Breast malignant, males, children
Carcinoma subtypes
Papillary carcinoma - invasive



Topic Completed: 1 August 2012

Revised: 12 April 2019

Revised: 28 January 2019

Copyright: (c) 2002-2019, PathologyOutlines.com, Inc.

PubMed search: Papillary carcinoma [title] breast


Monika Roychowdhury, M.D.
Page views in 2018: 10,862
Page views in 2019 to date: 5,868
Cite this page: Roychowdhury M Papillary carcinoma - invasive. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantpapillary.html. Accessed June 17th, 2019.
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
Clinical images

Contributed by Dr. Mark R. Wick

Mammogram

Gross description
  • Often grossly circumscribed
Gross images
AFIP images

Circumscribed and
partially cystic lesion
contains round fleshy
papillary nodules

Contributed by Dr. Mark R. Wick


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

Contributed by Dr. Mark R. Wick

Missing Image Missing Image Missing Image

Microinvasion



AFIP images

Papillary DCIS with invasion above fat

Residual papilloma in a malignant lesion



Images hosted on other servers:

Various images

Missing Image

Desmoplastic stromal reaction

Complex papillary structures

Invasion intro stroma (lower right)


Missing Image Missing Image

Apocrine change

Missing Image

Solid variant

Missing Image

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
Negative stains
  • Myoepithelial markers: calponin, smooth muscle myosin heavy chain, p63
Differential diagnosis
Back to top