Invasive lobular carcinoma is characterized microscopically by malignant monomorphic cells that form loosely dispersed linear columns that invade the normal tissues and encircle ducts. Compare this behavior with that of invasive carcinoma of no special type ductal not otherwise specified , which more commonly presents as a mass with vigorous desmoplastic response. Cells of invasive lobular carcinoma often preserve the architecture of the ducts, which limits the sensitivity of detection using mammography. Most invasive lobular carcinoma are grade 2 in the Nottingham histological grading system Therefore imaging evaluation of the contralateral breast is crucial.
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Heloisa Z. Rocha 1. Graciele C. Manica 1. Edneia A. Ramos 1. Breast cancer is the second leading cause of cancer death among women worldwide, and epidemiological studies may help understanding its mechanisms. Three hundred twenty-seven From these cases, 27 7.
Regarding the Nottingham score, most cases were intermediate grade Moreover, The breast carcinomas evaluated in this study presented a profile similar to that reported in the literature, with some peculiarities inherent to the local pathology service.
Nevertheless, the low frequency of in situ cases indicates failure in early diagnosis. Los carcinomas de mama evaluados en este estudio presentaron perfil semejante al expuesto en la literatura, con algunaspeculiaridades inherentes al servicio local. Breast cancer is the most common and the second leading cause of cancer death among women worldwide 1 , 2. Although the statistics account for it as a single disease, it is known that it has several anatomopathological classifications and distinct carcinogenesis models, as well as specific epidemiological trends 3 - 6.
In addition, invasive breast carcinoma are also categorized according to the immunophenotypic profile, through the immunohistochemical study for estrogen receptor ER , progesterone receptor PR and human epidermal growth factor receptor 2 HER2 , important prognostic and predictive markers, that will define the treatment and clinical management 3 - 5 , 7.
Anatomopathological evaluation is essential for the definition of therapeutic approach and prognosis. The same applies to epidemiological study, which defines the at-risk populations and disease screening protocol 5 , 7. A retrospective and analytical evaluation of anatomopathological reports with diagnosis of ductal, special types or lobular breast carcinoma confirmed in the HC-UFPR was performed.
From the data available at the Department of Pathology of the HC-UFPR, the search and selection method consisted of cases with diagnosis of ductal, lobular or special types of breast carcinoma performed during the period. The exclusion criteria were biopsies with results of other mammary pathologies, undetermined reports or with no the histological classification of carcinoma type.
After the previous selection of the reports, the carcinomas were qualified and categorized according to the usual nomenclature of ductal carcinoma in situ DCIS , lobular carcinoma in situ LCIS and invasive mammary carcinoma [invasive ductal carcinoma IDC , special types and invasive lobular carcinoma ILC ]. Results regarding the hormone receptor expression were obtained.
In the period between and , cases of ductal, special types or lobular breast cancer were diagnosed in the HC-UFPR. On average, there were approximately 60 diagnoses per year, which corresponds to five new cases per month Figure 1. The trendline shows a declining line for ductal carcinomas over the years. In the whole sample 27 7. Whereas the invasive carcinomas totaled cases Table 1 shows these data according to the type and histological subtype of each carcinoma.
Anatomopathological and epidemiological data on the diagnosed tumors were evaluated Table 2. Then, the lobular in situ with NA: not available in report. In almost all cases cases , carcinomas were observed in female subjects By contrast, On the other hand, No histology was significantly related to HER2, in spite of what was observed in the frequency Table 2.
It should be noted that the large number of reports of carcinomas with lack of relevant anatomopathological information IHC, tumor size, lymph node description, SBR grade or histological sub classification can be considered a limiting factor in the results, but especially in the therapeutic approach. However, for these analyzes, these samples were taken from the statistical evaluation according to the missing variable.
Therefore the HC-UFPR cases are close to the usual statistics for IDC and special types carcinomas, but shown to be decreased in relation to the expected mean for lobular carcinomas. The ILC diagnoses 6. The reason for this deviation may be related to the biological characteristics of lobular carcinoma, which, in its in situ form, is usually an incidental finding during biopsy, and in the invasive form it produces few mammographic and clinical changes 5 , 7.
Therefore, the diagnosis of this type of tumor is more difficult, which contributes to the low frequency in the HC-UFPR statistics. On the other hand, 7. However, the HC-UFPR showed that the pre-invasive diagnoses did not even come close to representing the internationally recommended value for new cases of breast malignancy. Strengthening this finding, it was verified that the invasive lesions showed a significant relation with patients older than or equal to 50 years of age, which should have the guarantee of early mammography findings Table 3.
The data point to the inefficiency of the breast cancer screening system in Curitiba, whether for the diagnosis or the referral of early cases, mainly DCIS. Regarding the first hypothesis, the screening of breast cancer in the city may not be inadequate, conversely, its organized screening configuration is a model for the country through the Curitibana Woman Program, implemented in primary care One of the possibilities is patient's non-compliance to the Program or even the existence of difficulties to implement it correctly.
The second hypothesis raised would also be reasonable, since the Erasto Gaertner Hospital is the municipal reference for cancer treatment, and it is obvious that it receives more cases than the HC-UFPR. However, the number of referrals issue only seems to be insufficient to justify such a low pre-invasive carcinoma index.
It is known that the histological grade of the tumor is directly related to the number of aberrant molecular alterations of the cell, the frequency of lymph node metastases, the recurrence of the disease and death, being, therefore, an important prognostic factor. Therefore, the histological grade is very relevant for breast cancer 3 , 4 , 6.
It can be inferred that IDC are responsible for the predominance of cases in grade 2, since the special types tend to be more homogeneous, with the exception of the medullary, which are usually high degree.
This finding strengthens the data in the literature, which demonstrate that ductal carcinomas present great heterogeneity 3 , 4 , 6. Regarding the evaluated cases, the staging found Table 2 disagrees with the recent literature.
Although the screening system have failed to diagnose DCIS, it certainly had the merit of increasing the number of early IDC or special-type carcinomas diagnoses, which may have a relatively good prognosis 7. However, we are still short of what is seen in developed countries, where diagnoses of DCIS are more common and the incidence of IDC tends to drop and stabilization 5 , 10 , Despite the lower histological aggressiveness of this tumor, its unique biological characteristics make diagnosis difficult 5.
Stage I was less frequent among lobular 3. The literature itself confirms this profile, indicating that lobular and ductal-lobular carcinomas tend to be diagnosed in more advanced Stages III and IV , with tumor size greater than 5 centimeters and positive lymph node 5. In the case of metastases, this tumor also contrasts with the IDC, since it has a higher frequency in the gastrointestinal tract, peritoneum, retroperitoneum, ovaries and meninges 3 , 4 , 7.
Therefore, the increasing availability of hormonal therapies and the prognostic value of the receptors emphasizes the importance of knowing IHC of breast tumors The expression of HER2 appears high This fact can: 1. Regarding the lobular carcinomas, the expression of hormone receptors corresponded to that provided by the literature Once again, this can be justified by the IHC criterion or may represent aggressive trends for the cases described. Despite this finding, there was no significant relationship of HER2 with any histology Table 3.
However, the HER2expression, when related to histology, was not statistically relevant, although the literature expected the lobular carcinomas trend not to express it Tables 2 and 3. This epidemiological survey found that ductal and lobular breast carcinomas diagnosed in the HC-UFPR between and , in general, presented a profile similar to that presented in the literature, with some peculiarities inherent to the local service. Findings consistent with other studies included a greater number of Nottingham grade 2 cases in the evaluated histology and rare grade 3 cases in the lobular neoplasia.
Cancer statistics, CA Cancer J Clin. Breast cancer precursors revisited: molecular features and progression pathways. Molecular and morphologic distinctions between infiltrating ductal and lobular carcinoma of the breast. Breast J.
Clinical characteristics of different histologic types of breast cancer. Br J Cancer. Ductal carcinoma in situ of the breast. N Engl J Med. Rotinas em mastologia. Porto Alegre: Artmed; WHO classification of tumours of the breast. Lyon: IARC; Ductal carcinoma in situ: terminology, classification, and natural history. J Natl Cancer Inst Monogr. Age-specific incidence rates of in situ breast carcinomas by histologic type, to Cancer Epidemiol Biomarkers Prev. Changing incidence of invasive lobular breast carcinoma among older women.
Different gene expression. Mol Biol Cell. Prognostic value of morphology and hormone receptor status in breast cancer - a population-based study. Breast cancer metastasis: markers and models. Nat Rev Cancer. Down regulation of ADAM33 as a predictive biomarker of aggressive breast cancer. Sci Rep. PMID: This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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