BACKGROUND: Pleomorphic and Florid Lobular carcinoma in situ (P/F LCIS) are rare variants of LCIS, the exact nature of which is still debated. AIM: To collect a large series of P/F LCIS diagnosed on preoperative biopsies and evaluate their association with invasive carcinoma and high grade duct carcinoma in situ (DCIS). Data obtained were compared with those reported in the literature. METHODS: A multi-institutional series of P/F LCIS was retrieved. All cases were diagnosed on pre-operative biopsies, which was followed by an open surgical excision. Data on post-operative histopathology were available. A literature review was performed. RESULTS: A total of 117 cases were collected; invasive carcinoma and/or DCIS was present in 78/117 cases (66.7%). Seventy cases of P/F LCIS were pure on biopsy and 31 of these showed pathological upgrade in post-surgical specimens. Pre-operative biopsy accuracy was 47/78 (60.3%); pre-operative biopsy underestimation of cancer was 31/78 (39,7.%). In the literature review papers, invasive carcinoma or DCIS was associated with 274 of 418 (65.5%) cases of P/F LCIS. Pre-operative biopsy accuracy was 66% (181/274) whereas pre-operative biopsy underestimation of cancer was 33.9% (93/274). CONCLUSIONS: The data presented here indicate that P/F LCIS is frequently associated with invasive carcinoma or high grade DCIS and that pre-operative biopsy is associated with an underestimation of malignancy. Open surgery is indicated when P/F LCIS is diagnosed pre-operatively.

Bacs Kiskun County Teaching Hospital Nyiriut 38 Kecskemet 6000 Hungary and Department of Pathology University of Szeged Allomas u 1 Szeged 6720 Hungary

Department of Biomedical and Neuromotor Sciences University of Bologna Unit of Anatomic Pathology at Bellaria Hospital Bologna C Baldovini present address is Anatomic Pathology Unit Santa Maria delle Croci Hospital Viale Randi 5 48121 Ravenna Italy

Department of Clinical Pathology Sahlgrenska University Hospital Gothenburg Sweden

Department of Histopathology St Vincent's University Hospital Dublin and School of Medicine University College Dublin Ireland

Department of Medical Sciences Pathology Unit University of Turin Via Santena 7 10126 Turin Italy

Department of Morphology Surgery and Experimental Medicine University of Ferrara Unit of Anatomic Pathology St Anna University Hospital Via A Moro 8 44124 Ferrara Italy

Department of Pathology Marmara University Hospital Istanbul 81190 Turkey

Department of Pathology Section A Navarra Health Service Hospital Complex of Navarra Irunlarrea 4 31008 Pamplona Spain

Department of Pathology University Hospital of S João Porto and Ipatimup 4200 319 Porto Portugal

Department of Statistical Sciences University of Bologna Via Belle Arti 42 40100 Bologna Italy

Department of Surgery and Translational Medicine Section of Pathological Anatomy Careggi University Hospital Largo G Alessandro Brambilla 3 50134 Firenze Florence Italy

Discipline of Pathology Lambe Institute for Translational Research NUI Galway Costello Road Galway Ireland

Division of Pathology Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa 56126 Pisa Italy

Pathology Division Santa Croce Hospital Vicolo Tiziano 5 10024 Moncalieri TO Italy

Pathology Unit Ospedale Nuovo S Maria della Scaletta via Montericco 4 40026 Imola Bologna Italy

The Fingerland Department of Pathology Charles University Faculty of Medicine and University Hospital Hradec Králové Sokolská 581 Hradec Králové 500 03 Czech Republic

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