SPECIAL FEATURES IN THE CLINICAL MANIFESTATION AND COURSE OF INVASIVE LOBULAR CARCINOMA OF THE BREAST

We examined 121 invasive lobular breast carcinomas (ILCs) with regard to certain standardise prognosis parameters, such as tumour size, receptor status, histological grading, the presence of lymphangiosis carcinomatosa, and the histological nodal status of the axillae and correlated these findings with follow-up data obtained over a mean period of 65 months. The parameters, tumour size, presence of lymphangiosis carcinomatosa, and nodal status, were found to be correlated and to have a significant influence on the patients' overall survival time, but not on relapse-free survival. Receptor status appeared to have no significant influence on patient survival. However, the incidence of death, owing to tumour-related causes, was higher among patients with receptor-negative tumours than amongst those with receptor-positive carcinomas. In contrast, the histological grading of a tumour appeared to exercise no effect on tumour prognosis. At 30%, the rate of local tumour recurrence at the primary site was markedly higher than for other histological types of breast carcinoma. In nearly one-half (45%) of such relapses, however, further tumour progression did not occur. Most tumours, exhibiting only local recurrence were initially node-negative, whilst those that produced distant metastases later had usually exhibited axillary lymph node metastases at primary therapy. Bilateral carcinomas occurred more frequently (15.6%) than is the case amongst ductal carcinomas. The observed tendency amongst ILCs toward local recurrence and bilateral growth might be accounted for in terms of their high incidence of multicentral tumour growth and associated pre-invasive neoplastic alterations. With regard to the period of survival, no significant difference emerged between tumours with no axillary lymph node metastases and those with one to three such secondary tumours. The effect of adjuvant chemotherapy may account for this finding. Differences in the expected survival period of patients with ILC and ductal breast carcinoma could well be due to the differing tendencies of these two histological tumour types in respect of metastatic spread and formation.