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Pleomorphic Lobular Carcinoma: A Controversially Aggressive Variant of Invasive Lobular Carcinoma of the Breast

An 89-year-old woman presented with a persistent breast mass of several months duration. She had a history of stage I, T1N0 invasive lobular carcinoma (ILC) of the ipsilateral breast 23 years prior for which she underwent lumpectomy with axillary lymph node dissection, followed by radiation therapy. Per report, the pathology showed ILC that was positive for estrogen receptor (ER) progesterone receptor (PR) and HER-2/neu, and 15 uninvolved lymph nodes. Mammogram showed increased density at the site of prior lumpectomy. Subsequent ultrasound (US) confirmed the findings in addition to an abnormally enlarged axillary lymph node. Magnetic resonance imaging showed a 10 × 8 × 5 cm multicentric non–mass-enhancing area extending from the skin anteriorly to the pectoralis major muscle posteriorly. Also, an enhancing lesion was concerning for osseous metastasis. US-guided core needle biopsy showed neoplastic cells with a predominantly sheet-like growth pattern of discohesive tumor cells and focal single-file growth characteristic of ILC (Figure 1A and B). The tumor cells had moderate to abundant eosinophilic cytoplasm with occasional cytoplasmic mucin and vacuolation. There was marked nuclear 744878 IJSXXX10.1177/1066896917744878International Journal of Surgical PathologyAbdelkader and Jorns research-article2017