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Mixed Invasive Ductal and Lobular Carcinoma
Kanchan Phalak, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Invasive carcinoma with mixed ductal and lobular features
            • Definitions

              • Heterogeneous group of invasive carcinomas having both ductal and lobular elements
              • Mixed invasive ductal and lobular carcinoma (IDC-ILC)
                • Invasive ductal carcinoma, no special type (IDC NST) comprises 10-49% of tumor; remainder demonstrates lobular morphology
                • Invasive lobular carcinoma (ILC) may be present within IDC to variable degree
              • Tubulolobular carcinoma (TLC): Distinctive type of carcinoma with both ductal and lobular features where ductal component shows well-formed tubules and remainder shows single dyscohesive cells in linear arrays resembling lobular carcinoma (together comprising > 75% of tumor)
                • Variable percentages of tubular and lobular components

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. McCart Reed AE et al: Mixed ductal-lobular carcinomas: evidence for progression from ductal to lobular morphology. J Pathol. 244(4):460-8, 2018
                                            2. Metzger-Filho O et al: Mixed invasive ductal and lobular carcinoma of the breast: prognosis and the importance of histologic grade. Oncologist. ePub, 2018
                                            3. Williams LA et al: Reproductive risk factor associations with lobular and ductal carcinoma in the Carolina Breast Cancer Study. Cancer Causes Control. 29(1):25-32, 2018
                                            4. Inoue M et al: Specific sites of metastases in invasive lobular carcinoma: a retrospective cohort study of metastatic breast cancer. Breast Cancer. 24(5):667-72, 2017
                                            5. Xiao Y et al: Mixed invasive ductal and lobular carcinoma has distinct clinical features and predicts worse prognosis when stratified by estrogen receptor status. Sci Rep. 7(1):10380, 2017
                                            6. Chesebro AL et al: Developing asymmetries at mammography: a multimodality approach to assessment and management. Radiographics. 36(2):322-34, 2016
                                            7. Johnson K et al: Lobular breast cancer series: imaging. Breast Cancer Res. 17:94, 2015
                                            8. Zengel B et al: Comparison of the clinicopathological features of invasive ductal, invasive lobular, and mixed (invasive ductal + invasive lobular) carcinoma of the breast. Breast Cancer. 22(4):374-81, 2015
                                            9. Porter AJ et al: Mammographic and ultrasound features of invasive lobular carcinoma of the breast. J Med Imaging Radiat Oncol. 58(1):1-10, 2014
                                            10. Arps DP et al: Invasive ductal carcinoma with lobular features: a comparison study to invasive ductal and invasive lobular carcinomas of the breast. Breast Cancer Res Treat. 138(3):719-26, 2013
                                            11. Ellis IO et al: Invasive carcinoma of no special type. In Lakhani SR et al: WHO Classification of Tumours of the Breast. 4th ed. Lyon: IARC. 34-8, 2012
                                            12. Phipps AI et al: Risk factors for ductal, lobular, and mixed ductal-lobular breast cancer in a screening population. Cancer Epidemiol Biomarkers Prev. 19(6):1643-54, 2010
                                            13. Suryadevara A et al: The clinical behavior of mixed ductal/lobular carcinoma of the breast: a clinicopathologic analysis. World J Surg Oncol. 8:51, 2010
                                            14. Bharat A et al: Tumor characteristics and patient outcomes are similar between invasive lobular and mixed invasive ductal/lobular breast cancers but differ from pure invasive ductal breast cancers. Am J Surg. 198(4):516-9, 2009
                                            15. Rakha EA et al: The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology. Breast Cancer Res Treat. 114(2):243-50, 2009
                                            16. Bartella L et al: Nonpalpable mammographically occult invasive breast cancers detected by MRI. AJR Am J Roentgenol. 186(3):865-70, 2006
                                            17. Günhan-Bilgen I et al: Tubulolobular carcinoma of the breast: clinical, mammographic and sonographic findings. Eur J Radiol. 60(3):418-24, 2006
                                            18. Bane AL et al: Invasive lobular carcinoma: to grade or not to grade. Mod Pathol. 18(5):621-8, 2005
                                            19. Elston CW: Classification and grading of invasive breast carcinoma. Verh Dtsch Ges Pathol. 89:35-44, 2005
                                            20. Harigopal M et al: Aberrant E-cadherin staining patterns in invasive mammary carcinoma. World J Surg Oncol. 3:73, 2005
                                            21. Arpino G et al: Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res. 6(3):R149-56, 2004
                                            22. Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
                                            23. Buist DS et al: Factors contributing to mammography failure in women aged 40-49 years. J Natl Cancer Inst. 96(19):1432-40, 2004
                                            24. Wheeler DT et al: Tubulolobular carcinoma of the breast. Am J Surg Pathol. 28:1587-93, 2004
                                            25. Korkola JE et al: Differentiation of lobular versus ductal breast carcinomas by expression microarray analysis. Cancer Res. 63(21):7167-75, 2003
                                            26. Li CI et al: Trends in incidence rates of invasive lobular and ductal breast carcinoma. JAMA. 289(11):1421-4, 2003
                                            27. Evans WP et al: Invasive lobular carcinoma of the breast: mammographic characteristics and computer-aided detection. Radiology. 225(1):182-9, 2002
                                            28. Goldstein NS: 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):425-34, 2002
                                            29. Acs G et al: 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, 2001
                                            30. Peiro G et al: 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, 2000
                                            31. Schnitt SJ et al: Pathology of invasive breast cancer. In Harris JR et al: Diseases of the Breast. 2nd ed. Philadelphia: Lippincott Williams & Wilkins. 431, 2000
                                            32. Rodenko GN et al: MR imaging in the management before surgery of lobular carcinoma of the breast: correlation with pathology. AJR Am J Roentgenol. 167(6):1415-9, 1996
                                            33. Sastre-Garau X et al: Infiltrating lobular carcinoma of the breast. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns. Cancer. 77(1):113-20, 1996
                                            34. Le Gal M et al: Mammographic features of 455 invasive lobular carcinomas. Radiology. 185(3):705-8, 1992
                                            35. Sickles EA: The subtle and atypical mammographic features of invasive lobular carcinoma. Radiology. 178(1):25-6, 1991
                                            36. Fisher ER et al: The pathology of invasive breast cancer. A syllabus derived from findings of the National Surgical Adjuvant Breast Project (protocol no. 4). Cancer. 36(1):1-85, 1975
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Invasive carcinoma with mixed ductal and lobular features
                                                      • Definitions

                                                        • Heterogeneous group of invasive carcinomas having both ductal and lobular elements
                                                        • Mixed invasive ductal and lobular carcinoma (IDC-ILC)
                                                          • Invasive ductal carcinoma, no special type (IDC NST) comprises 10-49% of tumor; remainder demonstrates lobular morphology
                                                          • Invasive lobular carcinoma (ILC) may be present within IDC to variable degree
                                                        • Tubulolobular carcinoma (TLC): Distinctive type of carcinoma with both ductal and lobular features where ductal component shows well-formed tubules and remainder shows single dyscohesive cells in linear arrays resembling lobular carcinoma (together comprising > 75% of tumor)
                                                          • Variable percentages of tubular and lobular components

                                                      IMAGING

                                                      • General Features

                                                        • Mammographic Findings

                                                          • Ultrasonographic Findings

                                                            • MR Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. McCart Reed AE et al: Mixed ductal-lobular carcinomas: evidence for progression from ductal to lobular morphology. J Pathol. 244(4):460-8, 2018
                                                                                      2. Metzger-Filho O et al: Mixed invasive ductal and lobular carcinoma of the breast: prognosis and the importance of histologic grade. Oncologist. ePub, 2018
                                                                                      3. Williams LA et al: Reproductive risk factor associations with lobular and ductal carcinoma in the Carolina Breast Cancer Study. Cancer Causes Control. 29(1):25-32, 2018
                                                                                      4. Inoue M et al: Specific sites of metastases in invasive lobular carcinoma: a retrospective cohort study of metastatic breast cancer. Breast Cancer. 24(5):667-72, 2017
                                                                                      5. Xiao Y et al: Mixed invasive ductal and lobular carcinoma has distinct clinical features and predicts worse prognosis when stratified by estrogen receptor status. Sci Rep. 7(1):10380, 2017
                                                                                      6. Chesebro AL et al: Developing asymmetries at mammography: a multimodality approach to assessment and management. Radiographics. 36(2):322-34, 2016
                                                                                      7. Johnson K et al: Lobular breast cancer series: imaging. Breast Cancer Res. 17:94, 2015
                                                                                      8. Zengel B et al: Comparison of the clinicopathological features of invasive ductal, invasive lobular, and mixed (invasive ductal + invasive lobular) carcinoma of the breast. Breast Cancer. 22(4):374-81, 2015
                                                                                      9. Porter AJ et al: Mammographic and ultrasound features of invasive lobular carcinoma of the breast. J Med Imaging Radiat Oncol. 58(1):1-10, 2014
                                                                                      10. Arps DP et al: Invasive ductal carcinoma with lobular features: a comparison study to invasive ductal and invasive lobular carcinomas of the breast. Breast Cancer Res Treat. 138(3):719-26, 2013
                                                                                      11. Ellis IO et al: Invasive carcinoma of no special type. In Lakhani SR et al: WHO Classification of Tumours of the Breast. 4th ed. Lyon: IARC. 34-8, 2012
                                                                                      12. Phipps AI et al: Risk factors for ductal, lobular, and mixed ductal-lobular breast cancer in a screening population. Cancer Epidemiol Biomarkers Prev. 19(6):1643-54, 2010
                                                                                      13. Suryadevara A et al: The clinical behavior of mixed ductal/lobular carcinoma of the breast: a clinicopathologic analysis. World J Surg Oncol. 8:51, 2010
                                                                                      14. Bharat A et al: Tumor characteristics and patient outcomes are similar between invasive lobular and mixed invasive ductal/lobular breast cancers but differ from pure invasive ductal breast cancers. Am J Surg. 198(4):516-9, 2009
                                                                                      15. Rakha EA et al: The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology. Breast Cancer Res Treat. 114(2):243-50, 2009
                                                                                      16. Bartella L et al: Nonpalpable mammographically occult invasive breast cancers detected by MRI. AJR Am J Roentgenol. 186(3):865-70, 2006
                                                                                      17. Günhan-Bilgen I et al: Tubulolobular carcinoma of the breast: clinical, mammographic and sonographic findings. Eur J Radiol. 60(3):418-24, 2006
                                                                                      18. Bane AL et al: Invasive lobular carcinoma: to grade or not to grade. Mod Pathol. 18(5):621-8, 2005
                                                                                      19. Elston CW: Classification and grading of invasive breast carcinoma. Verh Dtsch Ges Pathol. 89:35-44, 2005
                                                                                      20. Harigopal M et al: Aberrant E-cadherin staining patterns in invasive mammary carcinoma. World J Surg Oncol. 3:73, 2005
                                                                                      21. Arpino G et al: Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res. 6(3):R149-56, 2004
                                                                                      22. Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
                                                                                      23. Buist DS et al: Factors contributing to mammography failure in women aged 40-49 years. J Natl Cancer Inst. 96(19):1432-40, 2004
                                                                                      24. Wheeler DT et al: Tubulolobular carcinoma of the breast. Am J Surg Pathol. 28:1587-93, 2004
                                                                                      25. Korkola JE et al: Differentiation of lobular versus ductal breast carcinomas by expression microarray analysis. Cancer Res. 63(21):7167-75, 2003
                                                                                      26. Li CI et al: Trends in incidence rates of invasive lobular and ductal breast carcinoma. JAMA. 289(11):1421-4, 2003
                                                                                      27. Evans WP et al: Invasive lobular carcinoma of the breast: mammographic characteristics and computer-aided detection. Radiology. 225(1):182-9, 2002
                                                                                      28. Goldstein NS: 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):425-34, 2002
                                                                                      29. Acs G et al: 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, 2001
                                                                                      30. Peiro G et al: 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, 2000
                                                                                      31. Schnitt SJ et al: Pathology of invasive breast cancer. In Harris JR et al: Diseases of the Breast. 2nd ed. Philadelphia: Lippincott Williams & Wilkins. 431, 2000
                                                                                      32. Rodenko GN et al: MR imaging in the management before surgery of lobular carcinoma of the breast: correlation with pathology. AJR Am J Roentgenol. 167(6):1415-9, 1996
                                                                                      33. Sastre-Garau X et al: Infiltrating lobular carcinoma of the breast. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns. Cancer. 77(1):113-20, 1996
                                                                                      34. Le Gal M et al: Mammographic features of 455 invasive lobular carcinomas. Radiology. 185(3):705-8, 1992
                                                                                      35. Sickles EA: The subtle and atypical mammographic features of invasive lobular carcinoma. Radiology. 178(1):25-6, 1991
                                                                                      36. Fisher ER et al: The pathology of invasive breast cancer. A syllabus derived from findings of the National Surgical Adjuvant Breast Project (protocol no. 4). Cancer. 36(1):1-85, 1975