Papillary Breast Lesions: An Overview



General

  • Characterized by epithelial proliferation supported by fibrovascular cores +/- intervening myoepithelial cell layer

  • Carcinomas with predominantly papillary morphology have a better outcome




COMMON BENIGN FEATURES

  • Papillary lesion has a double cell layer (myoepithelial cells stain with p63 or calponin and are present in papillary fronds & periphery of involved space)

  • Epithelial cells have NO atypia- (NOTE: you can see ADH or DCIS in an IDP; Restricted luminal (pink) cytokeratin expression without brown myoepithelial cells supports the diagnosis of ADH)

  • Thick collagenous stroma within branching fibrovascular cores. Can have marked fibrosis (“sclerosing papilloma”). The overall appearance is heterogeneous with thick fibrovascular cores and other areas of adenosis.

  • Finding apocrine metaplasia is helpful (common in benign papillomas; unusual in papillary carcinomas)


ATYPICAL/MALIGNANT FEATURES

  • Increased cellularity surrounding the fibrovascular cores

  • Numerous epithelial cells not directly connected to a papilla (thin papillations)

  • Lack of myoepithelial cells

  • Fibrovascular cores can be very small and subtle (benign FV cores are thicker/more fibrotic)

  • Mitotic figures

  • Architectural complexity (Low power view may demonstrate circumscription and this within a dilated duct)





Papillary Breast Lesions: Common Diagnoses


Benign lesions:

  • Solitary (central) papilloma

  • Multiple (peripheral) intraductal papillomas

  • Atypical lesions:

  • Intraductal papilloma with ADH or DCIS

Malignant lesions:

  • Papillary DCIS

  • Encapsulated papillary carcinoma

  • Solid papillary carcinoma

  • Invasive papillary carcinoma


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These posts contain high yield information collected from various educational resources including textbooks, journal articles, educational websites and more. They are intended for educational use only and should NOT be taken as medical advice. I strongly believe the spreading of knowledge and depth of learned information should be encouraged in today's society rather than coveted. Membership is required to view these posts  and should be used solely for educational purposes only.