浸润性小叶癌(ILC)是浸润性乳腺癌(IBC)中最常见的特殊类型,占IBC的5-15%。ILC独特的组织形态学反映了一种特殊的肿瘤生物学,其标志是缺乏E-cadherin表达。然而,偶尔存在E-cadherin表达和无特殊类型的IBC(IBC,ILC中的NST)样形态,反之亦然,这使得诊断具有挑战性。我们介绍了两例ILC的肺泡变体,具有诊断挑战性的实体。第一例是一名81岁的女性,在1点和9点位置有两个离散的右乳房肿块。第二例是一名61岁女性,在11点和12点位置有两个离散的左乳房肿块。在这两种情况下都进行了核心针活检和随后的乳房切除术。在组织学上,在第一个病例中发现了三个肿瘤病灶.1点钟焦点显示IBC,NST,3/3级,导管原位癌(DCIS)和小叶原位癌(LCIS)。九点钟的焦点揭示了ILC,经典和肺泡变体,2/3级,而附近的第三个附带焦点是ILC,肺泡变体,两者均由缺乏E-cadherin和β-catenin免疫染色支持。第二例显示ILC,肺泡变体,活检和乳房切除术标本上11点病变中的LCIS成分为1级。12点位置的病变被诊断为IBC,NST,具有高级DCIS和LCIS组件的2级。区分ILC和IBC的肺泡变体是具有挑战性的,NST,和原位病变,因为重叠的形态和偶尔的E-cadherin表达。小叶细胞粘附的改变也可能是由于α-的丢失,β-,和γ-连环蛋白,和p120-catenin的细胞质重新定位。因此,在ILC,β-连环蛋白的缺乏可以与E-cadherin一起用作附属物。肌上皮标志物如p63和平滑肌肌球蛋白重链(SMMHC)可用于区分ILC与LCIS的肺泡变体。
Invasive lobular carcinoma (ILC) is the most common special type of invasive breast cancer (IBC), accounting for 5-15% of IBCs. The distinct histomorphology of ILC reflects a special tumor biology, the hallmark of which is the lack of E-cadherin expression. However, the occasional presence of E-cadherin expression and the presence of IBC of no special type (IBC, NST)-like morphologies in ILC and vice versa make the diagnosis challenging. We present two cases of the alveolar variant of ILC, a diagnostically challenging entity. The first
case is an 81-year-old female with two discrete right breast masses at 1 o\'clock and 9 o\'clock positions. The second
case is a 61-year-old female with two discrete left breast masses located at 11 o\'clock and 12 o\'clock positions. Core needle biopsies and subsequent mastectomy were performed in both cases. On histology, three tumor foci were identified in the first
case. The 1 o\'clock focus showed IBC, NST, grade 3/3, ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). The 9 o\'clock focus revealed ILC, classic and alveolar variants, grade 2/3, while a nearby third incidental focus was ILC, alveolar variant, both supported by lack of E-cadherin and β-catenin immunostaining. The second
case showed ILC, alveolar variant, grade 1 with LCIS component in the 11 o\'clock lesion on both biopsy and mastectomy specimens. The lesion at the 12 o\'clock position was diagnosed as IBC, NST, grade 2 with high-grade DCIS and LCIS components. It is challenging to distinguish the alveolar variant of ILC from IBC, NST, and in situ lesions because of the overlapping morphology and occasional E-cadherin expression. Altered adherence of lobular cells may also be due to loss of α-, β-, and γ-catenins, and cytoplasmic re-localization of p120-catenin. Therefore, in ILC, the lack of β-catenin can be used as an adjunct along with E-cadherin. Myoepithelial markers such as p63 and smooth muscle myosin heavy chain (SMMHC) can be used to distinguish the alveolar variant of ILC from LCIS.