Papillary carcinoma breast: A tertiary care institute experience

Abstract

Introduction: Breast cancer is the most common cancer in women globally and in India. Papillary lesions of the breast constitute around 5% of all the breast lesions. They encompasses a morphologically heterogeneous group of lesions, all of which share a growth pattern characterised by the presence of arborescent fibrovascular stalks lined by epithelial cells with or without a layer of myoepithelial cells. Invasive papillary carcinoma is an invasive adenocarcinoma which has predominant papillary morphology >90% in the invasive component. Invasive micropapillary carcinoma is a rare type accounting for only 0.9 to 2.0% of all invasive breast tumours. Encapsulated papillary carcinoma consists of fibrous capsule surrounding a nodule composed of delicate fibrovascular stalks, covered by monomorphic population of neoplastic epithelial cells. Micropapillary carcinoma is characterized by higher incidence of lymph node metastasis and lymphovascular invasion resulting in poor prognosis. The purpose of this study is to share the last 13 years experience regarding papillary lesions of breast in the department of pathology in our institute. Material and Methods: A 13-year (2006-2019) retrospective review of database of patients diagnosed with breast cancer was performed. The medical records of 8 patients with papillary breast cancer who underwent surgery were retrieved and their clinical data, surgical treatment and pathological findings were reviewed. Results: A total of 884 patients underwent mastectomy for invasive breast cancer during the 13 year period. Out of 884 patients, eight were diagnosed with papillary carcinoma breast (0.90%). Amongst the eight, three were diagnosed as invasive papillary carcinoma, two as encapsulated papillary carcinoma and rest three as invasive micropapillary carcinoma. The mean age of presentation was 63.3 (range 45-80) years. The tumour size ranged between 3.5 to 6cm in its greatest dimension. Two out of eight patients had lymph node metastasis with no distant metastasis. Conclusion: Papillary carcinoma of the breast is a rare entity, the reported incidence of pure micropapillary carcinomas is 0.9 to 2% of all breast cancers. It is associated commonly with lymph node metastasis at the time of presentation and have relatively poor prognosis. Much lower prevalence of papillary carcinoma breast was seen in our institutional study.