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Breast
Histopathologic Diagnoses
Malignant Lesions
Papillary Carcinoma, Invasive
Papillary Carcinoma, Invasive
Melissa Durand, MD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Invasive papillary carcinoma (IPC)

            • Definitions

              • Invasive carcinoma with > 90% exclusively papillary architecture of papillae with fibrovascular cores and lacking myoepithelial layer
              • Distinct from invasive micropapillary carcinoma
              • Distinct from in situ papillary carcinomas [solid papillary carcinoma, papillary DCIS, encapsulated papillary carcinoma (EPC)]
                • When these in situ processes have associated invasive component, invasive components usually display ductal, not papillary, features
              • IPC often has (papillary) DCIS in surrounding breast

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        • Genetics

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Rakha EA et al: Diagnostic challenges in papillary lesions of the breast. Pathology. 50(1):100-110, 2018
                                              2. Zheng YZ et al: Clinicopathological characteristics and survival outcomes in invasive papillary carcinoma of the breast: A SEER population-based study. Sci Rep. 6:24037, 2016
                                              3. Tan PH et al: Papillary and neuroendocrine breast lesions: the WHO stance. Histopathology. 66(6):761-70, 2015
                                              4. Kestelman FP et al: Imaging findings of papillary breast lesions: a pictorial review. Clin Radiol. 69(4):436-41, 2014
                                              5. Eiada R et al: Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances. AJR Am J Roentgenol. 198(2):264-71, 2012
                                              6. Schnitt, SJ et al: WHO Classification of Tumours of the Breast. Lyon: International Agency for Research on Cancer, 2012
                                              7. Chang JM et al: Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study. Eur Radiol. 20(5):1093-100, 2010
                                              8. Linda A et al: Unusual malignant tumors of the breast: MRI features and pathologic correlation. Eur J Radiol. 75(2):178-84, 2010
                                              9. Pal SK et al: Papillary carcinoma of the breast: an overview. Breast Cancer Res Treat. 122(3):637-45, 2010
                                              10. Yoo JL et al: Can MR imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
                                              11. Tse GM et al: The role of immunohistochemistry in the differential diagnosis of papillary lesions of the breast. J Clin Pathol. 62(5):407-13, 2009
                                              12. Brookes MJ et al: Radiological appearances of papillary breast lesions. Clin Radiol. 63(11):1265-73, 2008
                                              13. Kim TH et al: Sonographic differentiation of benign and malignant papillary lesions of the breast. J Ultrasound Med. 27(1):75-82, 2008
                                              14. Mercado CL et al: Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 238(3):801-8, 2006
                                              15. Carder PJ et al: Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology. 46(3):320-7, 2005
                                              16. Hill CB et al: Myoepithelial cell staining patterns of papillary breast lesions: from intraductal papillomas to invasive papillary carcinomas. Am J Clin Pathol. 123(1):36-44, 2005
                                              17. Nagi C et al: Epithelial displacement in breast lesions: a papillary phenomenon. Arch Pathol Lab Med. 129(11):1465-9, 2005
                                              18. Putti TC et al: Breast pathology practice: most common problems in a consultation service. Histopathology. 47(5):445-57, 2005
                                              19. Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
                                              20. Blaumeiser B et al: Invasive papillary carcinoma of the male breast. Eur Radiol. 12(9):2207-10, 2002
                                              21. Hoda SA et al: Practical considerations in the pathologic diagnosis of needle core biopsies of breast. Am J Clin Pathol. 118(1):101-8, 2002
                                              22. Renshaw AA: Predicting invasion in the excision specimen from breast core needle biopsy specimens with only ductal carcinoma in situ. Arch Pathol Lab Med. 126(1):39-41, 2002
                                              23. Liberman L et al: Case 35: intracystic papillary carcinoma with invasion. Radiology. 219(3):781-4, 2001
                                              24. Orel SG et al: MR imaging in patients with nipple discharge: initial experience. Radiology. 216(1):248-54, 2000
                                              25. Philpotts LE et al: Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology. 216(3):831-7, 2000
                                              26. Liberman L et al: Percutaneous large-core biopsy of papillary breast lesions. AJR Am J Roentgenol. 172(2):331-7, 1999
                                              27. McCulloch GL et al: Radiological features of papillary carcinoma of the breast. Clin Radiol. 52(11):865-8, 1997
                                              28. Soo MS et al: Papillary carcinoma of the breast: imaging findings. AJR Am J Roentgenol. 164(2):321-6, 1995
                                              29. Mitnick JS et al: Invasive papillary carcinoma of the breast: mammographic appearance. Radiology. 177(3):803-6, 1990
                                              30. Tabár L et al: Galactography: the diagnostic procedure of choice for nipple discharge. Radiology. 149(1):31-8, 1983
                                              31. KRAUS FT et al: The differential diagnosis of papillary tumors of the breast. Cancer. 15:444-55, 1962
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Invasive papillary carcinoma (IPC)

                                                        • Definitions

                                                          • Invasive carcinoma with > 90% exclusively papillary architecture of papillae with fibrovascular cores and lacking myoepithelial layer
                                                          • Distinct from invasive micropapillary carcinoma
                                                          • Distinct from in situ papillary carcinomas [solid papillary carcinoma, papillary DCIS, encapsulated papillary carcinoma (EPC)]
                                                            • When these in situ processes have associated invasive component, invasive components usually display ductal, not papillary, features
                                                          • IPC often has (papillary) DCIS in surrounding breast

                                                        IMAGING

                                                        • General Features

                                                          • Mammographic Findings

                                                            • Ultrasonographic Findings

                                                              • MR Findings

                                                                • Image-Guided Biopsy

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    • Genetics

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Rakha EA et al: Diagnostic challenges in papillary lesions of the breast. Pathology. 50(1):100-110, 2018
                                                                                          2. Zheng YZ et al: Clinicopathological characteristics and survival outcomes in invasive papillary carcinoma of the breast: A SEER population-based study. Sci Rep. 6:24037, 2016
                                                                                          3. Tan PH et al: Papillary and neuroendocrine breast lesions: the WHO stance. Histopathology. 66(6):761-70, 2015
                                                                                          4. Kestelman FP et al: Imaging findings of papillary breast lesions: a pictorial review. Clin Radiol. 69(4):436-41, 2014
                                                                                          5. Eiada R et al: Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances. AJR Am J Roentgenol. 198(2):264-71, 2012
                                                                                          6. Schnitt, SJ et al: WHO Classification of Tumours of the Breast. Lyon: International Agency for Research on Cancer, 2012
                                                                                          7. Chang JM et al: Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study. Eur Radiol. 20(5):1093-100, 2010
                                                                                          8. Linda A et al: Unusual malignant tumors of the breast: MRI features and pathologic correlation. Eur J Radiol. 75(2):178-84, 2010
                                                                                          9. Pal SK et al: Papillary carcinoma of the breast: an overview. Breast Cancer Res Treat. 122(3):637-45, 2010
                                                                                          10. Yoo JL et al: Can MR imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
                                                                                          11. Tse GM et al: The role of immunohistochemistry in the differential diagnosis of papillary lesions of the breast. J Clin Pathol. 62(5):407-13, 2009
                                                                                          12. Brookes MJ et al: Radiological appearances of papillary breast lesions. Clin Radiol. 63(11):1265-73, 2008
                                                                                          13. Kim TH et al: Sonographic differentiation of benign and malignant papillary lesions of the breast. J Ultrasound Med. 27(1):75-82, 2008
                                                                                          14. Mercado CL et al: Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology. 238(3):801-8, 2006
                                                                                          15. Carder PJ et al: Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology. 46(3):320-7, 2005
                                                                                          16. Hill CB et al: Myoepithelial cell staining patterns of papillary breast lesions: from intraductal papillomas to invasive papillary carcinomas. Am J Clin Pathol. 123(1):36-44, 2005
                                                                                          17. Nagi C et al: Epithelial displacement in breast lesions: a papillary phenomenon. Arch Pathol Lab Med. 129(11):1465-9, 2005
                                                                                          18. Putti TC et al: Breast pathology practice: most common problems in a consultation service. Histopathology. 47(5):445-57, 2005
                                                                                          19. Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
                                                                                          20. Blaumeiser B et al: Invasive papillary carcinoma of the male breast. Eur Radiol. 12(9):2207-10, 2002
                                                                                          21. Hoda SA et al: Practical considerations in the pathologic diagnosis of needle core biopsies of breast. Am J Clin Pathol. 118(1):101-8, 2002
                                                                                          22. Renshaw AA: Predicting invasion in the excision specimen from breast core needle biopsy specimens with only ductal carcinoma in situ. Arch Pathol Lab Med. 126(1):39-41, 2002
                                                                                          23. Liberman L et al: Case 35: intracystic papillary carcinoma with invasion. Radiology. 219(3):781-4, 2001
                                                                                          24. Orel SG et al: MR imaging in patients with nipple discharge: initial experience. Radiology. 216(1):248-54, 2000
                                                                                          25. Philpotts LE et al: Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance. Radiology. 216(3):831-7, 2000
                                                                                          26. Liberman L et al: Percutaneous large-core biopsy of papillary breast lesions. AJR Am J Roentgenol. 172(2):331-7, 1999
                                                                                          27. McCulloch GL et al: Radiological features of papillary carcinoma of the breast. Clin Radiol. 52(11):865-8, 1997
                                                                                          28. Soo MS et al: Papillary carcinoma of the breast: imaging findings. AJR Am J Roentgenol. 164(2):321-6, 1995
                                                                                          29. Mitnick JS et al: Invasive papillary carcinoma of the breast: mammographic appearance. Radiology. 177(3):803-6, 1990
                                                                                          30. Tabár L et al: Galactography: the diagnostic procedure of choice for nipple discharge. Radiology. 149(1):31-8, 1983
                                                                                          31. KRAUS FT et al: The differential diagnosis of papillary tumors of the breast. Cancer. 15:444-55, 1962