Invasive lobular breast cancer

Case contribution: Dr Radhiana Hassan


  • A 46 years old lady
  • Presented with right breast lump for 6 months
  • Painless, progressive increase in size
  • No family history of breast cancer
Bilateral mammogram in MLO view
Bilateral mammogram in CC view

Mammogram findings:

  • A focal density with stromal distortion seen at right upper outer quadrant (red arrows)
  • No obvious mass lesion. No suspicious clustered microcalcification
  • No skin thickening or nipple retraction is seen
Ultrasound of breast

Ultrasound findings:

  • An ill-defined hypoechoic mass at Rt9H-10H
  • The lesion measures about 19x17x30 mm
  • Posterior shadowing are seen with increased intralesional vascularity
  • No ductal ectasia, no enlarged lymph nodes

Progress of patient:

  • FNAC done shows presence of suspicious cells
  • Biopsy done shows malignant epithelial cells in trabeculae with prominent nucleoli. ER PR +ve. Impression: invasive breast carcinoma suggestive of lobular type
  • Right mastectomy and axillary clearance done one month later. HPE confirms invasive lobular carcinoma. T3N1 with 2 lymph nodes positive.

Diagnosis: invasive lobular breast carcinoma


  • Invasive lobular carcinoma (ILC), sometimes called infiltrating lobular carcinoma, is the second most common type of breast cancer after invasive ductal carcinoma
  • It accounts for about 10% -15% of all invasive breast cancers
  • It begins in the milk-producing glands (lobules) of the breast.
  • Compared to other types of breast cancer, lobular breast cancer:
    • Has different symptoms than other more common types of breast cancer
    • Often preserve the architecture of the duct which make it harder to see on mammogram. The sensitivity of mammography for the detection of Invasive lobular carcinoma reportedly ranges between 57-81%
    • May not be diagnosed until the cancer is large enough to cause symptoms
    • Is more likely to involve both breasts with a 5-year rate of bilateral cancer of 8% (4% synchronous and 4% metachronous tumors)
    • Overall survival rate is higher than invasive ductal carcinoma
Author: radhianahassan