Lobuläre Neoplasie und invasives lobuläres Mammakarzinom

ZusammenfassungDer Begriff der lobulären Neoplasie (LN) beinhaltet die atypische lobuläre Hyperplasie (ALH) und das lobuläre Carcinoma in situ (LCIS). Er umfasst ein Spektrum morphologisch heterogener, aber klinisch und molekularbiologisch verwandter Läsionen. Die LN gilt als nichtobligate Vorläuferläsion des invasiven Mammakarzinoms und gleichzeitig als Indikatorläsion für ein ipsi- und kontralaterales Karzinomrisiko der Patientin. Die seltenen pleomorphen und floriden Varianten des LCIS werden vom klassischen LCIS abgegrenzt. Das invasive lobuläre Mammakarzinom (ILC) unterscheidet sich vom nicht speziellen Typ des invasiven Mammakarzinoms (NST) durch E-Cadherin-Inaktivierung, Verlust der E-Cadherin-vermittelten Zelladhäsion und dem dadurch bedingten diskohäsiven Zellbild beim klassischen ILC. Variante Formen des ILC können vom klassischen Typ abweichende molekulare Eigenschaften und bei den gering differenzierten Formen solide und pleomorphe Differenzierungsmuster aufweisen. Für die Prognoseabschätzung des ILC sind Grading und die Abgrenzung von Varianten wichtige Parameter.AbstractThe term lobular neoplasia (LN) comprises both atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS) and thus a spectrum of morphologically heterogeneous but clinically and biologically related lesions. LN is regarded as a nonobligatory precursor lesion of invasive breast cancer and at the same time as an indicator lesion for ipsilateral and contralateral breast cancer risk of the patient. Rare pleomorphic or florid variants of LCIS must be differentiated from classical LCIS. The classical type of invasive lobular carcinoma (ILC) can be distinguished from the non-special type of invasive breast cancer (NST) by E-cadherin inactivation, loss of E-cadherin related cell adhesion and the subsequent discohesive growth pattern. Variant forms of ILC may show different molecular features, and solid and pleomorphic differentiation patterns in cases of high grade variants. Important parameters for the prognostic assessment of ILC are tumor grading and the recognition of morphological variants.

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