Papillary Lesions of the Breast: An Update

Abstract

Context.—Papillary lesions of the breast, characterized by the presence of arborescent fibrovascular cores that support epithelial proliferation, constitute a heterogeneous group of neoplasms with overlapping clinical manifestation and histomorphologic features, but may have divergent biological behavior. These lesions are exclusively intraductal neoplasms, although an invasive carcinoma may rarely have a predominantly papillary architecture. Although recognition of a papillary architecture is typically not challenging, the histologic distinction of these entities is not always straightforward. Historically, different terminologies and variable criteria have been proposed for a given entity by various authorities. The difficulty in classifying these lesions has been further confounded by the scarcity of data and the heterogeneity across different studies with regard to the molecular genetic characteristics of this group of lesions. Objective.—To provide an overview focusing on the current concepts in the diagnosis and classification of papillary lesions of the breast incorporating recent molecular genetic advances. Data Sources.—Data were obtained from pertinent peer-reviewed English-language literature. Conclusions.—The recent evolution of molecular techniques has enhanced our knowledge of the pathogenesis of papillary carcinomas of the breast. This, along with emerging outcome studies, has led to prognosis-based reclassification of some of these entities. Additional studies focusing on the molecular signatures are needed to identify potential decision tools to further stratify these lesions with respect to prognostic significance.

Breast cancer organoids from a patient with giant papillary carcinoma as a high-fidelity model

“…According to the WHO breast tumor classification [22], the pathology of papillary carcinoma of the breast is divided into intraductal papilloma with atypical ductal hyperplasia or DCIS, intraductal papillary carcinoma, coated papillary carcinoma or with infiltration, and solid papillary carcinoma or infiltration. Papillary carcinoma is rare, whose incidence is 0.5% to 1.0% in breast cancer, however, it is more common in postmenopausal women and older women with favorable prognosis [2][3][4]. This patient is a 63-year-old woman who was admitted with a painful, greater than 15 cm mass in her right breast.…”

“…Breast cancer is the most commonly diagnosed cancer (11.6%) and the leading cause of cancer death (6.6%) among females globally [1]. Papillary lesions of the breast initiate within the ducto-lobular system supported by fibrovascular cores, and comprise a heterogeneous group of neoplasms, including (a) intraductal papilloma, (b) papilloma with atypical ductal hyperplasia, (c) papilloma with ductal carcinoma in situ, and (d) papillary carcinoma [2,3]. Papillary carcinoma is an uncommon type of breast cancers with a better prognosis, accounting for 0.5-1% of breast cancers, and contains encapsulated and solid types [2][3][4].…”

Ultrasound-guided percutaneous microwave ablation of central intraductal papilloma: a prospective pilot study

“…IDPs are pathologically diagnosed as benign, or atypical or malignant [18]. IDPs comprise central IDP and peripheral IDP, with most having a central location and involving a single lesion [1]. Peripheral IDPs arise in the terminal duct lobular units; thus, these IDPs are often clinically occult and discovered incidentally upon imaging examination.…”

“…Intraductal papilloma (IDP) of the breast is a benign tumor, affecting 2-3% of the female population. IDP is the most common pathological finding in 30-50-year-old women who have pathological nipple discharge, accounting for 40-70% of cases [1][2][3]. IDP is characterized by the presence of a proliferating arborescent fibrovascular core lined with an outer epithelial layer and an inner myoepithelial layer [3].…”

A Correlation between Histochemical Patterns of Connective Tissue Fibers and AgNORs in Breast Lesions

“…Although the recent advancement in molecular technology has improved the diagnostic acumen and knowledge of histo-pathogenesis in tumor diagnosis, particularly for frequently encountered tissues such as breast lesions [11], conventional histopathology still practiced as a routine technique. As the bulk of current research efforts are focusing on advanced diagnostic technology, which is time-consuming and expensive, additional research focusing on the strengthening of conventional histopathologic evidence is recommended to facilitate the potential diagnostic decision using routine histopathology.…”