Skip to main content

Advertisement

SpringerLink
Log in

The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology

  • Preclinical Study
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Although invasive ductal (IDC) and lobular (ILC) breast carcinomas are well characterised in the literature, the biological and clinical significance of mixed tumours with both ductal and lobular components has not been investigated. In the current study, we have examined a well-characterised series of breast carcinoma with a long term follow-up that comprised 140 mixed tumours, 2170 IDC and 380 pure ILC. Results: Mixed tumours constituted 3.6% of all cases. The majority (59%) of the mixed tumours were grade 2 compared to 33% in IDC and 88% in ILC. Positive lymph nodes (LN) were found in 41% and definite vascular invasion (VI) in 26% of the cases. DCIS was detected in 123 (89%) and LCIS in 43 (31%) (both DCIS and LCIS were found in 39 cases). The majority of tumours were predominantly (>50 of tumour area) of ductal type (57%). When compared to pure IDC, mixed tumours showed an association with lower grade, ER positivity and lower frequency of development of distant metastases. When compared to pure ILC, mixed tumours showed an association with higher grade, positive LN metastasis, VI and development of regional metastasis. After adjustment for grade most of these differences were no longer apparent. There was an association between histologic type of carcinoma in LN metastasis and the predominant histologic type of the primary tumour. Mixed tumours showed metastatic patterns similar to that of ILC with frequent metastasis to bone. No clinically meaningful differences in survival were found between these mixed carcinomas and pure IDC or ILC of the breast or between mixed tumours with predominantly ductal or lobular phenotype.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sastre-Garau X, Jouve M, Asselain B et al (1996) Infiltrating lobular carcinoma of the breast. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns. Cancer 77(1):113–120

    Article  PubMed  CAS  Google Scholar 

  2. Lamovec J, Bracko M (1991) Metastatic pattern of infiltrating lobular carcinoma of the breast: an autopsy study. J Surg Oncol 48(1):28–33

    Article  PubMed  CAS  Google Scholar 

  3. Arpino G, Bardou VJ, Clark GM, Elledge RM (2004) Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res 6(3):R149–R156

    Article  PubMed  Google Scholar 

  4. Borst MJ, Ingold JA (1993) Metastatic patterns of invasive lobular versus invasive ductal carcinoma of the breast. Surgery 114(4):637–641. Discussion 41–42

    PubMed  CAS  Google Scholar 

  5. Li CI, Anderson BO, Daling JR, Moe RE (2003) Trends in incidence rates of invasive lobular and ductal breast carcinoma. JAMA 289(11):1421–1424

    Article  PubMed  Google Scholar 

  6. Ellis IO, Galea M, Broughton N et al (1992) Pathological prognostic factors in breast cancer II. Histological type. Relationship with survival in a large study with long-term follow-up. Histopathology 20(6):479–489

    PubMed  CAS  Google Scholar 

  7. Reeves GK, Beral V, Green J, Gathani T, Bull D (2006) Hormonal therapy for menopause and breast-cancer risk by histological type: a cohort study and meta-analysis. Lancet Oncol 7(11):910–918

    Article  PubMed  CAS  Google Scholar 

  8. Li CI, Anderson BO, Porter P et al (2000) Changing incidence rate of invasive lobular breast carcinoma among older women. Cancer 88(11):2561–2569

    Article  PubMed  CAS  Google Scholar 

  9. Molland JG, Donnellan M, Janu NC et al (2004) Infiltrating lobular carcinoma—a comparison of diagnosis, management and outcome with infiltrating duct carcinoma. Breast 13(5):389–396

    Article  PubMed  CAS  Google Scholar 

  10. Yoder BJ, Wilkinson EJ, Massoll NA (2007) Molecular and morphologic distinctions between infiltrating ductal and lobular carcinoma of the breast. Breast J 13(2):172–179

    Article  PubMed  CAS  Google Scholar 

  11. Rakha EA, El-Sayed ME, Powe DG et al (2008) Invasive lobular carcinoma of the breast: Response to hormonal therapy and outcomes. Eur J Cancer 44(1):73–83

    Article  PubMed  Google Scholar 

  12. Li CI, Daling JR, Malone KE et al (2006) Relationship between established breast cancer risk factors and risk of seven different histologic types of invasive breast cancer. Cancer Epidemiol Biomarkers Prev 15(5):946–954

    Article  PubMed  Google Scholar 

  13. Cleton-Jansen AM (2002) E-cadherin and loss of heterozygosity at chromosome 16 in breast carcinogenesis: different genetic pathways in ductal and lobular breast cancer? Breast Cancer Res 4(1):5–8

    Article  PubMed  CAS  Google Scholar 

  14. Korkola JE, DeVries S, Fridlyand J et al (2003) Differentiation of lobular versus ductal breast carcinomas by expression microarray analysis. Cancer Res 63(21):7167–7175

    PubMed  CAS  Google Scholar 

  15. Sarrio D, Perez-Mies B, Hardisson D et al (2004) Cytoplasmic localization of p120ctn and E-cadherin loss characterize lobular breast carcinoma from preinvasive to metastatic lesions. Oncogene 23(19):3272–3283

    Article  PubMed  CAS  Google Scholar 

  16. Tubiana-Hulin M, Stevens D, Lasry S et al (2006) Response to neoadjuvant chemotherapy in lobular and ductal breast carcinomas: a retrospective study on 860 patients from one institution. Ann Oncol 17(8):1228–1233

    Article  PubMed  CAS  Google Scholar 

  17. du Toit RS, Locker AP, Ellis IO et al (1991) An evaluation of differences in prognosis, recurrence patterns and receptor status between invasive lobular and other invasive carcinomas of the breast. Eur J Surg Oncol 17(3):251–257

    PubMed  CAS  Google Scholar 

  18. Yeatman TJ, Cantor AB, Smith TJ et al (1995) Tumor biology of infiltrating lobular carcinoma. Implications for management. Ann Surg 222(4):549–559. Discussion 59–61

    Article  PubMed  CAS  Google Scholar 

  19. Ferlicot S, Vincent-Salomon A, Medioni J et al (2004) Wide metastatic spreading in infiltrating lobular carcinoma of the breast. Eur J Cancer 40(3):336–341

    Article  PubMed  CAS  Google Scholar 

  20. Winston CB, Hadar O, Teitcher JB et al (2000) Metastatic lobular carcinoma of the breast: patterns of spread in the chest, abdomen, and pelvis on CT. AJR Am J Roentgenol 175(3):795–800

    PubMed  CAS  Google Scholar 

  21. Cocquyt VF, Blondeel PN, Depypere HT et al (2003) Different responses to preoperative chemotherapy for invasive lobular and invasive ductal breast carcinoma. Eur J Surg Oncol 29(4):361–367

    Article  PubMed  CAS  Google Scholar 

  22. Ashikari R, Huvos AG, Urban JA, Robbins GF (1973) Infiltrating lobular carcinoma of the breast. Cancer 31(1):110–116

    Article  PubMed  CAS  Google Scholar 

  23. Mate TP, Carter D, Fischer DB et al (1986) A clinical and histopathologic analysis of the results of conservation surgery and radiation therapy in stage I and II breast carcinoma. Cancer 58(9):1995–2002

    Article  PubMed  CAS  Google Scholar 

  24. Vo TN, Meric-Bernstam F, Yi M et al (2006) Outcomes of breast-conservation therapy for invasive lobular carcinoma are equivalent to those for invasive ductal carcinoma. Am J Surg 192(4):552–555

    Article  PubMed  Google Scholar 

  25. Korhonen T, Huhtala H, Holli K (2004) A comparison of the biological and clinical features of invasive lobular and ductal carcinomas of the breast. Breast Cancer Res Treat 85(1):23–29

    Article  PubMed  CAS  Google Scholar 

  26. Casolo P, Raspadori A, Drei B et al (1997) Natural history of breast cancer: lobular carcinoma versus ductal carcinoma in our experience. Ann Ital Chir 68(1):43–47 Discussion 48

    PubMed  CAS  Google Scholar 

  27. Peiro G, Bornstein BA, Connolly JL et al (2000) The influence of infiltrating lobular carcinoma on the outcome of patients treated with breast-conserving surgery and radiation therapy. Breast Cancer Res Treat 59(1):49–54

    Article  PubMed  CAS  Google Scholar 

  28. Silverstein MJ, Lewinsky BS, Waisman JR et al (1994) Infiltrating lobular carcinoma. Is it different from infiltrating duct carcinoma? Cancer 73(6):1673–1677

    Article  PubMed  CAS  Google Scholar 

  29. Toikkanen S, Pylkkanen L, Joensuu H (1997) Invasive lobular carcinoma of the breast has better short- and long-term survival than invasive ductal carcinoma. Br J Cancer 76(9):1234–1240

    PubMed  CAS  Google Scholar 

  30. Cristofanilli M, Gonzalez-Angulo A, Sneige N et al (2005) Invasive lobular carcinoma classic type: response to primary chemotherapy and survival outcomes. J Clin Oncol 23(1):41–48

    Article  PubMed  Google Scholar 

  31. Dixon JM, Anderson TJ, Page DL, Lee D, Duffy SW (1982) Infiltrating lobular carcinoma of the breast. Histopathology 6(2):149–161

    Article  PubMed  CAS  Google Scholar 

  32. du Toit RS, Locker AP, Ellis IO et al (1989) Invasive lobular carcinomas of the breast–the prognosis of histopathological subtypes. Br J Cancer 60(4):605–609

    PubMed  CAS  Google Scholar 

  33. Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410

    Article  PubMed  CAS  Google Scholar 

  34. Abd El-Rehim DM, Ball G, Pinder SE et al (2005) High-throughput protein expression analysis using tissue microarray technology of a large well-characterised series identifies biologically distinct classes of breast cancer confirming recent cDNA expression analyses. Int J Cancer 116(3):340–350

    Article  PubMed  CAS  Google Scholar 

  35. Rakha EA, El-Sayed ME, Green AR et al (2007) Prognostic markers in triple-negative breast cancer. Cancer 109(1):25–32

    Article  PubMed  CAS  Google Scholar 

  36. Rakha EA, Putti TC, Abd El-Rehim DM et al (2006) Morphological and immunophenotypic analysis of breast carcinomas with basal and myoepithelial differentiation. J Pathol 208(4):495–506

    Article  PubMed  CAS  Google Scholar 

  37. Abd El-Rehim DM, Pinder SE, Paish CE et al (2004) Expression of luminal and basal cytokeratins in human breast carcinoma. J Pathol 203(2):661–671

    Article  PubMed  Google Scholar 

  38. Abd El-Rehim DM, Pinder SE, Paish CE et al (2004) Expression and co-expression of the members of the epidermal growth factor receptor (EGFR) family in invasive breast carcinoma. Br J Cancer 91(8):1532–1542

    Article  PubMed  CAS  Google Scholar 

  39. Fondrinier E, Guerin O, Lorimier G (1997) A comparative study of metastatic patterns of ductal and lobular carcinoma of the breast from two matched series (376 patients). Bull Cancer 84(12):1101–1107

    PubMed  CAS  Google Scholar 

  40. Acs G, Lawton TJ, Rebbeck TR, LiVolsi VA, Zhang PJ (2001) Differential expression of E-cadherin in lobular and ductal neoplasms of the breast and its biologic and diagnostic implications. Am J Clin Pathol 115(1):85–98

    Article  PubMed  CAS  Google Scholar 

  41. Berx G, Cleton-Jansen AM, Nollet F et al (1995) E-cadherin is a tumour/invasion suppressor gene mutated in human lobular breast cancers. Embo J 14(24):6107–6115

    PubMed  CAS  Google Scholar 

  42. Goldstein NS (2002) Does the level of E-cadherin expression correlate with the primary breast carcinoma infiltration pattern and type of systemic metastases? Am J Clin Pathol 118(3):425–434

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Histopathology, School of Molecular Medical Sciences, Nottingham University Hospitals NHS Trust, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK

    Emad A. Rakha, Muhammad S. Gill, Maysa E. El-Sayed, Marium M. Khan, Zsolt Hodi, Andrew H. S. Lee & Ian O. Ellis

  2. Breast Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK

    Roger W. Blamey & Andrew J. Evans

Authors
  1. Emad A. Rakha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Muhammad S. Gill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maysa E. El-Sayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marium M. Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zsolt Hodi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roger W. Blamey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew J. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrew H. S. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ian O. Ellis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Emad A. Rakha or Ian O. Ellis.

Additional information

This study was approved by Nottingham Research Ethics Committee 2 under the title of “Development of a molecular genetic classification of breast cancer”.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rakha, E.A., Gill, M.S., El-Sayed, M.E. et al. The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology. Breast Cancer Res Treat 114, 243–250 (2009). https://doi.org/10.1007/s10549-008-0007-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-008-0007-4

Keywords

Search

Navigation