Breast malignant
In situ carcinoma
Papillary DCIS


Topic Completed: 1 January 2012

Revised: 12 September 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Papillary DCIS

Dina Kandil, M.D.
Page views in 2018: 4,663
Page views in 2019 to date: 3,961
Cite this page: Kandil D. Papillary DCIS. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantpapillaryDCIS.html. Accessed September 22nd, 2019.
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

AFIP images

Circumscribed and partially
cystic lesion contains round
fleshy papillary nodules

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

AFIP images

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

Postbiopsy 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
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
Back to top