Clinical Outcome in Pleomorphic Lobular Carcinoma
Sonia Narendra, Sarah M Jenkins, Roberto G Gamez, Aziza Nassar. Mayo Clinic, Rochester, MN
Background: Pleomorphic lobular carcinoma (PLC) was first described by Dixon et al. in 1982 as a variant of infiltrating lobular carcinoma (ILC). It has a typical architectural pattern of ILC; however, the neoplastic cells show marked nuclear atypia and pleomorphism. This variant is known to be multicentric and bilateral. Multiple studies have been performed that have shown a decrease in overall survival when compared to classic ILC. This study was undertaken to assess the overall outcome of patients with diagnosis of PLC and to assess the treatment modalities offered to patients with PLC.
Design: 39 cases of PLC were retrieved from the pathology files between 1985-2010. The H&E slides were reviewed and E-cadherin performed on all cases for confirmation. Clinical data was assessed and analyzed for patient age, time of diagnosis, type of surgical treatment, lymph node status, post-surgical treatment including radiation, hormonal and chemotherapy, recurrence and metastases, ER, PR and HER2 receptor status.
Results: Median age at the time of diagnosis was 61 years (range from 35.0 to 86.0). Of the 39 cases, 66.7% (26 patients) underwent mastectomy and 35.9% (14) had wide local excision. One patient underwent both mastectomy and wide local excision (WLE). The mean tumor size was 3.0 cm (range from 0.3 to 17.5 cm). Lymph node status was available for 38 patients. Most patients (52.6%, n=20) did not have any positive nodes, 21.1% (n=8) had 1-3 positive nodes, and 26.3% (n=10) had more than 3 positive nodes. In-situ component was present in 89.5% (34 of 38 patients for which data were available). Hormonal treatment was given to 48.7% (19 patients), chemotherapy to 41% (16) and radiation to 56.4% (22). The receptor status was available on 38 patients and 92.1% were ER positive, 71.1% were PR positive and 9.7% were HER2 positive. Almost one-third cases (33.3%) had recurrence or metastases. After a follow-up ranging from 208 days to 32 years, 7.7% are alive with disease, 79.5% are alive with no disease and 12.8% died of disease.
Conclusions: Our study showed that there was significantly higher risk of recurrence/metastases for stage N3 (p=0.02), WLE (p=0.03), more positive lymph nodes (p=0.003), and older age (p=0.03). The estimated median time-to-recurrence/metastasis (Kaplan-Meier) was 12.4 years (95% CI: 6.9 to 23.6).
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 1, Tuesday Afternoon