Intracystic papillary breast carcinoma
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Intracystic papillary carcinoma of the breast
- AKA encapsulated papillary carcinoma of the breast, abbreviated EPC.
General
- Very good prognosis[1] - it is similar to DCIS.
- Classical menopausal women.
- ~30% present with bloody discharge.[2]
Microscopic
Features:
- Lesion confined to a cyst.
- May have a thick fibrous capsule
- The involved space is not lined by myoepithelial cells.
- The cyst contains an abnormal epithelial proliferation with cribriform, solid or papillary architecture.
- Loss of myoepithelial cells within the epithelial proliferation is a key feature.
- Scattered large cells with pale eosinophilic cytoplasm may be observed[3].
- These cells are so-called globoid cells or clear cells and are immunoreactive for GCDFP-15.
- They should not be mistaken for myoepithelial cells.
- Neoplastic epithelial cells:
- Nuclear atypia - including: nucleoli, nuclear pleomorphism.
IHC:
- Calponin/p63/SMA/CK5-6
- Loss of myoepithelial cells within the tumour.
- Loss of myoepithelial cells at the cyst wall.
- ER - Homogeneous staining of the epithelial proliferation.
Photos:
Breast - Intracystic Papillary Carcinoma - Medium power (SKB)
Breast - Intracystic Papillary Carcinoma - Medium power (SKB)
Breast - Intracystic Papillary Carcinoma - High power (SKB)
Breast - Papillary Intracystic Carcinoma, Solid Variant - low power (SKB)
Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)
Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)
Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)
Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)
Breast - Intracystic papillary adenocarcinoma (top) with associated invasive ductal carcinoma (bottom) (SKB)
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- Intraductal papilloma.
- Absent or scant stroma favors papillary carcinoma over papilloma.
- Is there a single cell or dual cell population in the lesion?
- ER staining will be heterologous in a benign lesion.
- Myoepithelial markers (calponin/p63/SMA +ve)s hould be positive in a benign lesion.
- Papillary ductal carcinoma in situ
- Papillary DCIS shows myoepithelial cells (calponin/p63/SMA +ve) at the periphery of the involved spaces
- But papillary DCIS should be negative for myoepithelial cells within the focus of DCIS
- Papillary intracystic carcinoma does not show myoepithelial cells at the periphery of the involved spaces
- Invasive papillary carcinoma of the breast
- Similar architecture but no cystic space, frankly invasive.
- Very rare.
- Invasive carcinoma arising in association with papillary intracystic carcinoma
- Epithelial entrapment in the encysting fibrous tissue should not be interpreted as invasion.
- Carcinoma must be seen in the breast tissue outside the encysting fibrous tissue.
- Infiltrating carcinoma is usually of the 'no special type' variety.
- Adenoid cystic carcinoma of the breast
- The solid variant looks basaloid - solid adenoid cystic carcinoma or a 'basal-like' carcinoma should be considered in these cases.
Notes
- Many potential pitfalls with papillary breast lesions on needle core biopsy.
- Complete excision is recommended[6].
- Adequately and carefully sample the specimen to exclude an invasive component.
- Report only the size of the invasive component (if present) to prevent over-estimation of tumor stage.
IHC
- Loss of myoepithelial markers within the lesion.
- ↑ Rakha, EA.; Gandhi, N.; Climent, F.; van Deurzen, CH.; Haider, SA.; Dunk, L.; Lee, AH.; Macmillan, D. et al. (Aug 2011). "Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis.". Am J Surg Pathol 35 (8): 1093-103. doi:10.1097/PAS.0b013e31821b3f65. PMID 21753694.
- ↑ Rodríguez, MC.; Secades, AL.; Angulo, JM. (Nov 2010). "Best cases from the AFIP: intracystic papillary carcinoma of the breast.". Radiographics 30 (7): 2021-7. doi:10.1148/rg.307105003. PMID 21057133.
- ↑ Collins, LC.; Schnitt, SJ. (Jan 2008). "Papillary lesions of the breast: selected diagnostic and management issues.". Histopathology 52 (1): 20-9. doi:10.1111/j.1365-2559.2007.02898.x. PMID 18171414.
- ↑ Collins, LC.; Schnitt, SJ. (Jan 2008). "Papillary lesions of the breast: selected diagnostic and management issues.". Histopathology 52 (1): 20-9. doi:10.1111/j.1365-2559.2007.02898.x. PMID 18171414.
- ↑ Pathmanathan, N.; Albertini, AF.; Provan, PJ.; Milliken, JS.; Salisbury, EL.; Bilous, AM.; Byth, K.; Balleine, RL. (Jul 2010). "Diagnostic evaluation of papillary lesions of the breast on core biopsy.". Mod Pathol 23 (7): 1021-8. doi:10.1038/modpathol.2010.81. PMID 20473278.
- ↑ Rizzo, M.; Linebarger, J.; Lowe, MC.; Pan, L.; Gabram, SG.; Vasquez, L.; Cohen, MA.; Mosunjac, M. (Mar 2012). "Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up.". J Am Coll Surg 214 (3): 280-7. doi:10.1016/j.jamcollsurg.2011.12.005. PMID 22244207.