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Lobular Neoplasia: Evolution of Its Significance and Morphologic Spectrum

Characterized by a solid proliferation of generally small, loosely cohesive cells in the terminal duct-lobular units, lobular intraepithelial neoplasia was first described in detail by Foote and Stewart in the 1940s, who designated it as lobular carcinoma in situ. It was noted at the time that this lesion is most often an incidental finding, multicentric and often bilateral process. Shortly after this original description, these proliferations were subdivided into atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS); mastectomy was the treatment recommended for the latter and no therapy was deemed necessary for ALH. The criteria for separation of ALH from LCIS varied significantly from one institution to another. At a time when mastectomy was the main treatment for anything designated as carcinoma in situ, one major reason for introduction of ALH was undoubtedly to prevent mastectomy for the more limited versions of the lesion.