Invasive Lobular Carcinoma

Posted by asalsamadi @asalsamadi, Jul 4 4:23pm

Message:
Hello,
My mother (age 47) was recently diagnosed with Invasive Lobular Carcinoma (ILC) of the left breast.

Initial pathology findings show:
• ER positive
• PR positive
• HER2 negative
• Low Ki-67 index
• No confirmed lymph node involvement yet

Here is the detailed clinical timeline and current concerns:

✅ Three months ago, a single indeterminate lesion was detected in the left breast by ultrasound. It was not biopsied at the time and was considered non-alarming. However, due to recent developments, the lesion is now undergoing further histopathological reassessment.

✅ Currently, new additional masses have been identified in the left breast, and a small lesion has appeared in the right breast. A biopsy was taken from the right breast lesion, and we are still awaiting pathology results.

✅ She also reports mild neck pain and stiffness, which has persisted for some time and is causing anxiety about possible bone metastasis.

✅ Imaging workup including breast MRI and pelvis scan has been performed, but we are still waiting for the final reports.

✅ She has thalassemia minor (low baseline hemoglobin), which we’re concerned may affect her ability to tolerate treatment (surgery, chemotherapy, etc.).

⸻

Our primary concerns and questions are:
1. Given her tumor biology (ER+/PR+, HER2-, low Ki-67), what is the estimated risk of metastasis at this stage, especially considering the recent emergence of bilateral breast lesions?
2. Is neck pain/stiffness a possible early sign of bone metastasis, or could it be more likely musculoskeletal/stress-related in such cases?
3. What additional imaging or tests would you consider essential to confidently rule out distant spread (e.g., PET-CT, bone scan)?
4. Does her thalassemia minor status require any adjustments in treatment planning or monitoring?
5. Is bilateral involvement (left multiple lesions + right small lesion) typical in lobular carcinoma, and does this impact prognosis or treatment strategy?

We are extremely anxious and would truly appreciate your expert perspective and guidance.

– A very concerned daughter 💛

Interested in more discussions like this? Go to the Breast Cancer Support Group.

worried1111 | @worried1111 | Jul 5 10:08am

The initial pathology of a low KI-67 is good. Most importantly if the cancer has not spread to the lymph nodes there is a 95% chance it has not metastasized. My heart goes out to you. I and my daughters were in your position in 2021.

lynnn | @lynnn | Jul 6 9:47am

I am so sorry your Mom has been going through this. I have had cancer in both breasts and doing well. But please be aware that comments on here are not expert guidance but rather individual experiences which can be very helpful. Your questions would be best answered by a medical
professional albeit this is a good source for encouragement based on the
interventions others have undergone. My best wishes to you and your Mom.

Colleen Young, Connect Director | @colleenyoung | Jul 6 7:58pm

@asalsamadi, you're asking very good questions to discuss with your mom's cancer team. Is she being seen at a comprehensive cancer center? Do you go with her to her appointments? When do you have an appointment to review the new biopsy results?

asalsamadi | @asalsamadi | Jul 10 2:08am

Here is the scan result:
Patient history: Invasive lobular carcinoma of the right breast
Procedure: Contrast-enhanced CT scan of the chest, abdomen, and pelvis
Date: [Add date of scan here if known]

💠 Chest (Lung Findings):
• A 3mm ground-glass nodule is noted in the right middle lobe.
• This lesion is nonspecific and currently too small to characterize.
• Follow-up imaging may be recommended to evaluate stability over time.
• Mediastinal lymph nodes measuring up to 7 mm are seen in the paratracheal and prevascular areas.
• These are mildly enlarged but below the typical threshold for pathologic enlargement.
• Clinical correlation and further assessment may be needed depending on oncologic staging.
• No pleural effusion or chest wall abnormalities are seen.
• Trachea and bronchi are unremarkable.

💠 Abdomen and Pelvis:
• Liver, gallbladder, pancreas, adrenal glands, and kidneys appear normal in size and morphology.
• No liver lesions, no biliary dilatation, and no ascites detected.
• A small splenule (accessory spleen) measuring 6mm is seen adjacent to the spleen (benign variant).
• The uterus shows thickened endometrial lining → recommend follow-up pelvic ultrasound.
• A simple ovarian cyst on the left ovary measuring 33×25 mm is noted.

💠 Overall Impression:
• No evidence of definite metastatic disease in the liver, abdomen, or pelvis.
• Indeterminate 3mm ground-glass nodule in the right lung — needs follow-up.
• Mildly enlarged mediastinal lymph nodes — nonspecific.
• Thickened endometrium and ovarian cyst may warrant gynecologic evaluation.

Colleen Young, Connect Director | @colleenyoung | Jul 10 7:11am

@asalsamadi, keep in mind that we are all patients and family members on this forum. Doctors do not monitor this site. To get a professional opinion, please discuss the scan results with your mother's oncologist.

The scan looks like it was very thorough and you will have a clearer picture about next steps. This scan is only one piece of the puzzle. Together with her age, medical history and other test results your mother's cancer team will be able to discuss the results and next steps with you.

If you would like the opinion of Mayo Clinic experts, you can submit a request for an appointment here: http://mayocl.in/1mtmR63