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Breast malignant, males, children

In situ carcinoma

Papillary DCIS


Reviewer: Dina Kandil, M.D. (see Reviewers page)
Revised: 8 November 2012, last major update January 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● DCIS with fibrovascular stalks
● Traditionally, a myoepithelial cell layer is not considered to be present

Terminology
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● Also called noninvasive papillary carcinoma
● Different from intraductal papilloma with DCIS

Epidemiology
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● Mean age is 65 years, older than DCIS overall

Clinical
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● 90% of lesions are low grade, so outcome is favorable
● Thought to arise from large ducts
● Associated with multiple papillomas
● Involves multiple ducts, unlike intracystic papillary carcinoma, but there is partial overlap between these lesions

Gross description
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● Well circumscribed mass within a distended duct or may extend throughout ducts to involve a large area
● Mean 2 cm

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

Micro description
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● Solid lobular growth, neuroendocrine-like festoons and rosettes and prominent fibrovascular septa
● Cells are polygonal, oval or spindled with abundant granular eosinophilic cytoplasm and bland ovoid nuclei
● Accumulation of basophilic intracellular mucin
● Often pagetoid spread and well developed vascular network
● Variable stromal sclerosis or signet ring cells
● Usually no necrosis

Micro images
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Complex architecture


Globoid cells are present


Multiple finger like projections in dilated ducts


High power demonstrates lack of fibrovascular cores

   
Fusion of papillae


Intraductal tumor


Complex papillary branching


Nuclear atypia

   
Atypical epithelial proliferation


Papillary carcinoma with fibroadenoma


Complex compact papillary pattern


Columnar cell nuclei have variable staining


Overlapping and crowded nuclei


Solid apocrine carcinomatous area


Apocrine papillary carcinoma with cribriform area (arrows at apocrine snouts)


Inconspicuous myoepithelial cells (arrows)

                 
Irregular sclerotic border     Trapped neoplastic glands in sclerotic reaction
*Neither of these examples constitutes invasion

Other images: high power #1; #2; post-biopsy hemorrhage #1;; #2

Cytology description
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● Compared to intraductal papilloma, is more cellular with more complex papillae containing thin disorganized fronds, mild to moderate nuclear atypia, and prominent dissociation with many single papillae (Cancer 2002;96:92)

Cytology images
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Various images

Virtual slides
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Papillary carcinoma

Negative stains
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● Myoepithelial cell markers are negative within the papillae but present at the periphery (Histopathology 2007;51:657, Am J Clin Pathol 2005;123:36)

Differential diagnosis
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Intraductal papilloma: variably fibrotic fibrovascular cores covered by both epithelial and myoepithelial cells; myoepithelial cell markers are positive both at the periphery of the duct space and within the papillae
Apocrine metaplasia
Encapsulated papillary carcinoma: myoepithelial cells are absent both within the papillae and at the periphery of the duct spaces

End of Breast malignant, males, children > In situ carcinoma > Papillary DCIS


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