The Incidence of Concurrent Lobular Carcinoma In Situ (LCIS), Columnar Cell Lesions (CCL) and Tubular Carcinoma (TC): An Analysis of 105 Cases
I Alvarado-Cabrero, ME Rojas-Torres, V Rubio. Mexican Oncology Hospital, Mexico, DF, Mexico
Background: Recent study (Brandt, et al, Adv in Anat Pathol 2008; 15(3): 140-6) have described a strong association between LCIS, CCL and TC. The Rosen Triad, named in tribute to its first categorical description by the eponymous pathologist, is a morphological observation that may have important clinical and pathologic implications. There is no appreciable literature that addresses the simultaneous occurrence of these 3 lesions. In this study, our aim was to evaluate the frequency of this triad in our patient population.
Design: The archives of the Department of Pathology, Mexican Oncology Hospital were retrospectively searched to identify cases of TC diagnosed from 1999 to 2007. Only excisional biopsies or mastectomies were included. TC was composed of more than 90% ducts that were well formed with a single layer of epithelial cells with low grade nuclei and separated by a desmoplastic stroma. The CCLs were classified into 3 different categories (CCL without hyperplasia, CCLs with hyperplasia lacking atypia, and CCLs with atypia). LCIS was defined as a population of neoplastic cells causing expansion and enlargement of the lobules. We also examined various clinical factors (age, presentation, tumor size). The presence of an associated ductal carcinoma in situ (DCIS) was also assessed. Sections from each case were evaluated by immunohistochemistry with hormonal receptors (ER, PR) and Her 2/neu.
Results: We identified 105 patients with Tubular Carcinoma with a mean age at diagnosis of 55 yr, the mean tumor size was 1.5cm. All patients presented with a radiographically detected mass. None of the patients were found to have multifocal or multicentric tumors. In 63 of 105(60%) cases of TC, both LCIS and at least one type of CCL were identified. All elements of the triad coexisted within the same space. In the triad group, CCLs with atypia were identified in 44 of 63 patients(70%), 22% (14/63) cases were associated with CCLs with hyperplasia without atypia. DCIS was present in 26 of 63(41%) triad cases. All 3 lesions (TC, CCL and LCIS) were ER positive, PR positive and Her-2/neu negative.
Conclusions: Our study of 105 patients shows that TC is often associated with CCL and LCIS (60% of cases). These results are consistent with the study of Brandt et al. These findings support the hypothesis that TC and LCIS have direct evolutionary links to CCLs.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 21, Tuesday Afternoon