Other carcinoma subtypes, WHO classified
Invasive papillary

Topic Completed: 1 August 2012

Minor changes: 4 July 2020

Copyright: 2002-2019,, Inc.

PubMed search: Papillary carcinoma [title] breast

Monika Roychowdhury, M.D.
Page views in 2019: 13,124
Page views in 2020 to date: 11,542
Cite this page: Roychowdhury M. Invasive papillary. website. Accessed November 23rd, 2020.
  • 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


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
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AFIP images

Papillary DCIS with invasion above fat

Residual papilloma in a malignant lesion

Images hosted on other servers:

Various images

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Desmoplastic stromal reaction

Complex papillary structures

Invasion intro stroma (lower right)

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Apocrine change

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Solid variant

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Solid variant with spindling


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
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