Pleomorphic and florid lobular carcinoma in situ of the Breast: A systematic review of current evidence and knowledge gaps

Massimo Ferrucci; Daniele Passeri; Francesco Milardi; Giacomo Montagna; Anna C. Beck; Riccardo Audisio; Fredrick Wärnberg; Gianluca Franceschini; Lucio Fortunato; Matteo Ghilli; Valentina Guarneri; Alberto Marchet; Rocco Cappellesso; Angelo Paolo Dei Tos; Tari Ann King

doi:10.1016/j.breast.2026.104711

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Pleomorphic and florid lobular carcinoma in situ of the Breast: A systematic review of current evidence and knowledge gaps

Journal article

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Pleomorphic and florid lobular carcinoma in situ of the Breast: A systematic review of current evidence and knowledge gaps

Massimo Ferrucci, Daniele Passeri, Francesco Milardi, Giacomo Montagna, Anna C. Beck, Riccardo Audisio, Fredrick Wärnberg, Gianluca Franceschini, Lucio Fortunato, Matteo Ghilli, …

Breast (Edinburgh), Vol.86, 104711

04/01/2026

DOI: 10.1016/j.breast.2026.104711

PMCID: PMC12905746

PMID: 41643481

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Abstract

Pleomorphic (PLCIS) and florid (FLCIS) lobular carcinoma in situ are uncommon entities, characterized by significant architectural distortion and cellular atypia. Their rarity poses three key clinical challenges: diagnostic variability, histologic upgrade and risk of local recurrence (LR). Currently, no standardized management guidelines exist. This systematic review provides the most comprehensive synthesis to date of the available evidence on clinical, radiologic, pathologic, and molecular characteristics of P/FLCIS, and evaluates outcomes associated with different treatment strategies. A systematic literature search was conducted across major biomedical databases up to June 2025. Eligible studies were original case series reporting primary data on P/FLCIS. From 5402 screened records, 38 studies were included, comprising 629 total cases: 411 PLCIS, 98 FLCIS, and 120 categorized as LCIS with pleomorphic or non-classic features. The pooled upgrade rate was 35.3% (PLCIS 35.1%, FLCIS 33.3%; p = 0.843), predominantly to invasive carcinoma (28.8%). Among 258 pure P/FLCIS cases with available follow-up (median, 50 months) the overall LR rate was 12.4% (PLCIS 13.1%, FLCIS 9.1%; p = 0.618), with invasive recurrences representing the majority (62.5%; p = 0.04). Margin status was significantly associated with risk of LR (positive margins 38.2%, close margins (<2 mm) 20.0%, negative margins 3.0%; p < 0.001). Data on adjuvant treatments were inconsistent and heterogeneous. Given the high upgrade rate and significant risk of LR for P/FLCIS, complete surgical excision with negative margins is strongly advised to ensure definitive diagnosis and reduce future breast events. The role of adjuvant therapies remains unclear, highlighting the urgent need for standardized, multicenter studies to guide optimal clinical management. •Pleomorphic and florid lobular carcinoma in situ are rare and understudied.•Diagnostic variability, histologic upgrade and recurrence risk are key challenges.•Upgrade rate reaches 35.5%, mostly to invasive carcinoma.•Local Recurrence risk is strongly associated with surgical margin status.•Complete surgical excision with negative margins is the mainstay of treatment.

Breast Cancer

Breast recurrence

Breast surgery

Classic lobular carcinoma in situ

Florid lobular carcinoma in situ

Margin status

Pleomorphic lobular carcinoma in situ

Upgrade rate

Details

Title: Subtitle: Pleomorphic and florid lobular carcinoma in situ of the Breast: A systematic review of current evidence and knowledge gaps
Creators: Massimo Ferrucci - Istituto Oncologico Veneto
Daniele Passeri - University of Padua
Francesco Milardi - University of Padua
Giacomo Montagna - Memorial Sloan Kettering Cancer Center
Anna C. Beck - University of Wisconsin–Madison
Riccardo Audisio - Sahlgrenska University Hospital
Fredrick Wärnberg - University of Gothenburg
Gianluca Franceschini - Agostino Gemelli University Polyclinic
Lucio Fortunato - Azienda Ospedaliera San Giovanni Addolorata
Matteo Ghilli - Azienda Ospedaliera Universitaria Pisana
Valentina Guarneri - Istituto Oncologico Veneto
Alberto Marchet - Istituto Oncologico Veneto
Rocco Cappellesso - University of Padua
Angelo Paolo Dei Tos - University of Padua
Tari Ann King - Breast Cancer Research Foundation
Resource Type: Journal article
Publication Details: Breast (Edinburgh), Vol.86, 104711
DOI: 10.1016/j.breast.2026.104711
PMID: 41643481
PMCID: PMC12905746
NLM abbreviation: Breast
ISSN: 0960-9776
eISSN: 1532-3080
Publisher: Elsevier Ltd
Language: English
Date published: 04/01/2026
Academic Unit: Surgery
Record Identifier: 9985139299002771

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