descriptive statistics were performed to record and tabulate the abdominal metastatic spread. Prognostic significance of abdominal metastases and individual abdominal metastatic sites was studied using the Log-rank test and construction of Kaplan-Meier curves. RESULTS The most frequent sites of intra-abdominal metastatic invasive lobular breast cancer were peritoneum (55 patients, 47%), followed by liver (37 patients, 32%), bowel (34 patients, 29%), ovary (33 patients, 28%), retroperitoneum (16 patients, 14%), ureter (16 patients, 14%), and lymph nodes (15 patients, 13%). Bowel obstruction was noted in 15 patients (13%) and hydronephrosis in 25 patients (22%). The median abdominal metastasis-free survival was 76 months (interquartile range: 17-191). The overall survival (OS) was 86 months (interquartile range: 49-188). Patients with abdominal metastases had shorter OS. Patients with hepatic metastases had shorter overall survival than those patients without hepatic metastases (p = 0.02, Log-Rank test). CONCLUSION Invasive lobular breast cancer has a predilection for metastasizing to both typical (liver) and atypical intra-abdominal sites (peritoneum, GI tract, and adnexa). Presence of intra-abdominal disease and hepatic metastases in patients with ILC negatively affects overall survival.
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49
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Tian W, Zhou Y, Wu M, Yao Y, Deng Y. Ovarian metastasis from breast cancer: a comprehensive review. Clin Transl Oncol 2018; 21:819-827. [DOI: 10.1007/s12094-018-02007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
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50
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Bourcier K, Fermeaux V, Leobon S, Deluche E. Lobular Breast Carcinoma Metastasis to the Thyroid Gland: Case Report and Literature Review. J Breast Cancer 2018; 21:463-467. [PMID: 30607169 PMCID: PMC6310724 DOI: 10.4048/jbc.2018.21.e55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/16/2018] [Indexed: 12/20/2022] Open
Abstract
Metastasis from primary cancer to the thyroid is uncommon in breast cancer. Here we present a case of lobular breast carcinoma that metastasized to the thyroid. A 54-year-old woman without symptoms was admitted to our institution for staging of the lymph node above the left clavicle. An 18F-fluoro-deoxy-D-glucose positron emission tomography scan was performed for staging, and low uptakes were observed in the left supraclavicular and cervical lymph nodes. High uptake was seen in the posterior and lower left lobe of the thyroid. Histologic findings indicated lobular breast carcinoma (positive GATA3, loss of E-cadherin expression) metastatic to the thyroid with a luminal profile. Immunohistochemical analysis was negative for primary thyroid or parathyroid carcinoma. To our knowledge, this is the first report of a patient presenting a metastatic invasive lobular carcinoma in the thyroid and lymph nodes without a prior diagnosis of breast cancer.
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Affiliation(s)
- Kevin Bourcier
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | | | - Sophie Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Elise Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
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