Invasive Lobular Carcinoma of the Breast I

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Invasive lobular carcinoma (ILC):
    • Is a diverse group of tumors that share common features:
      • Loss of E-cadherin
      • Dyscohesive growth pattern:
        • With less tissue reaction
  • They are broadly classified into two main entities:
    • In Situ (LCIS):
      • Three entities:
        • Classic
        • Florid
        • Pleomorphic
  • Invasive (ILC):
    • Two entities:
      • Classic
      • Aggressive variants
  • Each entity has unique:
    • Histology, clinical behavior, and management decisions
  • Classic LCIS:
    • Type A and Type B:
      • Slight differences in histology
      • Same treatment
    • On needle core biopsy (NCB):
      • B3 (lesion of uncertain malignant potential) with atypia:
        • Requires a vacuum assisted excision (VAE) to exclude higher risk lesions
    • LCIS is considered a risk factor for increase risk of developing breast cancer:
      • Requires close follow-up
      • No need for complete excision or negative margins
  • Florid LCIS (mass forming or necrotizing LCIS):
    • Mimic solid DCIS or comedo DCIS on H and E but E-cadherin negative
    • Recommendation:
      • Excision because there is a higher risk of coexisting invasion
      • Margins and radiation therapy should be discussed if no invasion
  • Pleomorphic LCIS:
    • High grade nuclei, higher risk of HER2+, ER negative, and invasion
    • B5a indicates a diagnosis of LCIS classified as a “high-grade” or “definite malignancy” based on the “B5” category:
      • Which usually signifies a cancerous finding on a core needle biopsy, meaning the cells are abnormal and considered
    • Requires excision
    • Managed as DCIS
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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