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Breast malignant, males, children

In situ carcinoma

Solid 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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Clinical behavior:
● 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
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● Also called neuroendocrine DCIS

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

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

Micro description
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● 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

Micro images
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Solid tumor with focal fibrovascular stroma


Solid variant with spindling


Inconspicuous fronds centrally (AFIP)

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

Virtual slides
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Two cases

Cytology description
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● 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
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● Chromogranin or synaptophysin in 50%, ER and PR

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

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

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