Breast – Malignant, Males, Children

Home Chapter Home Jobs Conferences Fellowships Books

Breast-malignant, males, children

Morphologic variants of DCIS

Papillary DCIS

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

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

Revised: 19 August 2009

Last major update: August 2009

Variants: intracystic papillary carcinoma (categorized with the invasive carcinomas), solid papillary DCIS

Definition

=========================================================================

● Proliferation of tumor cells in association with fibrovascular stalks

● Traditionally, a myoepithelial cell layer is not considered to be present

Terminology

=========================================================================

● Also called noninvasive papillary carcinoma

Epidemiology

=========================================================================

● Mean age is 65 years, older than DCIS overall

Clinical

=========================================================================

● 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 description

=========================================================================

Circumscribed and partially cystic lesion

contains round fleshy papillary nodules (AFIP)

Microscopic description

=========================================================================

● Delicate fibrovascular or avascular connective tissue cores covered by monotonous epithelial cells

● Often cribriform DCIS present; detached “secondary papilla” are common

● Features favoring papillary DCIS vs. papilloma are uniformity in size and shape of epithelial cells, columnar cells that are arranged perpendicular to duct axis, no/scattered myoepithelial cells (J Clin Pathol 2007;60:315), nuclear hyperchromasia, high nuclear/cytoplasmic ratio, loss of nuclear polarity, cell layering, frequent mitotic activity with atypical mitotic figures

● May resemble urothelial carcinoma (Mod Path 1999;12:287)

● Minimal stroma, no apocrine metaplasia, no cribriform or trabecular patterns, usually no benign proliferative disease in adjacent breast

● Note: scattered, large pale eosinophilic cells (clear / globoid bodies) may be mistaken for myoepithelial cells, but are GCDFP15+ and actin negative

Micro images

=========================================================================

Complex architecture Globoid cells are present Layering of cells and loss

of polarity

Multiple finger like projections High power demonstrates Fusion of papillae

in dilated ducts lack of fibrovascular cores

Intraductal tumor Complex papillary Fusion of papillae

branching

Nuclear atypia Atypical epithelial proliferation

Papillary carcinoma with fibroadenoma

Complex compact Columnar cell nuclei Overlapping and

papillary pattern have variable staining crowded nuclei

Solid apocrine Apocrine papillary carcinoma Inconspicuous

carcinomatous area with cribriform area (arrows myoepithelial cells

at apocrine snouts) (arrows)

Irtregular sclerotic border Trapped neoplastic glands in sclerotic reaction

Neither of these examples constitutes invasion

Other images: high power #1; #2; post-biopsy hemorrhage #1; #2

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

=========================================================================

Fig 1A: feather like papilla with numerous thin haphazardly arranged fronds and a delicate fibrovascular core (Pap), 1B: highly complex papilla with numerous small clusters aggregated around a well defined fibrovascular core (Pap), 1C: filiform fronds (Pap); 1D: detached single fronds (Pap); 1E: cellular dyscohesion and columnar cells with mild atypia (Pap)

Virtual slides

=========================================================================

Papillary carcinoma

Negative stains

=========================================================================

● Myoepithelial markers are negative / variable, including smooth muscle actin, smooth muscle myosin heavy chain, calponin, p63, CD10 and CK 5/6 (Histopathology 2007;51:657, AJCP 2005;123:36)

Differential diagnosis

=========================================================================

● Papilloma - myoepithelial cells clearly present, no atypia

● Invasive papillary carcinoma - neoplastic epithelial structures infiltrate breast beyond the fibrous wall and have a recognized pattern of invasive carcinoma

End of Breast – Malignant, Males, Children > Papillary DCIS

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by Copyright, (c) 2001-2009, PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions.