Papillary Lesions of Breast - Limitations of H&E and Pivotal Role of IHC: Single Cancer Centre Study

  • Anjali Sharma Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan https://orcid.org/0000-0002-6371-2385
  • Syeda Firdos Jamil Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan https://orcid.org/0000-0003-3392-5571
  • Chaitali Singh Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan
  • Arpita Mathur Department of Pathology, Mahatama Gandhi Medical College, Jaipur, Rajasthan
  • Amandeep Talwar Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan
  • Simran Gilhotra Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan
DOI: https://doi.org/10.21276/apalm.3097
Keywords: Papillary Breast Lesions, Myoepithelial cells, Immunomarkers, P63, CK5/6

Abstract

Background–Papillary breast lesions constitute wide spectrum of heterogeneous pathological group. Diagnosis becomes challenging in case of overlapping histomorphological features. Material & methods–Retrospectively 69 papillary lesion were taken into consideration from January 2017 to March 2021.Results – Routine H&E & CK5/6, P63 is used for further differentiation. Cases were divided into three main divisions 1) benign –intraductal papilloma 2) atypical – intraductal papilloma with ADH/ DCIS 3) malignant - Intra ductal papillary carcinoma, encapsulated papillary carcinoma, solid papillary carcinoma & invasive papillary carcinoma. Papilloma comprised of 28 patients between 25-60 years of age & varies in size from 0.6 to 2.8 cm. Papilloma with ADH/DCIS accounted for 8 patients between 34-65 years age group with size of lesion between 0.5 to 3.0 cm. Intraductal papillary carcinoma comprised of 12 patients with size range 1.6 to 4.0 cm in age group of 42 to 65 years. Encapsulated papillary carcinoma comprised of 4 patients with age between 60 to 73 years and lesion size 0.8 to 14 cm. Solid Papillary carcinoma comprised of 10 patients between 39-81 years of age & lesion varies in size from 1.0 to 8.5 cm. Invasive papillary carcinoma comprised of 7 patients between age of 65 to 80 year and size varies between 2.0 to 6.5 cm. Conclusion – Diagnosis of papillary carcinoma is challenging and its classification includes different entities that have specific diagnostic criteria. Due to heterozygosity in morphology of benign, atypical and malignant subtypes, morphological features should be supplemented by IHC for accurate diagnosis.

References

Difficult diagnosis in breast pathology. Papillary lesion of breast chapter 3. J. Clin. Pathol. 2009:62;407-13.

Sakr R and Uzan S et al.Risk of breast cancer associated with papillomaEur J of Surg Oncol 2008:34; 1304–8

Page DL et al.Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma Cancer. 1996:78; 258–66

Ibarra JA.Papillary lesions of the breast Breast J. 2006:12; 237–51

Vani D, Geetanjali S, Punja GM, Bharathi M. A case of invasive papillary breast carcinoma: Fierce façade with favourable prognosis. J Can Res Ther [serial online] 2015;11:1029

Ueng SH, Mezzetti T, Tavassoli FA. Papillary Neoplasms of the Breast A Review. Arch Pathol Lab Med. 2009;133:896-907.

Pal SK, Lau SK, Kruper L, Nwoye U, Grberoglio C, Gupta RK. Papillary carcinoma of the breast: An overview. Breast Cancer Res Treat 2010;122:637-45.

Lam WW, Chu WC, Tang AP, Tse G, Ma TK. Role of radiologic features in the management of papillary lesions of the breast. Am J Roentgenol. 2006;186:1322- 27.

Rosen PP. Papilloma and related benign tumours. In: Rosen PP, editors. Rosen’s Breast Pathology. 3rd edition. Philadelphia: Lippincott Williams and Wilkins; 2009. Pp. 85-136.

MacGragan G, Moinfar F, Raju U. Intraductal papillary neoplasms. In: Tavassoli FA, Devilee P, editors. World health organization classification of tumours. Pathology and Genetics of tumours of the breast and female genital organs. Lyon: IARC press; 2003. Pp. 76-80.

Collins LC, Schnitt SJ. Papillary lesions of the breast: selected diagnostic and management issues. Histopathology. 2008;52:20-29.

Page DL, Salhany KE, Jensen RA, Dupont WD. Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer. 1996;78:258-66.

Collins L., Achacoso N A, Nekhlyudov L et al. clinical and pathological features of ductal carcinoma in situ associated with the presence of flatepithelial atypia: an analysis of 543 patients. Mod Pathol. 2007;20:1149-55.

Wang H, Tsang P, D’Cruz C, Clarke K. Follow-up of breast papillary lesion on core needle biopsy: experience in African-American Population. Diagnostic Pathology. 2014;9:86.

Benkaddour YA, Hasnaoui SE, Fichtali K. Intracystic Papillary Carcinoma of the Breast: Report of Three Cases and Literature Review. Case Reports in Obstetrics and Gynecology. 2012;2012:979563.

Rosen PP. Intraductal carcinoma. In: Rosen PP, editors. Rosen’s Breast Pathology. 3rd edition. Philadelphia: Lippincott Williams and Wilkins; 2009. Pp. 285-357.

Farrokh D, Abedi M, Rastegar Y F. An Intracystic Papillary Carcinoma of the Breast. Iran J Cancer Prev. 2013; 6: 118–121.

Leal C, Costa I, Fonseca D, Lopes P, Bento MJ, Lopes C. Intracystic (encysted) papillary carcinoma of the breast: a clinical, pathological, and immunohistochemical study. Hum. Pathol. 1998; 29:1097– 1104.

Lefkowitz M, Lefkowitz W, Wargotz ES. Intraductal (intracystic) papillary carcinoma of the breast and its variants: a clinicopathological study of 77 cases. Hum. Pathol. 1994; 25: 802– 9.

Harris KP, Faliakou EC, Exon DJ, Nasiri N, Sacks NP, Gui GP. Treatment and outcome of intracystic papillary carcinoma of the breast. Br. J. Surg. 1999; 86: 1274.

Saremian J, Rosa M. Solid papillary carcinoma of the breast: a pathologically and clinically distinct breast tumor. Arch Pathol Lab Med. . 2012; 136: 1308-11.

Nassar H, Qureshi H, Volkanadsay N, Visscher D. Clinicopathologic analysis of solid papillary carcinoma of the breast and associated invasive carcinomas. Am J Surg Pathol. 2006;30:501-07.

Eremia IA, Ciobanu M, Tenea T, Comanescu MV, Craitoiu S. Invasive papillarycarcinoma of the mammary gland: Histopathologic and immunohistochemical aspects. Rom J Morphol Embryol 2012; 53:811-5

Published
2022-01-04
Issue
Vol 8 No 12 (2021)
Section
Original Article

Copyright (c) 2022 Anjali Sharma, Syeda Firdos Jamil, Chaitali Singh, Arpita Mathur, Amandeep Talwar, Simran Gilhotra

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