Solid papillary DCIS

Breast malignant, males, children
In situ carcinoma
Solid papillary DCIS

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

Revised: 18 October 2016, last major update January 2012

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PubMed Search: Solid papillary DCIS

Table of Contents

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

Definition / general

Indolent behavior if no invasion
Can be associated with invasive colloid / mucinous or neuroendocrine carcinomas (Am J Surg Pathol 1995;19:1237, Pathol Int 2007;57:421)
With invasion, patients often die of disease (Am J Surg Pathol 2006;30:501)

Terminology

Also called neuroendocrine DCIS

Epidemiology

Uncommon (2% of breast cancer)
Age 60+ years

Case reports

Solid and cystic papillary carcinoma (Ann Diagn Pathol 2004;8:126)

Microscopic (histologic) description

Circumscribed, large cellular nodules separated by bands of dense fibrosis
Network of fibrovascular cores, but discrete papillae are not identified
Solid growth with cellular streaming and low grade, ovoid or spindled cells, resembling usual ductal hyperplasia
Cells may have endocrine features with granular eosinophilic cytoplasm and fine chromatin
May have pseudorosettes with palisading around small vascular spaces
Often mitotic figures
May have intracytoplasmic and extracellular mucin

Microscopic (histologic) images

Images hosted on PathOut server:

Inconspicuous fronds centrally (AFIP)

Images hosted on other servers:

Solid tumor with focal fibrovascular stroma

Solid variant with spindling

Tumor cells in cords
and festoons, with well
-defined fibrovascular
septa and vascular cores

Cytology description

Malignant features include hypercellularity, highly discohesive clusters, numerous isolated cells and severe overcrowding
Benign features include small and bland nuclei, low nuclear-cytoplasmic ratio and inconspicuous nucleoli (Diagn Cytopathol 2007;35:417)

Positive stains

Chromogranin or synaptophysin in 50%, ER and PR

Negative stains

Usually negative for myoepithelial markers (Histopathology 2007;51:657), including CK5 / 6, but entrapped benign and myoepithelial cells may be positive (Hum Pathol 2006;37:787)
34betaE12 (Virchows Arch 2007;450:539), HER2

Differential diagnosis

LCIS: no fibrovascular septa, no papillary features
Metastatic carcinoid: clinical history of primary, may not be papillary, usually ER negative
Solid variant of adenoid cystic carcinoma: biphasic with small inconspicuous intercalated ducts mixed with myoepithelium and small collagenous spherules
Usually ductal hyperplasia involving a papilloma: no atypia, mosaic staining pattern with CK5/6+