Papillary Carcinoma of Breast: Clinicopathological Characteristics, Management, and Survival

Abstract

Objective. To study clinicopathological features, treatment strategies, and prognosis of papillary carcinoma of breast. Material and Methods. Data from 58 patients were retrospectively reviewed from January 2010 to December 2016. Four types of papillary carcinoma (on final resected specimen) were included, i.e., invasive papillary carcinoma (IPC), intracystic (encapsulated) papillary carcinoma (EPC), solid papillary carcinoma (SPC), and papillary DCIS (ductal carcinoma in situ). Various features of the four types were observed and compared. Results. Of the 58 patients, 8 were males (13.7%). The mean age at presentation was 61 years; the mean tumor size was 33 mm. The frequency of each histological type was as follows: IPC ( n = 22 /38%), EPC ( n = 22 /38%), SPC ( n = 12 /20.6%), and papillary DCIS ( n = 2 /3.4%). Only two patients were ER negative (both IPC). HER-2 Neu was positive in 3 patients only, out of which 2 died of progressive disease (one EPC and one IPC). LN metastasis was present in 3 (5%) patients (one in each of 1st three types) and only one died of bone metastasis that was also Her-2Neu positive. All patients underwent upfront surgery except two patients who had synchronous IDC on the contralateral side. Breast conservation surgery (BCS) was performed in 34 (58.6%) and mastectomy in 22 (37.9%) patients. 13 patients did not undergo invasive axillary staging; the rest of 43 (74%) patients did (32 sentinel biopsy and 11 axillary dissection). Chemotherapy was given to 18 patients (31%), mostly to IPC ( n = 12 ). Only 2 patients had bone metastasis (one was IPC and one EPC). Cancer-related death was observed in 3 patients. For all groups combined, 5-year OS was 98% and DFS was 92%. Conclusion. Overall, papillary carcinoma of the breast has an excellent prognosis, even though less intense treatment modalities were used. It is still difficult to define the optimum management and avoid overtreatment, given the limited data in the literature.

Comparison of clinicopathologic characteristics and survival outcomes of various subtypes of breast cancer

“…19 . Owing to the rarity of the disease and the complexity of its histological classi cation, there is no universally accepted consensus on the management of patients with invasive papillary carcinoma 20 . Interestingly, invasive papillary carcinoma is relatively more prevalent among males 21 which is consistent with our observation of invasive papillary carcinoma breast cancer subtypes in male patients.…”

Encapsulated papillary carcinoma of the breast: A single institution experience

“…The clinical manifestation of EPC mimics a benign breast tumor, as the most common symptom is a palpable breast mass ( 22 , 23 ). As for the tumor size, cases of EPC associated with invasive carcinoma were larger when compared with the non-invasive counterparts.…”

Invasive papillary carcinoma of the breast

“…The IPC has a slow biological activity, tends to progress gradually and has low rates of lymph node and distant organ metastasis. In the current literature, the majority of IPC are classified as luminal type, histologically graded as grade 2 according to the Nottingham system, and have a low TNM stage ( 3 , 24 ). Hashmi et al.…”

“…The IPC has a slow biological activity, tends to progress gradually and has low rates of lymph node and distant organ metastasis. In the current literature, the majority of IPC are classified as luminal type, histologically graded as grade 2 according to the Nottingham system, and have a low TNM stage (3,24). Hashmi et al retrospectively compared 44 patients with IPC and 1268 patients with IDC and found that IPC had more favorable pathological features than IDC in terms of tumor T stage, axillary lymph node metastasis, Ki-67 index, PR and HER2 expression (25).…”

“…They constitute less than 3% of all breast lesions ( 1 , 2 ). According to the latest WHO classification of breast tumors (5th edition), papillary neoplasms of the breast include benign and malignant lesions ( Table 1 ) ( 3 ). Benign papillary neoplasms, also known as intraductal papilloma, are most commonly found in multiparous women and have a low risk of becoming malignant ( 4 ).…”