Differential Diagnosis for a Papillary Lesions of the Breast

• The differential diagnosis for a papillary lesion:
  • Discovered on FNA is broad:
    • FNA is often not able to reliably distinguish between benign, atypical, in situ, or invasive lesions
  • Even if core needle biopsy can be performed:
    • Papillary lesions often require surgical excision for complete characterization
• The wide range of pathologic terms involving the word “papillary” leads to confusion:
  • And there is a spectrum of malignant potential among papillary lesions
• Therefore, proper identification is key to the treatment approach: 
  • Intraductal papilloma (IDP), 
  • IDP with atypia
  • IDP with ductal carcinoma in situ (DCIS)
  • Papillary DCIS
  • Papillary carcinoma
  • Invasive micropapillary carcinoma

• Intraductal papilloma:
  • Is a benign, circumscribed, intraductal proliferation:
    • Which can be categorized as:
      • Central IPD
      • Peripheral IDP
  • Central IDP:
    • Often presents as nipple discharge
  • Peripheral IDP:
    • The condition of multiple peripheral IDPs is also referred to as papillomatosis
  • IDP with atypia is similar to atypical ducal hyperplasia (ADH):
    • In that there is architectural and cytologic atypia:
      • That fails to meet criteria for DCIS
    • When it does meet this threshold:
      • It is termed papilloma with DCIS
  • Papillary DCIS
    • Which is fundamentally DCIS:
      • That has prominent papillary architecture:
        • It does not arise within an IDP
  • Papillary carcinoma:
    • Is uncommon:
      • Accounts for only 1% to 2% of all breast cancers
    • It is more often found in older women
    • Presents as a central circumscribed mass:
      • Bloody nipple discharge is common
    • Papillary carcinoma of the breast can be further classified as:
      • Encapsulated or solid types:
        • Both of which have an excellent prognosis
  • Invasive micropapillary carcinoma:
    • Is a type of ductal cancer
    • With a growth pattern consisting of numerous small pseudo-papillary clusters of cells
    • It is an aggressive form of breast cancer:
      • That is most often high grade with frequent lymphatic involvement
• References:
  • Tse GM Ma TK, Lui PC, Ng DC, Yu AM, Vong JS, et at. Fine needle aspiration cytology of papillary lesions of the breast: how accurate is the diagnosis? J Clin Pathol. 2008;61(8):945-949.
  • Jorns JM. Papillary lesions of the breast: a practical approach to diagnosis. Arch Pathol Lab Med. 2016;140(10):1052-1059
  • Yang Y, Liu B, Zhang X, Fu L. Invasive micropapillary carcinoma of the breast: An update. Arch Pathol Lab Med. 2016;140(8):799-805.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #BreastCancer #IntraductalPapilloma #IDP #PapillaryLesionsoftheBreast