Breast – Malignant, Males, Children - Papillary carcinoma

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Breast-malignant, males, children

Papillary carcinoma - invasive

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 30 September 2009

Last major update: September 2009

Terminology

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● Literature often does NOT clearly differentiate between in situ and invasive papillary tumors

Epidemiology

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● Rare; invasive and in-situ papillary tumors together are 1-2% of breast carcinomas in women

● Average age 63-67 years

Clinical

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● Invasive carcinoma can arise in papillomas

● 50% arise in central part of breast; 25-33% associated with nipple discharge

● Most papillary carcinomas are in situ and not invasive

● Invasive portions of papillary DCIS are either papillary carcinoma or ductal carcinoma NOS

● Often clinical axillary metastases are actually sinus histiocytosis (AJCP 1980;73:313)

● Circumscribed tumors with no apparent invasion may lack myoepithelial markers at tumor-stromal interface (Histopathology 2007;51:657

Treatment and prognosis

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● 5 year survival is 90%, better than invasive ductal NOS (although some of the papillary cases may, in fact, be in situ only)

X-ray

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● Rounded and circumscribed

Case reports

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● 35 year old man with invasive papillary carcinoma and infiltrating ductal carcinoma (Int J Surg Pathol 2008;16:311)

● 44 year old woman with painless breast lump (Biomed Imaging Interv J 2005;1:e5)

● 63 year old woman with clinical post-traumatic hemorrhagic cyst (The Internet Journal of Surgery 2007;11(1))

● 96 year old woman (Archives 2005;129:e128)

● Rare bilateral tumor (Clin Imaging 2007;31:419)

Gross description

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● Often grossly circumscribed

Gross images

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Thick cyst wall with nodular lesions Circumscribed and partially cystic lesion

contains round fleshy papillary nodules (AFIP)

Other images: hemorrhagic tumor nodule with focal infiltration

Microscopic description

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● Circumscribed, delicate fibrovascular stroma in arborizing pattern

● Either papillary or solid foci formed by ducts nearly or completely filled by a solid neoplastic proliferation

● Also ribbons or trabeculae

● Cells have moderate to abundant cytoplasm, intermediate histologic grade, moderate or marked mucin, often papillary DCIS (at periphery), microcalcifications

● Variable collagen

● Rarely cribriform or comedonecrosis

Micro images

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Complex papillary structures Invasion intro stroma (lower right)

supported by delicate fibrous stalks

Core biopsy shows papillary Invasion

architecture, monotonous cells with

nuclear hyperchromasia; inset shows

pleomorphism and mitotic figures

Apocrine change

AFIP images:

Papillary DCIS with Invasion into Residual papilloma in a malignant lesion -

invasion (above) fat carcinoma arising in a papilloma

Fig 1: solid tumor with pushing margins

Fig 2: invasion of adipose tissue

Fig 3: sheets of tumor cells with delicate fibrovascular stroma

Fig 4: numerous mitotic figures

Fig 1: papillary carcinoma

Fig 2: recurrence in myocutaneous flag

Fig 3: recurrent invasive ductal carcinoma

Cytology description

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● Hypercellular, papillary clusters, hemorrhagic background, palisading rows of tall columnar cells, cellular atypia, calcification, eosinophilic bipolar cytoplasmic granules (Acta Cytol 1999;43:767)

Positive stains

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● Mucin stains with mucicarmine, Alcian blue, PAS

● ER and GCDFP-15

● Variable synaptophysin

● Neuron-specific enolase

Differential diagnosis

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● Fibroadenoma at FNA (Archives 2000;124:1667)

● Metastatic papillary carcinoma

End of Breast – Malignant, Males, Children > Papillary carcinoma - invasive

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