Papillary DCIS

Breast malignant, males, children
In situ carcinoma
Papillary DCIS

Author: Dina Kandil, M.D. (see Authors page)

Revised: 18 October 2016, last major update January 2012

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Papillary DCIS

Table of Contents

Cite this page: Papillary DCIS. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantpapillaryDCIS.html. Accessed July 14th, 2017.

Definition / general

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

Terminology

Also called noninvasive papillary carcinoma
Different from intraductal papilloma with DCIS

Epidemiology

Mean age is 65 years, older than DCIS overall

Clinical features

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

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

Gross images

Images hosted on PathOut server:

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

Microscopic (histologic) description

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

Microscopic (histologic) images

Images hosted on PathOut server:

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 (left) and trapped neoplastic glands in sclerotic reaction (right); neither of these examples constitutes invasion

Images hosted on other servers:

Complex architecture

Globoid cells are present

Multiple finger like projections in dilated ducts

High power demonstrates lack of fibrovascular cores

Fusion of papillae

Nuclear atypia

Papillary carcinoma with fibroadenoma

High power

Post-biopsy hemorrhage

Cytology description

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

Images hosted on other servers:

Various images

Negative stains

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

Apocrine metaplasia
Encapsulated papillary carcinoma: myoepithelial cells are absent both within the papillae and at the periphery of the duct spaces
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