Breast Pathology by Sami Shousha

Author:Sami Shousha
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Intraductal Papillary Carcinoma (Papillary DCIS)

This is a rare type of breast cancer. Although intraductal papillary carcinoma is the term endorsed by the World Health Organization (WHO) working group and is used to describe this lesion in the relevant chapter of the fourth edition of WHO blue book [29], here we refer to it using the most frequent term that we use in routine practice (papillary DCIS) to avoid confusion with other noninvasive papillary carcinomas, namely, EPC and SPC. Our view is also supported by adopting this terminology (papillary DCIS) in the table included in page “104” of the intraductal papillary carcinoma chapter of the WHO book to describe it when compared to other types of papillary lesions [29]. Papillary DCIS is basically a variant of the classic DCIS because it originates in the terminal duct lobular unit and is distributed in the same manner and, therefore, requires similar management. It is typically multifocal and peripheral in location and usually coexists with other variants of DCIS particularly cribriform DCIS. It is therefore important to distinguish solitary, central papillary carcinomas from papillary DCIS, as the latter may require a wider excision because of its more extensive distribution. Papillary DCIS often present, as other variants of DCIS, with mammographic microcalcification. Rarely papillary DCIS presents as a nipple discharge or a mass lesion which are the most common presentation of EPC and SPC. No specific macroscopic features for papillary DCIS have been recognized.

Papillary DCIS is a subtype of DCIS that show a papillary growth pattern, characterized by fibrovascular cores covered by neoplastic epithelium (Fig. 11.1). Unlike DCIS involving papilloma, papillary DCIS lacks evidence of residual preexisting benign papillary lesion. The absence of myoepithelial cells within the intraluminal papillary fronds with their preservation at the peripheral epithelial-stromal interface throughout the lesion is one of the most important distinguishing features of papillary DCIS. The epithelial cells supported by the fibrovascular stalks can display a variety of proliferative patterns in addition to the typical papillary pattern even with the same ducts including cribriform, solid, micropapillary, or stratified spindle cell patterns. Other rare cell types which can be seen in papillary DCIS include tall hyperchromatic cell with tall cells covering thin fibrous stalks with or without nuclear clearing similar to the tall cell variant of papillary thyroid carcinoma. This variant is also observed in EPC. Malignant cells of papillary DCIS can rarely present as compact uniform columns or as transitional cell, which resembles transitional cell carcinoma of the bladder. The neoplastic cells often appear bland and are categorized as low or intermediate grade. High-grade papillary DCIS does occur, albeit with lower frequency. Localized apocrine metaplasia is generally absent, although rarely, complete apocrine differentiation may be present leading to what is called apocrine papillary intraductal carcinoma. These apocrine papillary DCIS often displays abundant epithelial proliferation in solid or cribriform pattern, with well-defined epithelial atypia.

Fig. 11.1(a) Papillary DCIS showing multiple ducts with malignant papillary growth of low-grade neoplastic cells. Myoepithelial cells are maintained at the periphery of the ducts. (b)

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