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
Features differentiating intraductal papilloma with ductal carcinoma in situ, papillary DCIS, and papillary 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

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