Pathological criteria and practical issues in papillary lesions of the breast – a review

Abstract

Papillary lesions of the breast include a broad spectrum of lesions, ranging from benign papilloma, papilloma with atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) to papillary carcinoma. The accurate diagnosis of mammary papillary lesions is a challenge for pathologists, owing to the overlapping features among these lesions. In this review, some of the diagnostic criteria of papillary lesions are discussed, with special emphasis on some key morphological features, namely fibrovascular cores, epithelial proliferation in a solid pattern, intraductal papilloma complicated by ADH or DCIS, and invasion and its mimics. The roles of immunohistochemistry, and the interpretation of myoepithelial cell markers, hormone receptors, and high molecular weight cytokeratin, are addressed. Finally, novel biomarkers and genetic aberrations in papillary lesions are summarized.

Low‐grade intraductal carcinoma of the salivary gland with prominent oncocytic change: a newly described variant

“…The LG‐IDC observed in the present cases was morphologically similar to intraductal papillary neoplasms of the breast, including intraductal papillary carcinoma and encapsulated papillary carcinoma, formerly called intracystic papillary carcinoma . Unlike intraductal papillary carcinoma of the breast, the present cases did not show arborescent papillary growth on slender fibrovascular cores.…”

“…26 The LG-IDC observed in the present cases was morphologically similar to intraductal papillary neoplasms of the breast, including intraductal papillary carcinoma and encapsulated papillary carcinoma, formerly called intracystic papillary carcinoma. [27][28][29] Unlike intraductal papillary carcinoma of the breast, the present cases did not show arborescent papillary growth on slender fibrovascular cores. Furthermore, encapsulated papillary carcinoma of the breast lacks myoepithelial cells at the periphery of the tumour, and the invasive nature of this tumour has been described.…”

Solid Papillary Carcinoma of the Breast: A Review

“…Some authors suggest that pick up the rate of invasive carcinoma is better with core biopsy when compared to FNA. Others report that core has a low accuracy as most biopsies are taken centrally while the invasion is usually found in the periphery [4,5,16,17]. Therefore, surgical excision is recommended after especially when there are cellular atypia, high-risk lesions on imaging or imaging-histological discordance.…”

“…Therefore, surgical excision is recommended after especially when there are cellular atypia, high-risk lesions on imaging or imaging-histological discordance. Excision biopsy also allows pathological classification of the lesion with various immunohistochemistry stains and can also assess invasion [5,17].…”

“…Nuclear palisading and pseudorosette formation around capillary vessels and mitotic figures are also standard features. An organoid pattern with microcystic spaces, foamy macrophages, and microcalcifications can also be seen, but these features are less common [11,13,[14][15][16][17].…”