Breast Cancer/Surgical Pathology Report
Right breast, stereotypic core biopsy result: Lobular carcinoma in situ with focal pleomorphic features and calcifications. No definite invasion identified. E-cadherin immunostains show weak staining (with respect to the benign ducts) and confirm involvement of sclerosing adenosis. The size of the expanded lobules in conjunction with the large cell size, presence of nucleoli and scattered mitotic figures with focal calcification is consistent with a diagnosis of LCIS with pleomorphic features.
An excisional biopsy with needle localization of the area revealed the following diagnosis: Florid LCIS comes to within less than 0.1 cm of the anterior margin and 0.2 cm from the medial margin; the posterior margin is equivocal for involvement of florid LCIS. No invasive carcinoma identified. Non-neoplastic changes include atypical and florid ductal hyperplasia, sclerosing adenosis with intraductal calcifications. Several sections show prominently distended acinar structures filled by cells with larger nuclei, some with notable nucleoli. E-cadherin immunostains confirm the presence of widespread LCIS, with the macroacinar foci also showing decreased staining. Immunostains do not highlight invasive carcinoma. These features are thought to represent both classic and special/florid types of LCIS, the latter due to the large cell size, macroacini and calcifications. The lack of more prominent nuclear atypia and mitotic figures in these sections falls short of pleomorphic LCIS, though some of these foci may be considered to represent hybrid LCIS-DCIS. Florid type is present in several sections.
A second opinion (re-read) on these slides stated LCIS predominantly classic and focal pleomorphic type. The lumpectomy diagnosis: LCIS, classic type, with associated microcalcifications.
I'm very concerned about my diagnosis, expecially the original pathology report and don't know what to think. I'm concerned about pleomorphic and florid LCIS. I've read that these are variants to LCIS and could behave more aggressively. The doctor seen for the second opinion recommended radiation because of pleomorphic on the core biopsy. The original surgeon does not recommend radiation because this is rare and not enough studies have been done. Is a mastectomy a reasonable approach? I don't know the level of concern I should have here. How likely will I get an invasive cancer in the future? With classic LCIS it is 1-2 percent per year, but do I have a higher grade of LCIS and therefore, am I at an even higher risk? I'm getting conflicting opinions. Everything I read about pleomorphic and florid LCIS concerns me. Please help.
I understand your concern and confusion. Your risk is higher than with a normal cancer in situ (cancer stage 0) because of the cell signs of higher activity here. But it is - as far as we now know - not - yet - an invasive cancer. In cancer in situ cases the normal procedure is just lumpectomy followed by whole breast radiation therapy and that has statistically just as good results as mastectomy. Here with these higher activity signs there may be more reasons to be more active. Mastectomy may be an alternative to the procedure above but if so the logical conclusion must be to consider bilateral mastectomy since the risk is probably increased also in the other breast. I'm not sure you need to be that radical. A lumpectomy followed by radiation therapy AND frequent bilateral MRI breast scan check ups may be good enough. MRI because it will be better to find any malignancies AND to be able to check your breasts even though there is sclerosing adenosis there and probably also higher breast tissue density in general (and it will not give you any extra radiation burden). But of course the choice is yours! Do what will make you as comfortable as possible! Good luck!
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