Papillary lesions of the breast

Abstract

Papillary lesions of the breast represent a heterogeneous group of lesions including benign papillomas, papillomas with focal epithelial atypia, fully fledged ductal carcinoma in situ (DCIS) or lobular neoplasia, papillary DCIS, encapsulated papillary carcinomas without or with invasion, solid papillary carcinomas, and invasive papillary carcinomas. A micropapillary pattern characterized by lack of fibrous stalks within the papillae is observed in micropapillary DCIS and invasive micropapillary carcinoma. In addition, a variety of other rare breast lesions reveals a papillary architecture such as tall cell carcinoma with reversed polarity (TCCRP) and mucinous cystadenocarcinoma, adenomyoepithelioma, and secretory carcinoma. In addition, benign lesions such as usual ductal hyperplasia, apocrine metaplasia, gynecomastia, and juvenile papillomatosis may show a papillary or micropapillary architecture. Fragments of a benign papilloma in a breast biopsy are considered a lesion of uncertain malignant potential (B3 in the European classification) and excision is mostly recommended. Although the knowledge about molecular pathology of papillary breast lesions has increased, there is not sufficient evidence for diagnostically useful molecular features, yet. The aim of this review is to provide an update on papillary and micropapillary lesions with emphasis on problematic areas for daily diagnostic work including biopsies.

Invasive micropapillary breast carcinoma: A retrospective study on the clinical imaging features and pathologic findings

“…Although IMPC was listed as a subtype of invasive breast carcinoma in 1993, no consensus has been successfully reached on which criteria to use for diagnosis and determining the type of disease based on the percentage of the IMPC component (12). Regardless of the tumor size and the proportion of the IMPC component, a few studies have emphasized the importance of the histologic features in determining the invasiveness of IMPC (4,13). In our study, data from 63 patients with a micropapillary component ratio ranging from 10% to 100% were reviewed, and the clinical imaging features were highly indicative of the malignancy of IMPC.…”

“…Thirteen years later, IMPC was defined and included in the World Health Organization's (WHO) classification of breast tumors (3). Pathologists have described IMPC lesions as having an inside-out reversed polarity pattern with a typical cuticle-like microvillous secretory surface facing the stroma, resulting in a gap between the stroma and the neoplastic epithelial cells (4). Prior studies have demonstrated that as an aggressive variant, IMPC is linked to a larger tumor size, more advanced Tumor, Node, Metastasis (TNM) staging, a greater proportion of nodal involvement, and a higher degree of lymphovascular invasion (LVI); these characteristics can contribute to a high early recurrence rate and a poorer prognosis (5).…”

A Very rare case report of male invasive micropapillary breast carcinoma in China and review of literature

“…IMPC is easy to early metastasized to lymph node is the most prominent characteristics, some patients before early diagnosis, cancer cells already metastasized throughout the body through the blood vessels, lymphatic system, the risks of recurrence of primary focal distance and metastasis of cancer cells were reduced [12] . As early as 2004, Pettinato et al reported that IMPC lymph node metastasis rate was as high as 80 % [13] .…”

Breast cancer risk in papilloma patients: Osteopontin splice variants indicate prognosis

“…Fragments of a benign papilloma in a breast biopsy are considered a lesion of uncertain malignant potential (B3 in the European classification), and excision is mostly recommended [ 5 ], although its necessity has been subject to debate [ 6 – 8 ]. A single papilloma imparts a cancer risk similar to conventional proliferative fibrocystic change.…”