Papillary Lesions Of Breast Research Articles

Papillary carcinoma of the male breast in a comparatively young patient: A case report of a rare entity

Breast carcinoma in men is rare and intra-cystic papillary carcinoma of male breast is an extremelyrare entity. Papillary lesions of male breast comprise of the spectrum of lesions ranging from benignintraductal papilloma to intraductal papillary carcinoma and invasive papillary carcinoma. It occursmost commonly in the seventh decade of life and accounts for <1% of all breast malignancies. Thepresent case report is of a comparatively younger, 37 years old male who presented with a mass onlower quadrant (retro-areolar region) of the left breast.

Spectrum of Papillary Breast Lesions According to World Health Organization Classification of Papillary Neoplasms of Breast.

IntroductionPapillary breast lesions are segregated into benign and malignant based on the presence or absence of myoepithelial cells in the papillary cores. Papillary breast lesions are further classified into: intraductal papilloma, papilloma with atypical ductal hyperplasia (ADH)/ductal carcinoma in situ (DCIS), papillary DCIS, solid papillary carcinoma in situ, solid papillary carcinoma with invasion, invasive solid papillary carcinoma, encapsulated papillary carcinoma and encapsulated papillary carcinoma with invasion. In this study, we evaluated the spectrum of papillary breast lesions in resection specimens of the breast according to the latest World Health Organization (WHO) classification of breast tumors.MethodsThis was a retrospective cross-sectional study, and was conducted at Liaquat National Hospital for a period of six years, from January 2012 till December 2017. Data of patients that underwent surgeries for breast tumors were included in the study. All specimens were grossed, according to defined protocols, and representative sections were taken after inking resection margins. Hematoxylin and eosin-stained sections were examined by experienced histopathologists, and myoepithelial stains (p63 and myosin) were done in selected sections of all tumors. Histopathological classification of papillary tumors was performed according to WHO classification of breast tumors.ResultsThe study involved 190 excision specimens of papillary breast lesions. Mean age of the patients was 45.6±17.1 years. Most of the lesions were between two and five centimetres (69.1%). For invasive carcinomas (n = 76), the most frequent grade was II (52.6%). For in situ and invasive carcinomas (n = 129), lymphovascular invasion and axillary metastasis were noted in 5.4% and 9.3% cases, respectively. Among papillary breast lesions, 36.8% were benign (intraductal papilloma, solitary or multiple) while 63.2% harbored ADH, DCIS, or invasive carcinoma. Invasive papillary carcinoma was the most frequent malignant papillary lesion (20%), followed by solid papillary carcinoma with invasion (12.6%). We found significant associations between patient’s age and tumor size with histological type of papillary lesion as benign papillary lesions had smaller size and younger age compared to malignant papillary lesions.ConclusionWe noted a high frequency of malignancy in papillary breast lesions. Moreover, malignant papillary lesions were significantly associated with higher age and larger tumor size.

Papillary Lesions of the Breast: A Review

Papillary breast lesions are rare breast tumors that comprise a broad spectrum of diseases. Pathologically they present as mass-like projections attached to the wall of the ducts, supported by fibrovascular stalks lined by epithelial cells. On mammogram they appear as masses that can be associated with microcalcifications. Ultrasound is the most used imaging modality. On ultrasound papillary lesions appear as homogeneous solid lesions or complex intracystic lesions. A nonparallel orientation, an echogenic halo or posterior acoustic enhancement associated with microcalcifications are highly suggestive of malignancy. MRI has proven to be useful to establish the extent of the lesion. Core needle biopsy is the gold standard for diagnosis. Surgical excision is usually recommended, although treatment for papillomas without atypia is still controversial.

Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision

BackgroundThe management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions.MethodsWe retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe.ResultsMost patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low.ConclusionsBreast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.

Factors associated with disease upgrading in patients with papillary breast lesion in core-needle biopsy.

Traditionally, surgical excision is recommended for benign papillary lesions in core-needle biopsy (CNB) because of their malignant potency. The aim of this study was to identify factors associated with disease upgrading to malignancy in patients with benign papillary lesions in CNB. A total of 179 female patients were evaluated retrospectively who were diagnosed as having a benign papillary lesion in CNB and underwent a subsequent surgical excision between January 2007 and December 2016. Ultrasonography-guided CNB was performed using a 14-gauge needle gun method. The rate of upgrade to malignancy was 10.6% (7.6% in papillary lesions without atypia vs. 33.3% in papillary lesions with atypia; P=0.001). The univariable analysis revealed that older age at diagnosis (≥50 years old), menopause, lesion size on ultrasonography, palpability, multifocality, and atypia in CNB were associated with upgrading. The multivariable analysis revealed that age ≥50 years (OR, 4.6; 95% CI, 1.5-14.1; P=0.008), lesion size of ≥2 cm (OR, 6.4; 95% CI, 1.9-21.1; P=0.002), and atypia in CNB (OR, 5.1; 95% CI, 1.5-18.2; P=0.011) were significantly associated with upgrading to malignancy. Upgrading to malignancy in patients with benign papillary lesions in CNB was associated with age ≥50 years, lesion size ≥2 cm, and atypia in CNB.

Development of breast papillary index for differentiation of benign and malignant lesions using ultrasound images

Papillary breast lesions include a wide spectrum of pathologies ranging from benign to malignant. The word papillary originates from finger-like projections, or papules, which are seen when these lesions are projected under a microscope. Papillary breast lesions have an array of radiological features at presentations; hence differentiation between benign and malignant based on imaging features is challenging. Histopathological diagnosis is crucial for the distinction and further management of the lesions. Traditionally, tumor and ductal excision is the treatment of choice for malignant and atypical or benign papilloma with imaging discordance. However, current clinical practice guidance advocates complete surgical excision, even for asymptomatic and purely benign papillomas diagnosed on core needle biopsy, as they are highly associated with atypia and malignant upstage on subsequent surgery. Computer aided diagnosis (CAD) is a non-invasive method of diagnosing medical signals/images using advanced image processing followed by soft computing techniques. In this study, we have developed a non-invasive CAD system for differentiating benign versus malignant papillary breast lesions using bi-dimensional empirical mode decomposition (BEMD) and the discrete cosine transform (DCT) followed by locality sensitive discriminant analysis (LSDA). The developed model is validated using a large collection of ultrasound images of papillary breast lesions, and achieved a maximum performance of 98.63% accuracy. We have also developed a breast papillary index, which may in the future be used as a substitute for the conventional soft computing techniques. The developed model can be utilized as a tool to assist radiologists in their routine clinical practice after validation with a larger database.

Carcinoma papilar encapsulado de mama

Encapsulated carcinoma is an infrequent tumour of the breast, which is surrounded by a fibrous capsule and forms part of the spectrum of papillary breast lesions. Diagnosis is histopathological and these tumours have a favourable prognosis. These tumours are a rare clinicopathological entity and represent a diagnostic challenge. Negative basal membrane markers and the absence of myoepithelial cells may lead to over-diagnosis and over-treatment. If allowed by the breast-tumour ratio, treatment consists of sectoral resection. Sentinel node analysis is controversial. We present the case of a postmenopausal woman with a palpable nodule in the left breast, immunogeneologically classified as BI-RADS 4 c. Histological study of the core biopsy specimen showed invasive ductal papillary carcinoma.Sector tumoural resection was performed with oncological margins and sentinel node study. The definitive histopathological diagnosis was encapsulated papillary carcinoma with microinvasion, associated with a focus of low-grade ductal carcinoma in situ. Treatment was completed with radiotherapy and adjuvant hormone therapy. Encapsulated papillary carcinomas represent 0.2% to 2% of breast tumours. Histological diagnosis is difficult, both with cytological and histological samples, and is based on the absence of myoepithelial cells, both in the periphery and inside the tumour. Treatment is surgical and consensus is lacking on the indication for adjuvant therapy. Most authors, however, report that these tumours respond well to radiotherapy.

Lesiones papilares intraductales mamarias: nuestra experiencia 2007-2017

ObjectivesTo provide a review and analysis of cases of intraductal papillary breast lesions diagnosed at our centre between January 2007 and December 2017, and to study the association between papillary lesions and breast cancer. Patients and methodsWe performed a retrospective descriptive study using the pathology database of our centre. We included 135 patients with a pathological diagnosis of papillary lesion (isolated benign papilloma, multiple papillomatosis, papilloma with carcinoma in situ, papilloma with atypia or intraductal papillary carcinoma). The main variables were age, the diagnostic procedures performed, the presence of higher-grade lesions associated with the papillary lesion, and the development of breast neoplasms during follow-up. ResultsThe patients’ mean age was 50 years. Ductoscopy had high sensitivity (88%). Twelve patients (9%) had carcinomas on the papillary lesion or its surrounding areas (8 carcinomas in situ and 4infiltrating carcinomas) and 4patients (3%) had associated atypical hyperplasia. With a mean follow-up of 34 months, 6 patients had recurrence as a papillary lesion (one multiple papillomatosis and 5papillomas), 3 patients relapsed with a neoplastic lesion, and one patient developed a contralateral neoplasm. ConclusionsIn the presence of a suspected papillary lesion and nipple secretion, ductoscopy should be considered due to its high sensitivity. The high incidence of neoplasms associated with papillary lesions or their development during follow-up justifies their complete surgical excision and strict follow-up.

Papillary carcinoma breast: A tertiary care institute experience

Introduction: Breast cancer is the most common cancer in women globally and in India. Papillary lesions of the breast constitute around 5% of all the breast lesions. They encompasses a morphologically heterogeneous group of lesions, all of which share a growth pattern characterised by the presence of arborescent fibrovascular stalks lined by epithelial cells with or without a layer of myoepithelial cells. Invasive papillary carcinoma is an invasive adenocarcinoma which has predominant papillary morphology >90% in the invasive component. Invasive micropapillary carcinoma is a rare type accounting for only 0.9 to 2.0% of all invasive breast tumours. Encapsulated papillary carcinoma consists of fibrous capsule surrounding a nodule composed of delicate fibrovascular stalks, covered by monomorphic population of neoplastic epithelial cells. Micropapillary carcinoma is characterized by higher incidence of lymph node metastasis and lymphovascular invasion resulting in poor prognosis. The purpose of this study is to share the last 13 years experience regarding papillary lesions of breast in the department of pathology in our institute. Material and Methods: A 13-year (2006-2019) retrospective review of database of patients diagnosed with breast cancer was performed. The medical records of 8 patients with papillary breast cancer who underwent surgery were retrieved and their clinical data, surgical treatment and pathological findings were reviewed. Results: A total of 884 patients underwent mastectomy for invasive breast cancer during the 13 year period. Out of 884 patients, eight were diagnosed with papillary carcinoma breast (0.90%). Amongst the eight, three were diagnosed as invasive papillary carcinoma, two as encapsulated papillary carcinoma and rest three as invasive micropapillary carcinoma. The mean age of presentation was 63.3 (range 45-80) years. The tumour size ranged between 3.5 to 6cm in its greatest dimension. Two out of eight patients had lymph node metastasis with no distant metastasis. Conclusion: Papillary carcinoma of the breast is a rare entity, the reported incidence of pure micropapillary carcinomas is 0.9 to 2% of all breast cancers. It is associated commonly with lymph node metastasis at the time of presentation and have relatively poor prognosis. Much lower prevalence of papillary carcinoma breast was seen in our institutional study.

The genetic architecture of breast papillary lesions as a predictor of progression to carcinoma

Intraductal papillomas (IDP) are challenging breast findings because of their variable risk of progression to malignancy. The molecular events driving IDP development and genomic features of malignant progression are poorly understood. In this study, genome-wide CNA and/or targeted mutation analysis was performed on 44 cases of IDP, of which 20 cases had coexisting ductal carcinoma in situ (DCIS), papillary DCIS or invasive ductal carcinoma (IDC). CNA were rare in pure IDP, but 69% carried an activating PIK3CA mutation. Among the synchronous IDP cases, 55% (11/20) were clonally related to the synchronous DCIS and/or IDC, only one of which had papillary histology. In contrast to pure IDP, PIK3CA mutations were absent from clonal cases. CNAs in any of chromosomes 1, 16 or 11 were significantly enriched in clonal IDP lesions compared to pure and non-clonal IDP. The observation that 55% of IDP are clonal to DCIS/IDC indicates that IDP can be a direct precursor for breast carcinoma, not limited to the papillary type. The absence of PIK3CA mutations and presence of CNAs in IDP could be used clinically to identify patients at high risk of progression to carcinoma.

Ultrasound guided vacuum assisted excision of breast papillary lesions with no atypia: Single centre experience after 2018 UK Breast Screening guidelines

Abstract Purpose: Papillary lesions with no atypia (PLNA) are breast lesions with unknown potential of malignancy (B3). New B3 guidelines published in 2018 by NHS Breast Screening Programme proposed VAE (vacuum assisted

Breast papillary lesions: a retrospective analysis from oncology set up of Pakistan

Background: Papillary lesions of the breast are a heterogeneous group of breast lesions that are difficult to diagnose as benign or malignant. These lesions have varied morphologic features that carry differing prognostic implications for affected patients. Accurate diagnosis is required to ensure that effective treatment is achieved. Papillary lesions can have increased risk of carcinoma and recurrence, in these patients even for lesions yielding a benign concordant diagnosis of papilloma at percutaneous biopsy, surgical excision may be warranted. Malignant lesions are usually surgically treated. Depending on stage-adjuvant chemotherapy and/or radiation therapy is given.Methods: A retrospective study was conducted at Shaukat Khanum Memorial hospital and Research Centre Lahore Pakistan. We reviewed the electronic records of diagnostic and registered patients from January 2007 till December 2017 in women imaging section, in age range of 25 to 75 years. Total 150 diagnosed patients with benign or malignant breast papillary lesions were selected and their conventional breast imaging (mammography and ultrasound) and histopathology was retrospectively analyzed on SPSS.Results: Patients were predominantly asymptomatic or on follow-up to an abnormal mammogram. Of the 150 cases most of the patients had intra-ductal papilloma followed by invasive papillary carcinoma and intra cystic papillary carcinoma. Few patients had intra-ductal papillomatosis and invasive micro papillary carcinoma.Conclusions: Conventional breast imaging remains the first main stay and quite sensitive in detecting breast papillary lesions leading to early detection and management.

Papillary Lesions of the Male Breast: A Study of 117 Cases and Brief Review of the Literature Demonstrate a Broad Clinicopathologic Spectrum.

Papillary lesions of the male breast (PLMB) are uncommon. To date, PLMB have been reported as individual case reports and in relatively small series. We reviewed cases of PLMB diagnosed at our medical center over a 19-year (2000-2019) period. A total of 117 cases were identified, with an age range of 7 months to 88 years. These cases included 3 of papillary ductal hyperplasia, 5 intraductal papillomas, 1 adenomyoepithelioma, 5 atypical papillomas (ie, papillomas with atypia), 51 papillary ductal carcinoma in situ, 14 encapsulated papillary carcinomas, 38 solid papillary carcinomas, and 8 invasive papillary carcinomas. Malignant papillary neoplasms, including invasive and noninvasive ones, had a mean size of 1.3 cm (range: 0.3 to 4.4 cm), and all were ER and HER2. Fifty-four percent (19/35) of carcinomas were treated with excision alone, 46% (16/35) underwent mastectomy, and 63% (22/35) had axillary lymph node sampling. Only one case had metastatic involvement of axillary lymph nodes. Of the cases with follow-up, no (0/8) invasive carcinoma showed distant metastasis or proved fatal, and no (0/23) noninvasive papillary carcinoma recurred. Two notable cases of PLMB were encountered: one of a 7-month-old boy with NF1 mutation and florid papillary hyperplasia, and another of a 57-year-old man with Klippel-Feil syndrome and bilateral solid papillary carcinoma, invasive and oligometastatic on one side and noninvasive on the other. On the basis of this study of PLMB cases, the largest to date, and review of literature, we conclude that PLMB span a broad clinicopathologic spectrum, and that both invasive and noninvasive papillary carcinomas have relatively good prognosis.

Benign breast papillary lesions diagnosed on core biopsy: upgrade rate and risk factors associated with malignancy on surgical excision.

Evaluation of radiologically detected breast lesions is a common task in surgical pathology. Some benign lesions on biopsy are associated with an upgrade to in situ or invasive carcinoma on excision. The non-atypical breast papilloma has published upgrade rates of 0 to 29%. Traditionally, papillomas have been managed surgically, but the wide range of upgrade rates has raised uncertainty about the need for routine surgical excision. This study aims to identify risk factors associated with upgrade and determine the upgrade rate of non-atypical papillomas at our institution. In a retrospective review of pathology reports, we identified 266 patients with a diagnosis of benign papilloma on breast core biopsy. One hundred eighty-two patients underwent surgical resection. The final surgical pathology reports of all patients were reviewed and divided into one of two groups-benign or malignant. Twenty-one patients had a final diagnosis of in situ or invasive carcinoma, resulting in an upgrade rate of 12%. Radiologically detected lesions with calcifications were at higher risk for upgrade (OR = 4.45, 95% CI 1.08-18.27) than lesions without calcifications. Additionally, advanced patient age (OR = 1.07, 95% CI 1.03-1.13) and lesion size greater than 0.5cm (OR = 2.59, 95% CI 0.38-17.48) was associated with upgrade to malignancy. Routine surgical excision of all papillomas is not recommended. Younger patients without high-risk features may benefit from clinical and radiologic follow-up alone. Accurate risk stratification will spare low-risk women unnecessary surgery.

Treatment and Outcome of 341 Papillary Breast Lesions

BackgroundPapillary breast lesions constitute a pathological heterogeneous group and display diverse clinical and imaging features. This study was conducted to analyze the upgrade rate of intraductal papilloma diagnosed on core needle biopsy and to assess the possible risk factors associated with upgrade to higher-risk lesions. We also examined the long-term outcomes in patients who received resection of the papillary lesions.Materials and methodsThe clinical and pathology records of 324 female patients who were diagnosed with papillary lesions based on core needle biopsy (CNB) from February 2010 to October 2016 at our institution were retrospectively analyzed. Patients were grouped by initial diagnosis into two groups (papilloma with or without atypia) and followed-up for long-term outcomes. For the upgrade to higher-risk lesions after excision, upgraded lesions were compared with benign papillomas for the collected variables.ResultsA total of 341 lesions were included for final analysis, and all were available for follow-up. Papillomas with or without atypia diagnosed by CNB were found in 9 and 332 lesions, respectively. Papillomas without atypia on CNB were treated by open excision (n = 265) or vacuum-assisted biopsy (VAB) (n = 67), which yielded similar event-free rate (p = 0.19). The upgrade rate of this group to higher-risk lesions was 9.9%. Peripheral (p = 0.011) lesions in postmenopausal (p = 0.001) or older (p = 0.001) patients with papillomas without atypia based on CNB showed significantly higher upgrade rates. Papillomas with atypia on CNB were all managed by open excision, and concurrent malignancy was found in two lesions.ConclusionIn conclusion, our results support benign papillary lesions based on CNB require further treatment. Peripheral lesions occurring in older or postmenopausal women are at higher risk for upgrade.

ASO Author Reflections: Management of Benign Papillary Breast Lesions: Placing Outcomes into a Larger Perspective.

ASO Author Reflections: Management of Benign Papillary Breast Lesions: Placing Outcomes into a Larger Perspective.

Can we now reach a consensus on the management of benign papillary breast lesions?

Management of benign breast lesions diagnosed by core needle biopsy (CNB) remains a controversial topic. Specifically, there is no consensus on the management of intraductal papillomas, despite multiple studies to determine whether excision or observation should be the next best step (1-5). When CNB yields a diagnosis of intraductal papilloma with atypia, excisional biopsy of the lesion is generally performed. For intraductal papillomas without atypia, however, a large retrospective study recently published in the Annals of Surgical Oncology suggests that observation without excision is likely a safe alternative (6). This is based on a low rate of malignancy found on surgical excision of 327 lesions diagnosed as benign papillomas on CNB, as well as no incidence of cancer found on follow-up for those (n=61) who did not undergo excision.

Benign Papillary Breast Mass Lesions: Favorable Outcomes with Surgical Excision or Imaging Surveillance.

There is no consensus regarding the management of benign papillary breast lesions diagnosed on image-guided core needle biopsy (IGCNB). This is a retrospective review of 407 patients within Kaiser Permanente Northern California diagnosed between 2012 and 2013. The study focused on patients presenting with a mass lesion and who were diagnosed with a benign papillary breast lesion (BPBL) on IGCNB. Patients who did not have surgical excision of the IGCNB papilloma were followed for at least 2years. A total of 327 patients (80%) underwent surgical excision, 61 patients (15%) had follow-up imaging, and 19 patients (5%) had no surgery or imaging. Overall among women with surgical excision, 9.5% had a high-risk lesion, 3.4% had in situ cancer, and 2.4% had invasive cancer. An upgrade to an in situ cancer or invasive cancer was more common among women with a lesion greater than 1cm, a palpable breast mass, age > 50years, or if the lesion was > 5cm from the nipple. No cancers were diagnosed in 61 women followed by imaging surveillance. This is the largest, single-cohort study of benign papillary mass lesions diagnosed on IGCNB. On surgical excision, the overall rate of upgrade to in situ cancer and invasive cancer was low, and almost all cancers diagnosed had favorable features. Because no cancers were found in women who were followed by imaging, we conclude that outcomes for BPBL diagnosed on IGCNB are favorable whether surgical excision or surveillance is the treatment choice.

Papillary breast lesions diagnosed by percutaneous needle biopsy: management approach.

Papillary breast lesions are a heterogeneous group of neoplasms of diverse imagenological, clinical and morphological presentation that display different behaviour, prognosis and, therefore, controversial diagnosis and management. The aim of this study is to propose an algorithm for the management of mammary lesions.Materials and methodsWe show a retrospective review of breast imaging reporting, percutaneous needle biopsy information, histological-pathological reports and subsequent management.ResultsA total of 7,920 biopsies were reviewed. Only 136 biopsies from 130 patients with papillary lesions met the inclusion criteria. There was a correlation between the pathologic findings from percutaneous biopsy and the final surgical histologic result in patients with surgery recommendation in all but 2 (2.12%) cases in which the surgery results were upgraded to a malignant disease.ConclusionsThe algorithm proposed in this paper for the management of mammary lesions significantly reduces the possibilities of upgrading and favours decision making between follow-ups or surgery in patients with papillary lesions of the breast.

Papillary Lesions of Breast: An Experience in a Tertiary Care Centre

Papillary Lesions of Breast: An Experience in a Tertiary Care Centre