|Year : 2016 | Volume
| Issue : 3 | Page : 363-365
The pattern of invasive lobular carcinoma in the patients diagnosed with breast cancer from Balochistan
AH Baloch1, AN Khosa1, N Bangulzai1, H Sadia2, M Ahmed3, F Khan3, M Jan1, M Tareen3, MH Kakar1, J Shuja3, HK Naseeb3, J Ahmad4
1 Department of Livestock Management, Faculty of Veterinary and Animal Sciences, Lasbela University of Agriculture, Water and Marine Sciences, Uthal, Balochistan, Pakistan
2 Department of Biotechnology, Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
3 Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
4 Department of Biotechnology, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
|Date of Web Publication||24-Feb-2017|
Department of Livestock Management, Faculty of Veterinary and Animal Sciences, Lasbela University of Agriculture, Water and Marine Sciences, Uthal, Balochistan
Source of Support: None, Conflict of Interest: None
Introduction: Invasive lobular carcinoma (ILC) is the second most common type of breast cancer accounting for 5%–15% of all the breast cancer cases. The present study was performed on 171 breast cancer patients from Balochistan registered in CENAR (Center for Nuclear Medicine and Radiotherapy), Quetta. Materials and Methods: Written consent was obtained from the patients. The history of the disease was taken from the patients, and the patients' enrollment files were retrieved. Results: Of the 171 patients, 5 (2.96%) were diagnosed with ILC with tumor Grade II, and stage of the cancer reported was Grade III in all the 5 patients affected with ILC. Conclusion: ILC is the second most common type of breast cancer diagnosed with comparatively lower grade but almost reported infiltrating.
Keywords: Balochistan, breast, carcinoma, infiltrating, invasive lobular carcinoma, lobular
|How to cite this article:|
Baloch A, Khosa A, Bangulzai N, Sadia H, Ahmed M, Khan F, Jan M, Tareen M, Kakar M, Shuja J, Naseeb H, Ahmad J. The pattern of invasive lobular carcinoma in the patients diagnosed with breast cancer from Balochistan. Indian J Cancer 2016;53:363-5
|How to cite this URL:|
Baloch A, Khosa A, Bangulzai N, Sadia H, Ahmed M, Khan F, Jan M, Tareen M, Kakar M, Shuja J, Naseeb H, Ahmad J. The pattern of invasive lobular carcinoma in the patients diagnosed with breast cancer from Balochistan. Indian J Cancer [serial online] 2016 [cited 2017 Apr 30];53:363-5. Available from: http://www.indianjcancer.com/text.asp?2016/53/3/363/200672
| » Introduction|| |
Breast cancer is the most commonly diagnosed cancer among women worldwide, and it is a diverse disease classified into various clinical types and subtypes based on histological, biological, and pathological features, clinical appearance, and behavior of the disease.,
Invasive lobular carcinoma (ILC), also referred as infiltrating lobular carcinoma, affects the milk-producing glands, the lobules of the breast tissue, with the capacity of metastasizing to the other parts of the body. It is the second most common type of breast cancer after invasive ductal carcinoma (IDC) accounting for 5%–15% of all the breast cancer cases.,,,,,,,,,, The cases of ILC are considered to be diagnosed comparatively with a lower grade, with almost good prognosis, and estrogen receptors-positive, but almost found infiltrating.,, ILCs cannot be easily palpated and captured mammographically with a diverse pattern of metastasis., ILCs are classified as pleomorphic, classic, Signet ring cells (malignant cells with large vacuoles) alveolar carcinoma, tubule-lobular, and solid subtypes. Variations in the characteristics are associated with the patients' population and different diagnostic methods.,,
The present study was performed on 171 breast cancer patients, >95% patients were diagnosed with IDC and 2.96% patients were diagnosed with ILC. Our objective in the current study was to investigate the occurrence and diverse pattern of ILC in the region.
| » Materials and Methods|| |
The current study was performed on 171 breast cancer patients from different areas of Balochistan registered in CENAR (Center for Nuclear Medicine and Radiotherapy), Quetta, for treatment. After agreement with the patients taking part in the study as volunteers, a written consent was obtained from all the patients.
The patients were interviewed about the history of the disease; the questions asked to the patients were about the ethnicity, marital status, fertility, pregnancy history, occurrence/onset of the disease, age at the onset of the disease, date of diagnosis, family history, dietary pattern and smoking history, and exposure to X-rays before the onset of the disease.
The files of the patients were retrieved and the clinical/diagnosed reports were recorded from the files. Age and body mass index (BMI) of the patients were also recorded.
| » Results|| |
Of the 171 breast cancer patients, 5 (2.96%) were diagnosed with ILC, 162 patients (95.86%) were diagnosed with IDC, whereas the other cases reported were 2 male patients diagnosed with breast cancer (primary lymphoma of breast), and 2 patients were reported to be diagnosed with ductal carcinoma in situ. Ethnicity of the patients included two patients were from Punjabi ethnic group and one from each Pashtun, Hazara, and Sindhi ethnic groups diagnosed with ILC of breast. BMI of the patients was also recorded, three patients were reported overweight and two patients were with normal BMI. The mean age of the patients was 49.6 years diagnosed with ILC, whereas three patients were diagnosed with ILC at postmenopausal age and two were diagnosed at premenopausal age. Out of the five cases of ILC, three patients were estrogen receptor and progesterone receptor (ERPR)-positive. All the five cases of ILC were diagnosed with tumor Grade II and the stage of the cancer was reported Grade III. Left breast tissue was affected in three patients and the right breast tissue was affected in two patients. Metastasis to the lymph nodes in all the five cases was high; the mean number of lymph nodes involved by tumor was 8.9. Dermis of the areola and nipple was involved in two breast cancer cases, whereas in one of the two cases, the pagetoid spread was also observed. Perinodal extension was reported in all the five cases.
| » Discussion|| |
ILC is quite a diverse form of breast cancer affecting the milk-producing glands (lobules) of the breast tissue. The metastatic pattern of ILC is almost similar to that of IDC; however, it is considered to spread unusual sites most commonly.,
The present study was performed to figure out the diverse pattern and prevalence of ILC. In the current study, we investigated the cases of ILC among the patients of breast cancer from different areas of Balochistan registered in the CENAR for chemo- and radio-therapies. ILC accounts for 5%–10% of all the breast cancer cases preceded by IDC that comprised 85%–95% of the breast cancer cases. In the current study, we identified 5 patients with ILC (2.96%) of all the breast cancer cases registered in CENAR during the period of current study was performed. Studies conducted in different areas of Pakistan proposing the cases of ILC 7%, 2%, and 2.98%, whereas the statistics from other part of the world suggest that 5-10% of all the breast cancer cases are reported as ILC., Incidences of ILC are most often reported to occur in postmenopausal age.,,,, In the present study, out of five cases, three patients were diagnosed at postmenopausal age, and the mean age of all patients with ILC was 49.6. ILC cases are reported to be positive with estrogen and progesterone receptors-positive and almost found infiltrating.,,,,, The current study revealed three cases with ERPR positive, and lymph node invasion was found in all the five cases with a mean of 8.9 of lymph nodes invaded by tumor.
| » Conclusion|| |
ILC is the second most common type of breast cancer affecting the lobules of the breast tissue and is a polycentric malignancy affecting the breast tissue with diverse pattern of invasion to other parts of the body.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Sharma GN, Dave R, Sanadya J, Sharma P, Sharma KK. Various types and management of breast cancer: An overview. J Adv Pharm Technol Res 2010;1:109-26.
Weigelt B, Geyer FC, Reis-Filho JS. Histological types of breast cancer: How special are they? Mol Oncol 2010;4:192-208.
Couch FJ, Kuchenbaecker KB, Michailidou K, Mendoza-Fandino GA, Nord S, Lilyquist J, et al.
Identification of four novel susceptibility loci for oestrogen receptor negative breast cancer. Nat Commun 2016;7:11375.
Oberman HA. Sarcomas of the breast. Cancer 1965;18:1233-43.
Wellings SR, Jensen HM, Marcum RG. An atlas of subgross pathology of the human breast with special reference to possible precancerous lesions. J Natl Cancer Inst 1975;55:231-73.
Fisher ER, Gregorio RM, Fisher B, Redmond C, Vellios F, Sommers SC. The pathology of invasive breast cancer. A syllabus derived from findings of the national surgical adjuvant breast project (protocol no 4). Cancer 1975;36:1-85.
Martinez V, Azzopardi JG. Invasive lobular carcinoma of the breast: Incidence and variants. Histopathology 1979;3:467-88.
The World Health Organization histological typing of breast tumors – Second edition. The World Health Organization. Am J Clin Pathol 1982;78:806-16.
Borst MJ, Ingold JA. Metastatic patterns of invasive lobular versus invasive ductal carcinoma of the breast. Surgery 1993;114:637-41.
Meijers-Heijboer H, van den Ouweland A, Klijn J, Wasielewski M, de Snoo A, Oldenburg R, et al.
Low-penetrance susceptibility to breast cancer due to CHEK2(*) 1100delC in noncarriers of BRCA1 or BRCA2 mutations. Nat Genet 2002;31:55-9.
Ludwig JA. Personalized therapy of sarcomas: Integration of biomarkers for improved diagnosis, prognosis, and therapy selection. Curr Oncol Rep 2008;10:329-37.
Rosa M, Mohammadi A, Masood S. Lobular carcinoma of the breast with extracellular mucin: New variant of mucin-producing carcinomas? Pathol Int 2009;59:405-9.
Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, Van de Vijver MJ, editors. WHO Classification of Tumours of the Breast. 4th
ed. Lyon: IARC; 2012.
Baloch AH, Shuja J, Daud S, Ahmed M, Ahmad A, Tareen M, et al.
Various aspects, patterns and risk factors in breast cancer patients of Balochistan. Asian Pac J Cancer Prev 2012;13:4013-6.
Rakha EA, El-Sayed ME, Powe DG, Green AR, Habashy H, Grainge MJ, et al.
Invasive lobular carcinoma of the breast: Response to hormonal therapy and outcomes. Eur J Cancer 2008;44:73-83.
Pestalozzi BC, Zahrieh D, Mallon E, Gusterson BA, Price KN, Gelber RD, et al.
Distinct clinical and prognostic features of infiltrating lobular carcinoma of the breast: Combined results of 15 International Breast Cancer Study Group clinical trials. J Clin Oncol 2008;26:3006-14.
McCart Reed AE, Kutasovic JR, Lakhani SR, Simpson PT. Invasive lobular carcinoma of the breast: Morphology, biomarkers and 'omics. Breast Cancer Res 2015;17:12.
Harris M, Howell A, Chrissohou M, Swindell RI, Hudson M, Sellwood RA. A comparison of the metastatic pattern of infiltrating lobular carcinoma and infiltrating duct carcinoma of the breast. Br J Cancer 1984;50:23-30.
Lamovec J, Bracko M. Metastatic pattern of infiltrating lobular carcinoma of the breast: An autopsy study. J Surg Oncol 1991;48:28-33.
Fechner RE. Histologic variants of infiltrating lobular carcinoma of the breast. Hum Pathol 1975;6:373-8.
Wheeler JE, Enterline HT. Lobular carcinoma of the breast in situ
and infiltrating. Pathol Annu 1976;11:161-88.
Selinko VL, Middleton LP, Dempsey PJ. Role of sonography in diagnosing and staging invasive lobular carcinoma. J Clin Ultrasound 2004;32:323-32.
Winchester DJ, Chang HR, Graves TA, Menck HR, Bland KI, Winchester DP. A comparative analysis of lobular and ductal carcinoma of the breast: Presentation, treatment, and outcomes. J Am Coll Surg 1998;186:416-22.
Sobinsky JD, Willson TD, Podbielski FJ, Connolly MM. Unusual metastatic patterns of invasive lobular carcinoma of the breast. Case Rep Oncol Med 2013;2013:986517.
Li CI, Uribe DJ, Daling JR. Clinical characteristics of different histologic types of breast cancer. Br J Cancer 2005;93:1046-52.
Mamoon N, Sharif MA, Mushtaq S, Khadim MT, Jamal S. Breast carcinoma over three decades in Northern Pakistan – Are we getting anywhere? J Pak Med Assoc 2009;59:835-8.
Khokher S, Qureshi MU, Riaz M, Akhtar N, Saleem A. Clinicopathologic profile of breast cancer patients in Pakistan: Ten years data of a local cancer hospital. Asian Pac J Cancer Prev 2012;13:693-8.
Mulholland MW, Lillemoe KD, Doherty GM, Maier RV, Simeone DM, Upchurch Jr. Greenfield's Surgery: Scientific Principles and Practice. 5th
ed., Vol. 74. Philadelphia, PA, USA: Lippincott Williams & Wilkins; 2011.
Lesser ML, Rosen PP, Kinne DW. Multicentricity and bilaterality in invasive breast carcinoma. Surgery 1982;91:234-40.
Li CI, Anderson BO, Porter P, Holt SK, Daling JR, Moe RE. Changing incidence rate of invasive lobular breast carcinoma among older women. Cancer 2000;88:2561-9.
Intra M, Rotmensz N, Viale G, Mariani L, Bonanni B, Mastropasqua MG, et al.
Clinicopathologic characteristics of 143 patients with synchronous bilateral invasive breast carcinomas treated in a single institution. Cancer 2004;101:905-12.
Fortunato L, Mascaro A, Poccia I, Andrich R, Amini M, Costarelli L, et al.
Lobular breast cancer: Same survival and local control compared with ductal cancer, but should both be treated the same way? Analysis of an institutional database over a 10-year period. Ann Surg Oncol 2012;19:1107-14.
Gann PH, Colilla SA, Gapstur SM, Winchester DJ, Winchester DP. Factors associated with axillary lymph node metastasis from breast carcinoma: Descriptive and predictive analyses. Cancer 1999;86:1511-9.
Voogd AC, Coebergh JW, Repelaer van Driel OJ, Roumen RM, van Beek MW, Vreugdenhil A, et al.
The risk of nodal metastases in breast cancer patients with clinically negative lymph nodes: A population-based analysis. Breast Cancer Res Treat 2000;62:63-9.
Vandorpe T, Smeets A, Van Calster B, Van Hoorde K, Leunen K, Amant F, et al.
Lobular and non-lobular breast cancers differ regarding axillary lymph node metastasis: A cross-sectional study on 4,292 consecutive patients. Breast Cancer Res Treat 2011;128:429-35.