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Home , Intraductal papilloma, Nipple adenoma

PAPILLARY LESIONS

Maria J Merino MD National Institute WHO New edition

Papillary lesions • Intraductal , • Atypical Papiloma • Papillary • Intracystic Papillary Carcinoma • • Papillomatosis • Multiple or Florid Hyperplasia • Juvenile Papillomatosis • Micropapillary DCIS • Micropapillary invasive cancer PAPILLARY TUMORS

• PAPILLOMA • or mass • Central • 2 Cell Types, Myoepithelial cells present • changes • Complex patterns • ‘Entrappment’

PAPILLOMA

PAPILLOMA

SMA

p63 Problems , biopsy and core

**Frozen Section…..Do not do it if you can

• ADH, DCIS • Sclerosis • Squamous metaplasia • Necrosis • Infarction

CORE BIOPSY Papilloma SMA SCLEROTIC PAPILLOMA

• Presents as calcified mass • Marked distortion of ducts • Central or peripheral • Entrapment • Keloid like collagen • Retains 2 cell layers –p63, calponin • OVERDIAGNOSIS ON SCNB SCLEROTIC PAPILLOMA SCLEROTIC PAPILLOMA PAPILLOMA WITH CENTRAL ENTRAPMENT Atypical Papilloma Atypical Papilloma

Papilloma with ADH and DCIS

• Focal areas with morphological and cytol. features of ADH. • Few myoep. cells in the areas • < 3mm Pap with ADH • > 3mm Pap with DCIS • 30% or 90%??? • WHO WG says Size should be used. • 4x increased risk of invasive carcinoma compared to papillomas without atypia

Myoepithelial cells present Papillary DCIS

Recommendations

Samples diagnosed as papilloma may not require excision provided that the size of the papilloma is concordant with the size and appearance of imaging findings. Suspicious or malignant features, excision

• Middleton et al LCIS

INTRACYSTIC…….ENCAPSULATED

PAPILLARY CARCINOMA

Intracystic papillary carcinoma of the . After mastectomy, radiotherapy or excisional biopsy alone. Carter, Orr and Merino, 1983 Cancer

• Intracystic papillary carcinoma of the breast (IPC) was distinguished from the more common papillary intraductal carcinoma (DCIS) and infiltrating carcinoma with a papillary pattern. IPC was defined as a solitary tumor with a pattern recognizable as carcinoma which is confined to a dilated duct. A series of 41 such cases was collected from three institutions. Twenty-nine patients underwent mastectomy; 11 of them had axillary dissections. None of these patients had metastatic disease in the axillary lymph nodes or recurrence in the follow-up period which averaged five years. Eleven patients did not have mastectomy or radiotherapy. Eight of these patients (followed for an average of ten years) had no recurrence. The only patients who developed invasive carcinoma were those with DCIS as well as IPC in the excisional biopsy. The data suggest that IPC is much more likely to be cured by local treatment than is IPC accompanied by DCIS. IPC

• ALONE 68 CASES

• WITH DCIS 52 CASES

• WITH INVASIVE CA 39 CASES IPC ALONE

• ELDERLY PATIENTS • 2% OF BREAST CA • MAY OR NOT HAVE NIPPLE DISCHARGE • CENTRAL OR PERIPHERAL • NO RECURRENCE Intracystic Papillary Carcinoma 41 cases

Gross: Circumscribed 81% Papillary 40% Micro: Papillary 100% Cribriforme 56% Necrosis 32% Solid 37%

Associated DCIS: 19/41=46% INTRACYSTIC PAPILLARY CARCINOMA

IPC IPC WITH INVASION

IPC WITH INVASION IPC IPC WITH DCIS IPC WITH DCIS

• 52 CASES • 3/52 (6%) HAD INVASIVE CA • NO RECURRENCES IPC WITH INVASIVE CARCINOMA

• 39 CASES • 9 ( 23% ) RECURRED AS INVASIVE CARCINOMA • 3/9 WITH AXILLARY LYMPH NODE BIOPSY HAD METASTASES Treatment of IPC

• ALONE CONSERVATIVE TREATMENT: ELDERLY PATIENT WITH CIRCUMSCRIBED LESION AND NEGATIVE MARGINS • WITH DCIS TREAT AS DCIS • WITH INVASIVE CA TREAT AS INVASIVE CA BENIGN NIPPLE TUMORS

•

ADENOMA OF NIPPLE

• MOST COMMONLY OVERDIAGNOSED LESION OF NIPPLE • ATYPIA, SOME MITOTIC FIGURES • MUSCLE INVASION • SQUAMOUS MORULES • EXTENDS ONTO EPIDERMIS • ADENOMYOEPITHELIA • NON-NECROTIC ADENOMA

FOLLOWUP ADENOMA

• 51 CASES • 7 IPSILATERAL 2 ARISING FROM ADENOMA (FP) 4 SEPARATE INVASIVE 1 WIDESPREAD DCIS • 3 CONTRALATERAL

• ROSEN & CACCIO

IPC ALONE