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Table of Contents
Terminology | Clinical features | Prognostic factors | Case reports | Clinical images | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Differential diagnosis | Additional referencesCite this page: Papillary carcinoma - invasive. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantpapillary.html. Accessed July 14th, 2017.
Terminology
- Literature often does NOT clearly differentiate between in situ and invasive papillary tumors
Clinical features
- Rare; invasive and in situ papillary tumors together are 1% - 2% of breast carcinomas in women
- Average age 63 - 67 years
- Present with bloody nipple discharge, abnormal mass or radiographic abnormalities (rounded and circumscribed)
- 50% arise in central part of breast; 25% - 33% associated with nipple discharge
- Most papillary carcinomas are in situ and are not invasive
- Invasive carcinoma can arise in papillomas
- Invasive portions of papillary DCIS are either papillary carcinoma or ductal carcinoma NOS
- Often, clinical axillary metastases are actually sinus histiocytosis (Am J Clin Pathol 1980;73:313)
- Circumscribed tumors with no apparent invasion may lack myoepithelial markers at tumor-stromal interface (Histopathology 2007;51:657)
Prognostic factors
- 5 year survival is 90%, better than invasive ductal NOS (although some of the papillary cases may, in fact, be in situ only)
Case reports
- 35 year old man with rare coexistence of invasive papillary carcinoma with infiltrating ductal carcinoma (Int J Surg Pathol 2008;16:311)
- 44 year old woman with intracystic papillary carcinoma of the breast (Biomed Imaging Interv J 2005;1:e5)
- 63 year old woman with post traumatic hemorrhagic cyst (The Internet Journal of Surgery;11:1)
- 96 year old woman with a tumorous lesion of the right breast (Arch Pathol Lab Med 2005;129:e128)
- Elderly woman with bilateral invasive papillary carcinoma of the breast (Clin Imaging 2007;31:419)
Clinical images
Images hosted on PathOut server:
Mammogram, courtesy of Dr. Mark R. Wick
Gross description
- Often grossly circumscribed
Gross images
Images hosted on PathOut server:
Courtesy of Dr. Mark R. Wick
Circumscribed and
partially cystic lesion
contains round fleshy
papillary nodules (AFIP)
Images hosted on other servers:
Hemorrhagic tumor nodule with focal infiltration
Microscopic (histologic) description
- Circumscribed, delicate fibrovascular stroma in arborizing pattern
- Either papillary or solid foci formed by ducts nearly or completely filled by a solid neoplastic proliferation
- Also ribbons or trabeculae
- Cells have moderate to abundant cytoplasm, low / intermediate histologic grade, moderate or marked mucin, often papillary DCIS (at periphery), microcalcifications
- May have solid pattern with no discrete papillary pattern, but an underlying fibrovascular stromal network is seen
- May have neuroendocrine features, extracellular or intracellular mucin
- Variable collagen
- Rarely cribriform or comedonecrosis
- Papillae often lack myoepithelial cells
Microscopic (histologic) images
Images hosted on PathOut server:
Courtesy of Dr. Mark R. Wick
Microinvasion, courtesy of Dr. Mark R. Wick
AFIP images:
Papillary DCIS with invasion above fat
Residual papilloma in a malignant lesion
Images hosted on other servers:
Various images
Desmoplastic stromal reaction
Complex papillary structures
Invasion intro stroma (lower right)
Apocrine change
Solid variant
Solid variant with spindling
H&E
Cytology description
- Hypercellular, papillary clusters, hemorrhagic background, palisading rows of tall columnar cells, cellular atypia, calcification and eosinophilic, bipolar, cytoplasmic granules (Acta Cytol 1999;43:767)
Positive stains
- Mucin stains with mucicarmine, Alcian blue and PAS
- ER and GCDFP-15
- Variable synaptophysin, neuron specific enolase
Differential diagnosis
- Fibroadenoma at FNA (Arch Pathol Lab Med 2000;124:1667)
- Metastatic papillary carcinoma
Additional references
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