Practical Considerations in Breast Papillary Lesions: A Review of the Literature

Agoumi, Mehdi; Giambattista, Joshua; Hayes, Malcolm

doi:10.5858/arpa.2015-0525-ra

Cited by 41 publications

(26 citation statements)

References 142 publications

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“…As far as pathology is concerned, papillary lesions include hyperplastic lesions, presumably benign or malignant tumors. Benign presumed neoplastic papillary lesions include large duct papilloma, peripheral duct papilloma, sclerosing papilloma, nipple adenoma, papilloma with low-grade neoplastic atypia and rare adenomyoepithelioma with papillary morphology [13,14]. Structurally, they bear resemblance to papillary malignant lesions such as low-grade papillary DCIS, encapsulated papillary carcinoma or solid papillary carcinoma, and the use of immunohistochemistry is required in differential diagnosis [14].…”

Section: Ultrasound and Pathology Diagnosismentioning

confidence: 99%

“…Benign presumed neoplastic papillary lesions include large duct papilloma, peripheral duct papilloma, sclerosing papilloma, nipple adenoma, papilloma with low-grade neoplastic atypia and rare adenomyoepithelioma with papillary morphology [13,14]. Structurally, they bear resemblance to papillary malignant lesions such as low-grade papillary DCIS, encapsulated papillary carcinoma or solid papillary carcinoma, and the use of immunohistochemistry is required in differential diagnosis [14]. Significant heterogeneity of papillary lesions is the reason why fine needle aspiration biopsy is not applicable in the diagnosis of IPs (high rate of false negative results), and even core needle biopsy presents a challenge for the pathologist [14].…”

Section: Ultrasound and Pathology Diagnosismentioning

confidence: 99%

“…Structurally, they bear resemblance to papillary malignant lesions such as low-grade papillary DCIS, encapsulated papillary carcinoma or solid papillary carcinoma, and the use of immunohistochemistry is required in differential diagnosis [14]. Significant heterogeneity of papillary lesions is the reason why fine needle aspiration biopsy is not applicable in the diagnosis of IPs (high rate of false negative results), and even core needle biopsy presents a challenge for the pathologist [14]. In contrast, a vacuum-assisted core needle biopsy may generate an almost unlimited number of specimens.…”

Section: Ultrasound and Pathology Diagnosismentioning

confidence: 99%

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Intraductal papilloma of the breast — management

2019

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In light of the growing availability of ultrasound testing and invasive diagnostic methods of the breast in everyday gynecologic practice, lesions of uncertain malignant potential, classified histologically as B3, have become a significant health issue. Intraductal papillomas (IPs) are the most common pathology in that group of lesions. Despite their benign histologic appearance, IPs may accompany malignant growths and the diagnosis made on the basis of biopsy material carries the risk of breast cancer (BC) underestimation. The article presents a review of the available literature on the management of patients diagnosed with intraductal papilloma at a standard core needle biopsy or vacuum-assisted core needle biopsy. The management is not uniform and depends not only on the verification technique or the accompanying pathological growths, but also on the result of clinical-pathological correlations. As it turns out, open surgical biopsy should not necessarily be recommended to every affected woman, and a growing number of sources have recently suggested that a control program would be sufficient in many cases. Thus, it is vital for gynecologists to be able to differentiate between those women who may be included in the annual ultrasound control program and those who require further surgical management.

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Section: Ultrasound and Pathology Diagnosismentioning

confidence: 99%

Section: Ultrasound and Pathology Diagnosismentioning

confidence: 99%

Section: Ultrasound and Pathology Diagnosismentioning

confidence: 99%

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Intraductal papilloma of the breast — management

2019

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“…They are characterized by a specific architecture composed of papillae, centered by fibrovascular cores and lined by epithelial cells with or without underlying myoepithelial cells. Some of them are made of micropapillae that are devoid of fibrovascular cores [2]. These features are usually well recognized.…”

Section: Introductionmentioning

confidence: 99%

“…Since 2003, 37 additional cases of this rare breast tumor were reported [5][6][7][8][9][10][11][12]. These tumors harbor specific histological and immunohistochemical features [2] and often consist of circumscribed solid nodules of epithelial cells arranged in nests or papillae. Epithelial cells are characterized by eosinophilic, cuboidal or tall cytoplasms, with altered nuclear polarity and nuclear grooves.…”

Section: Introductionmentioning

confidence: 99%

Solid papillary carcinoma with reverse polarity of the breast harbors specific morphologic, immunohistochemical and molecular profile in comparison with other benign or malignant papillary lesions of the breast: a comparative study of 9 additional cases

et al. 2018

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Solid papillary carcinoma with reverse polarity is a rare breast cancer of favorable prognosis that can be difficult to diagnose. We report here nine additional cases of this tumor, and we describe its morphologic, immunohistochemical and molecular profile in comparison to other types of papillary and micropapillary lesions of the breast that are intraductal papilloma with usual ductal hyperplasia, encapsulated papillary carcinoma, solid papillary carcinoma and invasive micropapillary carcinoma. We studied nine cases of this special papillary tumor and six of each other types mentioned above. We found that solid papillary carcinoma with reverse polarity harbor specific morphologic features as cuboid or tall cells with abundant eosinophilic cytoplasms located at the basal pole giving the impression of reverse nuclear polarity. Nuclei were sometimes grooved. Immunohistochemistry demonstrated the lack of myoepithelial cells, as in encapsulated papillary carcinoma and solid papillary carcinoma, questioning their invasive nature. Seven of nine solid papillary carcinoma with reverse polarity showed a low Ki67 proliferative index (Ki67 <5%). They showed expression of CK5/6 as in intraductal papilloma with usual ductal hyperplasia. They showed expression of calretinin and a low or lack of hormonal receptor (HR) expression that were not observed in other breast tumors studied. By whole-exome analysis, seven of nine solid papillary carcinomas with reverse polarity (78%) harbored a hotspot mutation in IDH2 (R172) that was totally absent in other groups. Six of nine tumors (67%) also harbored PRUNE2 mutation, including the two IDH2 wild-type cases. We also demonstrated for the first time in this breast tumor, immunostaining with a specific antibody IDH1/2 mutant R132/R172 (7/9) that can highlight IDH2 mutation. Moreover, transcriptomic analysis showed that proteoglycan pathway was significantly enriched. Our findings support the fact that solid papillary carcinoma with reverse polarity is a singular breast neoplasm that can be distinguished from other papillary breast tumors.

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