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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

Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.

 

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

 

Definition

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● Proliferation of tumor cells in association with fibrovascular stalks

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

 

Terminology

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● Also called noninvasive papillary carcinoma

 

Epidemiology

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Mean age is 65 years, older than DCIS overall

 

Clinical

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● 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

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● Well circumscribed mass within a distended duct or may extend throughout ducts to involve a large area

● Mean 2 cm

 

Gross description

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Circumscribed and partially cystic lesion                                  

contains round fleshy papillary nodules (AFIP)

 

Microscopic description

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● 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

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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#2post-biopsy hemorrhage #1#2

 

Cytology description

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● 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

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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

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Papillary carcinoma

 

Negative stains

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● 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

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● 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

 

 

 

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