Lobular Hyperplasia and neoplasia

 

 
Lobular Neoplasia is referring to a biopsy result that shows some ‘new cell growth‘ (neoplasia) , of cells that look like they were originally from the lobules of the breast.

Milk is produced in the lobules of the breast, then flows through small ducts to the nipple.

 
 

Update. I’ve learned that ‘Lobular neoplasia’ is a used as a broad category, that includes these: atypical lobular hyperplasia, lobular carcinoma in-situ and pleomorphic LCIS.

Although the wording Lobular Neoplasia raises anxiety, because people tend to worry about it turning into breast cancer, it helps to consider it only as a ‘significant risk factor‘, in the same way that age is a risk factor, but age doesn’t turn into cancer.

Hyperplasia” is also a word that means there is a proliferation of this new cell growth, which you may have noticed, is also what neoplasia means. Confusion is allowed.

This page still has some great material, however, we have created a newer version of Lobular Neoplasia.  Also there is a brand new section on our new breast cancer site about  Lobular Hyperplasia.

In terms of initial cancer staging, we can think of lobular neoplasia and atypical lobular hyperplasia as a pre-cancerous finding, just below lobular carcinoma in situ.

Atypical Lobular Hyperplasia or ALH

In the image above we can clearly see the proliferation of new cells, all quite similar and regular. The acinus of the breast lobule has been distended but not completely obliterated, as the lumen is still visible. Irregular cell nuclei and the disappearance of the lumen would likely upgrade the diagnosis to Lobular carcinoma in situ.

ALH, if present in a biopsy, seem to cause increased risk of 4-6 times for eventual breast cancer development. but, ALH actually ends up with a biopsy-proven cancer, later in life, in only about 10-20% of women with ALH.

LCIS

LCIS means ‘lobular carcinoma in situ‘. This is a very early diagnosis of cancer. We all want early diagnosis. When the cancer cells are only found in the breast lobule but not spread outward beyond the epithelial lining.

LCIS increases the risk for later breast cancer by approximately 7 to 12 times. The cancers that subsequently develop, take a long time to develop, like after 15 years, which is a long time.
An average woman with LCIS has approximately a 25% chance of breast cancer development later in life.

Prognosis and treatment for Lobular Neoplasia

When this page was originally written, people were unsure if lobular neoplasia had a cause-effect-relationship to future breast cancer.

Some kind of Lobular neoplasia is found on breast biopsies in .5% to 8%.

If a patient is high-risk from other things like age and family history, sometimes after a lobular neoplasia biopsy, they can be treated with preventive medicines such a tamoxifen or raloxifene. Tamoxifen is thought to reduce the risk of breast cancer development for an LCIS diagnosis by up to 56%. If there are microcalcifications discovered with lobular neoplasia, that can often indicate a higher risk for breast cancer development.

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Let’s do some Q&A…

• What is the meaning of lobular HYPERplasia? It is not considered breast cancer, but it is considered a precancerous condition. It occurs in the epithelial cell lining in the milk lobes, producing more cells than would normally grow there.
• What are the signs and symptoms of lobular hyperplasia? Lobular hyperplasia doesn’t cause any notable symptoms. It it usually found on a routine screening mammogram. In a few cases, it may cause breast pain. When hyperplasia shows up on a mammogram or ultrasound, a tissue sample can be taken to clear diagnosis.
• What are some tests used to diagnose lobular hyperplasia? Mammogram, ultrasound, core needle biopsy, and/or stereotacic biopsy.
• What are the treatment options for lobular hyperplasia? Lumpectomy, tamoxifen, and raloxifene. Avoid hormone replacement therapy! It uses estrogen and progestin, two hormones which reduce menopause symptoms, but which also fuel most breast tumors.
• What is the meaning of lobular NEOplasia? When this occurs, there is an increase in the number of cells contained in the lobules, together with a change in their appearance and behavior.
• How is lobular neoplasia diagnosed? It can be difficult to diagnose because most women with lobular neoplasia have no symptoms. It is usually diagnosed after a biopsy is done on the breast for some other reason, such as an abnormal finding on a mammogram or a suspicious breast lump. These procedures may include fine need aspiration biopsy, core needle biopsy, incisional biopsy, or excisional biopsy.
• What are the treatment options for lobular neoplasia? Close monitoring (regular clinical exams, regular screening mammography, MRI, and monthly breast self-exams), hormone therapy medicines (such as tamoxifen, raloxifene, exemestane, and anastrozole have been shown to reduce breast cancer risk), and risk-reducing surgery (prophylactic mastectomy). Also, you may want to consider taking part in a clinical trial that is testing a new approach to reducing the risk of breast cancer.

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References

 

• Dershaw DD. Does LCIS or ALH Without Other High-Risk Lesions Diagnosed on Core Biopsy Require Surgical Excision? The Breast Journal, Volume 9, Number 1, 2003 1-3.
• Cohen MA. Cancer Upgrade at Excisional Biopsy after Diagnosis of Atypical Lobular Hyperplasia or Lobular Carcinoma in Situ at Core-Needle Biopsy: Some Reasons Why. Radiology 2004; 231: 617-621.
• Lakhani SE. In Situ Lobular Neoplasia: time for an Awakening. Lancet 2003; 361: 96.
• Elsheikh TM, Silverman JF. Follow-up Surgical Excision is Indicated when Breast Core Needle Biopsies Show Atypical Lobular Hyperplasia or Lobular Carcinoma in Situ. Am. J. Surg. Pathol. Volume 29, Number 4, April 2005.
• Foster MC, Helvie MA, Gregory NE, Rebner M, Nees AV, Paramagul C. Radiology 2004; 231:31: 813-819.
• Page DL, Schuyler PA, Dupont WD et al. Atypical Lobular Hyperplasia as a Unilateral Predictor of Breast Cancer Risk: a Retrospective Cohort Study. Lancet 2003: 361: 125-129.
• Venkitaraman, R., Lobular Neoplasia of the breast. The Breast Journal (Oct. 2010) Volume 16, Issue 5, pages 519–528,
• Berg WA, Mrose HE, Ioffe OB. Atypical lobular hyperplasia or lobular carcinoma in situ at core-needle breast biopsy. Radiology. (feb. 2001)218(2):503-9.
• Hwang, H. Sullivan, ME., Susnick, B., Lobular neoplasia, Diagnostic Histopathy, (July 2010) Volume 16, Issue 7, Pages 337-344.
• Londero, V., Zuiani, C., Lilnda, A., Vianello, E., Furlan, A., Bazzocchi, M., Lobular neoplasia: Core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features. The Breast, (Dec. 2009) Volume 17, Issue 6, Pages 623-630.

 

 

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