Breast Pathology: Intraductal Papilloma

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Questions and Answers

What is the age range when intraductal papilloma of the breast most commonly occurs?

60-70 years

20-30 years

50-60 years

30-50 years (correct)

What is the typical diameter of an intraductal papilloma?

Less than 3 cm (correct)

More than 5 cm

Less than 1 cm

Less than 5 cm

What is the characteristic of the duct that contains the papilloma?

It is never affected

It is always constricted

It is always dilated

It may be dilated (correct)

What is the percentage of cases where intraductal papilloma is solitary?

90% Signup and view all the answers

What is the characteristic of the stroma in broad papillary fibrovascular cores of a papilloma?

It is always hyalinized Signup and view all the answers

What is the purpose of immunostains such as p63, calponin, and smooth muscle myosin heavy chain?

To highlight the presence of a myoepithelial cell component Signup and view all the answers

What is the characteristic of necrosis in intraductal papilloma?

It is nearly always absent Signup and view all the answers

What is the nature of intraductal papilloma according to clonal analysis?

It is a clonal lesion Signup and view all the answers

Encapsulated papillary carcinomas are typically

ER positive and HER2 negative Signup and view all the answers

What percentage of encapsulated papillary carcinomas have high-grade nuclei and a brisk mitotic rate?

3% Signup and view all the answers

Solid papillary carcinoma often presents in

older women Signup and view all the answers

What is commonly seen in solid papillary carcinoma?

Mucin production Signup and view all the answers

According to the WHO Working Group, how should tumors with rounded nests and a complete or partial myoepithelial cell layer be classified?

In situ carcinoma, solid papillary pattern Signup and view all the answers

What is the major differential diagnostic consideration for solid papillary carcinoma?

Usual ductal hyperplasia Signup and view all the answers

What is characteristic of solid papillary carcinoma with reverse polarity?

Apically located nuclei Signup and view all the answers

What is often present in the papillary cores of solid papillary carcinoma with reverse polarity?

Foamy histocytes Signup and view all the answers

Solid papillary carcinoma with reverse polarity typically infiltrates through the breast parenchyma and adipose tissue in a

Haphazard pattern Signup and view all the answers

What is the subsequent breast cancer risk similar to for proliferative lesions without atypia?

1.5-2 fold Signup and view all the answers

What is characteristic of papillary DCIS?

Single population of atypical epithelial cells Signup and view all the answers

What is a key feature that aids in the diagnosis of solid papillary carcinoma?

ER positivity and CK5/6 negativity Signup and view all the answers

What is a potential diagnostic trap in papillary DCIS?

Scattered large pale eosinophilic cells along the basal layer Signup and view all the answers

What is encapsulated papillary carcinoma often associated with?

Bloody nipple discharge Signup and view all the answers

What is a concern in the diagnosis of encapsulated papillary carcinoma?

Absence of myoepithelial cells at the periphery of the tumor Signup and view all the answers

What is important to evaluate for in encapsulated papillary carcinoma?

Areas of unequivocal conventional invasive carcinoma Signup and view all the answers

Why is it challenging to diagnose associated invasive carcinoma in encapsulated papillary carcinoma?

The majority of patients have undergone a core needle biopsy procedure Signup and view all the answers

What is a characteristic of papillomas with foci of atypical hyperplasia?

Associated with a substantially increased risk for carcinoma Signup and view all the answers

What is a characteristic of multiple papillomas?

Associated with a substantially increased risk for carcinoma Signup and view all the answers

What is a characteristic of papillary DCIS in contrast to DCIS involving a papilloma?

Absence of a myoepithelial cell layer along the fibrovascular cores Signup and view all the answers

What is a common feature of necrosis in papillomas involved by florid UDH?

It is most often focal in nature Signup and view all the answers

What is the result of sclerosis in papillomas?

Both A and B Signup and view all the answers

What is the diagnostic feature that supports the diagnosis of a sclerosed papilloma?

Presence of a two-cell layer Signup and view all the answers

What is the purpose of using ER and HMW cytokeratin stains in cases of florid UDH?

To distinguish between usual ductal hyperplasia and carcinoma in situ Signup and view all the answers

What is the characteristic feature of ductal adenoma?

Intraductal location with a dense fibrotic capsule Signup and view all the answers

What is the diagnostic feature that supports the diagnosis of ADH in an intraductal papilloma?

Combined use of ER and CK5/6 Signup and view all the answers

What is the recommendation of the WHO Classification of Tumors of the Breast Working Group for foci of low nuclear grade atypia?

Classify as intraductal papilloma with ADH Signup and view all the answers

What is a common feature of excision specimens of benign intraductal papilloma that have had a prior needling procedure?

Presence of small irregular nests and single epithelial cells with degenerative features Signup and view all the answers

What is the management approach for solitary intraductal papilloma?

Local excision Signup and view all the answers

What is the significance of squamous metaplasia in intraductal papilloma?

It is probably secondary to focal necrosis Signup and view all the answers

What is a characteristic feature of the epithelial cells in SPCRP?

They express both low and high molecular weight cytokeratins Signup and view all the answers

What is a key difference between SPCRP and 'breast tumor resembling tall cell variant of papillary thyroid carcinoma'?

SPCRP expresses breast markers and lacks expression of thyroid markers Signup and view all the answers

What type of mutations have been identified in SPCRP?

IDH2, PIK3CA, and PIK3R1 Signup and view all the answers

What is the clinical behavior of SPCRP?

Indolent and low-grade Signup and view all the answers

What should be excluded before diagnosing invasive papillary carcinoma?

All of the above Signup and view all the answers

Why is invasive papillary carcinoma a very rare entity?

Because it is often misclassified as papillary DCIS or encapsulated papillary carcinoma Signup and view all the answers

Study Notes

Intraductal Papilloma

Age range: 30-50 years
Can arise in large or small ducts
Can be identified grossly as a polypoid intraductal mass or found only on microscopic examination
Features:
- Soft and friable
- May have areas of hemorrhage
- Duct containing the papilloma may be dilated
Diameter rarely exceeds 3 cm
Approximately 90% of cases are solitary
Multiple papillomas are seen in slightly younger patients, arise in smaller, more peripherally located ducts, and are bilateral in one-quarter of cases

Morphologic Variations of Intraductal Papilloma

Partial or total hemorrhagic infarct
Necrosis (focal and rare)
Squamous metaplasia (uncommon)
Entrapped glands within or adjacent to the papilloma
Superimposed florid UDH (ductal hyperplasia)
Ductal adenoma (lacks arborescent papillary quality, but has intraductal location with a dense fibrotic capsule and distorted epithelial proliferation)
Sebaceous metaplasia (exceptionally rare)
ADH (atypical ductal hyperplasia) and DCIS (ductal carcinoma in situ) arising in an intraductal papilloma

Papillary Ductal Carcinoma In Situ

Distinct from papilloma with DCIS
Characterized by a single, uniform population of atypical epithelial cells
Cells are arranged perpendicular to the delicate fibrovascular cores
No myoepithelial cells lining the fibrovascular cores
Diagnostic clues:
- Presence of other patterns of DCIS in adjacent ducts
- Absence of apocrine metaplasia within the papillary proliferation

Encapsulated Papillary Carcinoma

Well-circumscribed papillary tumor surrounded by a thick fibrous capsule
Arises in older women, centrally located, and often presents as a breast mass with or without bloody nipple discharge
Microscopic features:
- Delicate fibrovascular cores
- Monotonous proliferation of atypical epithelial cells
- Solid or cribriform architecture
Absence of myoepithelial cells along the fibrovascular cores and at the periphery
Potential for low-grade invasive carcinoma

Solid Papillary Carcinoma

Presents in older women, often as an image-detected breast mass
Microscopic features:
- Multiple, solid nests of neoplastic epithelial cells
- Fine fibrovascular network conferring papillary architecture
- Spindled epithelial cells with a streaming appearance
- Granular eosinophilic cytoplasm and fine nuclear chromatin consistent with endocrine differentiation
- Mucin production
Absence of myoepithelial cells within the neoplastic nodules
Potential for invasive carcinoma

Solid Papillary Carcinoma With Reverse Polarity

Characterized by solid papillary nests of bland columnar epithelial cells with nuclei of low or intermediate grade located apically (reverse polarity)
Foamy histocytes are often present in the papillary cores
Tumor cells infiltrate through the breast parenchyma and adipose tissue in a haphazard pattern
Absence of a surrounding myoepithelial cell layer
Typically ER, PR, and HER2 negative
Express low and high molecular weight cytokeratins

Invasive Papillary Carcinoma

Very rare entity
Should be distinguished from papillary DCIS, encapsulated papillary carcinoma, and/or solid papillary carcinoma with associated invasive ductal or mucinous carcinoma

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Description

Learn about intraductal papilloma of the breast, its occurrence, symptoms, and characteristics. This quiz covers the pathology of intraductal papilloma, including its diagnosis and features.