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Case Reports
. 2020 May 31;12(5):e8376.
doi: 10.7759/cureus.8376.

Invasive Lobular Breast Carcinoma Can Be a Challenging Diagnosis Without the Use of Tumor Markers

Linda C Klumpp  1 , Rony Shah  1 , Naeem Syed  1 , Gustavo Fonseca  2   3 , Jeffrey Jordan  1
Affiliations
Case Reports

Invasive Lobular Breast Carcinoma Can Be a Challenging Diagnosis Without the Use of Tumor Markers

Linda C Klumpp et al. Cureus. .

Abstract

Invasive lobular carcinoma is often challenging to diagnose due to the lack of physical examination findings and macrocalcifications on mammography. The cells of invasive lobular carcinoma form a distinct single file pattern that can be identified on histology slides. Often, when patients present, there is metastasis to the bones, lymph nodes, and gastrointestinal tract. Tumor markers are a valuable tool in identification, especially the loss of E-cadherin protein. However, if E-cadherin protein is not available, epidermal membrane antigen, which inhibits E-cadherin, can prove to be a significant diagnostic tool. Epidermal membrane antigen was the key tumor marker in our patient case. Other tumor markers and histology stains can drive treatment plans and help predict prognosis.

Keywords: cam 5.2; e-cadherin; er positive; hematoxylin and eosin; her 2 negative; invasive lobular carcinoma; mammogram; metastatic breast cancer; single-file pattern; tumor markers.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Figure 1: CT of the abdomen/pelvis without contrast
Hepatosplenomegaly and patchy sclerosis of bones can be seen.
Figure 2
Figure 2. CT of the chest without contrast
Diffuse lytic and sclerotic bone lesions can be seen.
Figure 3
Figure 3. Anti-cytokeratin reagent stain (CAM 5.2)
Figure 4
Figure 4. ER marker for lobular breast adenocarcinoma
ER, estrogen receptor
Figure 5
Figure 5. H&E stain
H&E, hematoxylin and eosin
Figure 6
Figure 6. Mammogram of the left breast
Pleomorphic calcification with a 1-cm well-circumscribed mass in the left upper outer breast (top arrow) can be seen.
Figure 7
Figure 7. : Mammogram of the left breast
Left breast architectural distortion and single-file microcalcifications can be seen.
Figure 8
Figure 8. Ultrasound of the left breast
A 4-mm hypoechoic nodule at the 3’o clock position, 4 cm from the nipple, can be seen.
See this image and copyright information in PMC

References

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