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The Evolution of Lobular Neoplasia

Lerwill, Melinda F. MD

Advances in Anatomic Pathology: July 2006 - Volume 13 - Issue 4 - p 157-165

Lobular neoplasia of the breast, encompassing both atypical lobular hyperplasia and lobular carcinoma in situ, remains a poorly understood entity. Often misconceived of as simply a risk factor for subsequent carcinoma, lobular neoplasia likely constitutes both a generalized risk factor and a direct precursor to invasive disease. Recent molecular studies, particularly those examining alterations in the E-cadherin gene, provide compelling evidence to support a role for lobular neoplasia as a direct precursor to invasive lobular carcinoma. These molecular studies also provide early insights into the biologic relationship of atypical lobular hyperplasia and lobular carcinoma in situ. The ability to stratify lobular neoplasia into high-risk and low-risk categories based on molecular attributes is on the horizon. With this ability will come an evolution in our thinking, diagnosis, and management of this enigmatic disease.

James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, MA

Correspondence: Melinda F. Lerwill, MD, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114 (e-mail:

Received for publication April 6, 2006; accepted May 22, 2006

© 2006 Lippincott Williams & Wilkins, Inc.