Lymphocytic Lobulitis and Type2 and 3 Lobules Are Seen More Frenquently in Prophylactic Mastectomy from Women with BRCA Mutation.
Andy L Lo, Savvas E Mendrinos. NYU School of Medicine, New York, NY
Background: A woman's risk of developing breast cancer is greatly increased if she inherits a deleterious BRCA1 or BRCA2 mutation, and past studies have demonstrated a higher number of premalignant lesions in breast specimens of BRCA patients who undergo prophylactic mastectomy. There is not, however, a great deal of literature examining benign findings or histological changes in these patients.
Design: 30 consecutive cases of BRCA positive patients who underwent bilateral prophylactic mastectomies without atypical findings and 37 age-matched controls that were BRCA negative who underwent breast reduction surgery with no atypical findings, between 2005 and 2010, were examined. Predominant and secondary lobule types were recorded, as was the presence or absence of ductal hyperplasia, papillomas, lymphocytic lobulitis, radial scar, fibroadenomatous change, apocrine change and pseudoangiomatous stromal hyperplasia in accordance with established criteria. Lymphocytic lobulitis was defined as a diffuse increase in the number of lymphocytes in the intralobular specialized and perilobular stroma, present in >50% of the lobules.
Results: Lymphocytic lobulitis was identified in a larger number of BRCA positive prophylactic mastectomies (22/30 versus 2/37, p=<0.001). Additionally, BRCA patients showed a greater propensity to exhibit type 3 lobules as either the predominant or secondary lobule type, in contrast to patients in the breast reduction group (33% vs 5%). We also noted that in lobulitis positive cases with both a predominant and secondary lobule type, the lobulitis was more prominent in lobules of higher designation (types 2 and 3). No other significant differences identified.
Conclusions: Our study demonstrates that there is a significant difference in presence of lobulitis between patients with and without the BRCA mutation. Additionally, BRCA positive patients may demonstrate a different distribution of lobule types, in comparison to controls, and lobulitis may preferentially focus on these differences. Further studies are required to define possible relationships between BRCA status, lymphocytic lobulitis, lobule types, and possible cancer development.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 22, Monday Morning