25 Questions
Which of the following is a classification of papillary lesions of the breast according to the World Health Organization?
Intraductal papilloma
What is a common challenge for pathologists in diagnosing breast papillary lesions?
Overlapping morphological features and immunohistochemical profiles
Which type of breast papillary lesion features fibrovascular cores covered by epithelial cells with or without intervening myoepithelial cells?
Intraductal papilloma
Which type of breast papillary lesion is further classified into intraductal papilloma with atypical ductal hyperplasia /ductal carcinoma in situ?
Intraductal papilloma
What aspect of breast papillary lesions is discussed in the review?
Morphological and relevant immunohistochemical features
Which marker is used to differentiate benign and atypical/low grade malignancy in papillary lesions?
ER
What percentage of malignant papillary lesions express neuroendocrine markers?
40-50%
Which characteristic helps differentiate tall cell carcinomas with reversed polarity from other breast papillary lesions?
Distinct morphology
What is the routine diagnostic procedure for breast lesions, including papillary lesions?
Core needle biopsy
What is the indolent clinical-biological behavior of the majority of tumors in this group?
Indolent clinical-biological behavior means slow-growing and non-aggressive.
Which of the following is a characteristic feature of encapsulated papillary carcinoma?
Round and pushing border surrounded by a fibrous capsule
What distinguishes intraductal papilloma with atypical ductal hyperplasia (ADH) from ductal carcinoma in situ (DCIS)?
Size criterion of 3 mm
What is a distinguishing feature of solid papillary carcinoma?
Intracellular and extracellular mucin
Which characteristic feature helps differentiate intraductal papilloma from papillary ductal carcinoma in situ?
Presence of stromal invasion
What may mimic solid papillary carcinoma in situ?
Extensive involvement of myoepithelial cells
Which of the following is a clinical manifestation of papillary lesions of the breast?
Nipple discharge
What is the subtype of DCIS characterized by intraductal filiform arborizing fibrovascular cores devoid of myoepithelium?
Papillary DCIS
What is a common benign papillary lesion that can increase the risk of developing breast carcinoma?
Intraductal papilloma
Which lesions are grouped under invasive breast carcinoma and rare tumors due to their potential confusing terminology and similar solid papillary growth pattern?
Invasive micropapillary carcinoma and tall cell carcinoma with reversed polarity
What frequently accompanies changes in intraductal papillomas?
Usual ductal hyperplasia
Which type of carcinoma is characterized by solid cellular nodules punctuated by thin fibrovascular cores and monotonous plasmacytoid morphology?
Invasive papillary carcinoma
Which carcinoma shows the absence of myoepithelial cells along the papillae as well as at the periphery of the lesion?
Invasive papillary carcinoma
Which carcinoma is associated with frequent lymphovascular permeation and lymph nodes involvement?
Invasive micropapillary carcinoma
Which type of carcinoma contains hollow or morula-like aggregates of cuboidal to columnar neoplastic cells surrounded by empty clear spaces?
Invasive micropapillary carcinoma
Which type of carcinoma shows a solid papillary growth pattern and tumor cells containing abundant eosinophilic cytoplasm with nuclei typically located away from the basal pole?
Invasive papillary carcinoma
Study Notes
- Papillary lesions of the breast are a heterogeneous group of neoplasm with fibrovascular cores covered by epithelial cells and can range from benign to malignant.
- Classified into intraductal papilloma, papillary DCIS, encapsulated papillary carcinoma, solid papillary carcinoma, and invasive papillary carcinoma according to the WHO classification.
- Clinical manifestations include nipple discharge, palpable masses, and incidental findings.
- Diagnosis is challenging due to overlapping morphological features and immunohistochemical profiles, especially in the setting of core needle biopsy.
- Papillary lesions are frequently misinterpreted in the UK National Health Service Breast Screening scheme.
- Pathogenesis of papillary lesions is still enigmatic, despite increasing genetic studies.
- Papillary DCIS is a subtype of DCIS characterized by intraductal filiform arborizing fibrovascular cores devoid of myoepithelium, which is lined by neoplastic ductal epithelium.
- Intraductal papilloma is a common benign papillary lesion, which arises from central large lactiferous ducts or periphery terminal duct lobular units, and can increase the risk of developing breast carcinoma.
- Invasive micropapillary carcinoma and tall cell carcinoma with reversed polarity are grouped under invasive breast carcinoma and rare tumors, respectively, due to their potential confusing terminology and similar solid papillary growth pattern.
- The clinical behavior of papillary DCIS is similar with other variants of grade-matched DCIS.
- Frequently accompanying changes in intraductal papillomas include usual ductal hyperplasia, apocrine metaplasia, and less commonly or rarely infarction, squamous metaplasia, mucinous change, clear cell change, sebaceous metaplasia, and collagenous spherulosis.
Test your knowledge on the features of intraductal papilloma, including the superimposed usual ductal hyperplasia, heterogeneous epithelial cell proliferation, and the use of IHC for diagnosis.
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