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Breast malignant, males, children

Carcinoma subtypes

Papillary carcinoma - invasive

Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 4 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

● See also papillary DCIS, intracystic papillary carcinoma

Terminology
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● Literature often does NOT clearly differentiate between in situ and invasive papillary tumors

Clinical features
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● 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 features
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● 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
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● 35 year old man with invasive papillary carcinoma and infiltrating ductal carcinoma (Int J Surg Pathol 2008;16:311)
● 44 year old woman with painless breast lump (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 solid variant (Arch Pathol Lab Med 2005;129:e128)
● Elderly woman with rare bilateral tumor (Clin Imaging 2007;31:419)

Gross description
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● Often grossly circumscribed

Gross images
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Thick cyst wall with nodular lesions


Circumscribed and partially cystic lesion contains round fleshy papillary nodules (AFIP)

Hemorrhagic tumor nodule with focal infiltration

Micro description
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● 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

Micro images
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Various images

            
Complex papillary structures         Invasion intro stroma (lower right)
supported by delicate fibrous stalks

            
Core biopsy shows papillary architecture, monotonous cells with nuclear hyperchromasia

 
Apocrine change

AFIP images:
     
Papillary DCIS with            Residual papilloma in a malignant lesion
invasion above fat


Figure 1: papillary carcinoma
Figure 2: recurrence in myocutaneous flap
Figure 3: recurrent invasive ductal carcinoma

Cytology description
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● 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
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● Mucin stains with mucicarmine, Alcian blue and PAS
● ER and GCDFP-15
● Variable synaptophysin, neuron-specific enolase

Negative stains
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● Myoepithelial markers: calponin, smooth muscle myosin heavy chain, p63

Differential diagnosis
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● Fibroadenoma at FNA (Arch Pathol Lab Med 2000;124:1667)
● Metastatic papillary carcinoma

Additional references
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● Breast Cancer Res Treat 2010;122:637, Arch Pathol Lab Med 2009;133:893

End of Breast malignant, males, children > Carcinoma subtypes > Papillary carcinoma - invasive

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