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Beck M, Beltjens F, Arnould L, Coutant C, Vincent L. Evaluation of the management of intracystic papillary carcinoma. Bull Cancer 2023; 110:810-817. [PMID: 37179238 DOI: 10.1016/j.bulcan.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Intracystic papillary carcinoma is defined as papillary carcinoma located in a dilated or cystic duct. There is no consensus regarding the management of this lesion. The aim of our study is to evaluate the frequency of associated invasive lesions and the need to perform an axillary staging during surgery. MATERIAL AND METHODS This is a retrospective study concerning intracystic papillary carcinomas diagnosed at the Georges-François Leclerc Cancer Center between January 2010 and December 2021. Inclusion criteria were an age superior to 18 years and a histologic diagnosis confirmed at biopsy. RESULTS Fifty-nine patients were included in this study. All but one patient underwent surgery: 39 patients (67.2%) underwent lumpectomy, and 18 patients (31.1%) underwent total mastectomy. An axillary staging was performed in 51 patients (86.4%). On final histologic analysis, 31 patients (52.5%) had pure intracystic papillary carcinoma and/or associated with in situ and 27 patients (45.8%) had invasive and/or microinvasive lesions. After univariate analysis, the only variable significantly associated with the presence of invasive lesions on final histologic analysis was the palpation of the lesion with a P-value of 0.09. DISCUSSION Through this study, it appears necessary to discuss the realization of an axillary staging by conducting an axillary sentinel node procedure because of the high frequency of invasive lesions associated with intracystic papillary carcinoma.
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Affiliation(s)
- Marion Beck
- Georges-François Leclerc Cancer Center, Oncologic Surgery Department, 1, rue du Professeur Marion, 21000 Dijon, France.
| | - Françoise Beltjens
- Georges-François Leclerc Cancer Center, Biology and Pathology of Tumors Department, 1, rue du Professeur Marion, 21000 Dijon, France
| | - Laurent Arnould
- Georges-François Leclerc Cancer Center, Biology and Pathology of Tumors Department, 1, rue du Professeur Marion, 21000 Dijon, France
| | - Charles Coutant
- Georges-François Leclerc Cancer Center, Oncologic Surgery Department, 1, rue du Professeur Marion, 21000 Dijon, France; Georges-François Leclerc Cancer Center, Health Sciences Training and Research Unit, University of Burgundy, 1, rue du Professeur Marion, 21000 Dijon, France
| | - Laura Vincent
- Georges-François Leclerc Cancer Center, Oncologic Surgery Department, 1, rue du Professeur Marion, 21000 Dijon, France
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Abstract
Papillary lesions of the breast represent a heterogeneous group of lesions including benign papillomas, papillomas with focal epithelial atypia, fully fledged ductal carcinoma in situ (DCIS) or lobular neoplasia, papillary DCIS, encapsulated papillary carcinomas without or with invasion, solid papillary carcinomas, and invasive papillary carcinomas. A micropapillary pattern characterized by lack of fibrous stalks within the papillae is observed in micropapillary DCIS and invasive micropapillary carcinoma. In addition, a variety of other rare breast lesions reveals a papillary architecture such as tall cell carcinoma with reversed polarity (TCCRP) and mucinous cystadenocarcinoma, adenomyoepithelioma, and secretory carcinoma. In addition, benign lesions such as usual ductal hyperplasia, apocrine metaplasia, gynecomastia, and juvenile papillomatosis may show a papillary or micropapillary architecture. Fragments of a benign papilloma in a breast biopsy are considered a lesion of uncertain malignant potential (B3 in the European classification) and excision is mostly recommended. Although the knowledge about molecular pathology of papillary breast lesions has increased, there is not sufficient evidence for diagnostically useful molecular features, yet. The aim of this review is to provide an update on papillary and micropapillary lesions with emphasis on problematic areas for daily diagnostic work including biopsies.
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Affiliation(s)
- Janina Kulka
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, 1091, Budapest, Hungary, E.U..
| | - Lilla Madaras
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, 1091, Budapest, Hungary, E.U.,Department of Pathology, Uzsoki Hospital, Budapest, Hungary
| | - Giuseppe Floris
- Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Graz, Austria.,School of Medicine, Johannes Kepler University, Linz, Austria
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Wang ZK, Liu F, Wang Y, Wang XD, Tang P, Li W. Preliminary experience of hybrid endoscopic submucosal dissection by duodenoscope for recurrent laterally spreading papillary lesions. World J Gastroenterol 2020; 26:5673-5681. [PMID: 33088160 PMCID: PMC7545392 DOI: 10.3748/wjg.v26.i37.5673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/08/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management strategies for recurrent ampullary adenoma after endoscopic papillectomy are still controversial. Patients with the recurrent papillary lesions need to receive repetitive endoscopic interventions due to the limitations of conventional endoscopic techniques.
AIM To assess the feasibility, efficacy, and safety of hybrid endoscopic submucosal dissection (ESD) by duodenoscope for recurrent, laterally spreading papillary lesions.
METHODS We enrolled two patients with recurrent, laterally spreading, duodenal papillary adenomas with no intraductal extension confirmed by follow-up between March 2017 and September 2018. After marking the resection borders of the lesion using a dual knife, a submucosal cushion was created by injecting a mixture of saline solution, methylene blue, and adrenaline. A total circumferential incision and submucosal excision was performed by dual knife combined with insulated-tip diathermic knife, and then the lesion was ligated and resected using an electric snare. Endoscopic hemostasis was applied during the endoscopic procedures. Moreover, the endoscopic retrograde cholangiopancreatography (ERCP) procedures, including selective cannulation and stent implantation of biliary and pancreatic ducts, were performed. Additionally, we performed endoclip closure for mucosal defect after ESD.
RESULTS Hybrid ESD using a duodenoscope and biliary and pancreatic stent placement were performed successfully in two patients. The endoscopic size of recurrent papillary lesions was no more than 2 cm. Generally, the average total procedure time was 95.5 min, and the procedure time of ESD and ERCP was 38.5 min and 15.5 min, respectively. No serious complications occurred during the intraoperative and postoperative periods. The histopathological examination revealed tubulovillous adenoma negative for neoplastic extension at the cut margin in both patients. The duodenoscopic follow-up and histopathology of biopsy specimens at 3 mo after ESD showed no residual or recurrent lesions in ampullary areas in both cases. Both cases have been followed up with no recurrence to June 2020.
CONCLUSION Hybrid ESD by duodenoscope is technically challenging, and may be curative for recurrent, laterally spreading papillary adenomas < 2 cm. It should be performed cautiously in selected patients by experienced endoscopists.
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Affiliation(s)
- Zi-Kai Wang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Fang Liu
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yun Wang
- Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, Beijing, China
| | - Xiang-Dong Wang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Ping Tang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Wen Li
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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Li X, Gao H, Xu M, Wu Y, Gao D. Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision. BMC Surg 2020; 20:204. [PMID: 32933518 PMCID: PMC7493139 DOI: 10.1186/s12893-020-00869-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background The 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. Methods We 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. Results Most 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. Conclusions Breast 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.
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Affiliation(s)
- Xiaohui Li
- Nosocomial Infection Department, The Second Hospital, Shandong University Cheeloo College of Medicine, Jinan, 250033, China
| | - Hua Gao
- Department of Thoracic and General Surgery, Shandong Provincial Chest Hospital, Jinan, 250101, China
| | - Minling Xu
- Maternity and Child Care Center of DeZhou, DeZhou, 253015, China
| | - Yang Wu
- Department of Breast Surgery, The Second Hospital, Shandong University Cheeloo College of Medicine, No. 247, Beiyuandajie Street, Jinan, 250033, China
| | - Dezong Gao
- Department of Breast Surgery, The Second Hospital, Shandong University Cheeloo College of Medicine, No. 247, Beiyuandajie Street, Jinan, 250033, China.
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Tagliati C, Ercolani P, Marconi E, Simonetti BF, Giuseppetti GM, Giovagnoni A. Apparent diffusion coefficient value in breast papillary lesions without atypia at core needle biopsy. Clin Imaging 2019; 59:148-153. [PMID: 31821971 DOI: 10.1016/j.clinimag.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The main aim of the study was to assess if the mean apparent diffusion coefficient (ADC) value was significantly different between papillary lesions (PL) without atypia and PLs with atypical or malignant foci. A secondary objective was to evaluate if patients mean age, MRI BI-RADS® descriptors and assessment category were significantly different between these two PL groups. METHODS In this eight year retrospective study were included 122 patients (mean age, 51 years; range, 24-78) with 122 PLs without atypia at micro-histological examination after core needle biopsy (CNB) performed under sonographic guidance. All patients underwent surgical excision biopsy within 3 months after CNB. All patients underwent MRI examination before surgical excision, including STIR, DWI and Dynamic Contrast-Enhanced sequences. RESULTS Mean ADC value difference between PLs without and with atypia or malignant foci was statistically significant (p < 0.0001). Mean ADC value optimal threshold in order to distinguish the two groups was 1.418 × 10-3 mm2/s. A mean ADC value ≤ 1.418 × 10-3 mm2/s could predict atypical or malignant foci within a PL with 83.9% sensitivity and 75.8% specificity. No statistically significant difference was found with regard to patients mean age, MRI BI-RADS® descriptors and assessment category between these two PL groups. CONCLUSIONS Mean ADC value of PLs without atypia at CNB is an efficient tool in order to help distinguish between PLs without and with atypical or malignant foci at final pathology on surgical excision, and it could be used to help decide how to manage these lesions.
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Affiliation(s)
- Corrado Tagliati
- School of Radiology, Università Politecnica delle Marche, Ancona, Italy.
| | - Paola Ercolani
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Elisabetta Marconi
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Barbara Franca Simonetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Gian Marco Giuseppetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
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Bendifallah S, Canlorbe G. [Common benign breast tumors including fibroadenoma, phyllodes tumors, and papillary lesions: Guidelines]. ACTA ACUST UNITED AC 2015; 44:1017-29. [PMID: 26547891 DOI: 10.1016/j.jgyn.2015.09.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning common benign breast tumors: fibroadenoma (FA), phyllodes breast tumors (PBT), and papillary lesions (BPL). METHODS Bibliographical search in French and English languages by consultation of PubMed, Cochrane and international databases. RESULTS In case of percutaneous biopsy diagnosis of FA, clinico-radiologic and pathologic discordance or complex FA or proliferative lesions or atypia with FA, a family history of cancer, it seems legitimate to discuss management in a multidisciplinary meeting. When surgery is proposed for FA, periareolar compared to direct incision is associated with more insensitive nipple but better aesthetic results (LE4). When surgery is proposed for FA, indirect incision is preferable for better cosmetic results (Grade C). Techniques of percutaneous destruction or resection can be used (Grade C). The WHO classification distinguishes three categories of phyllodes tumors (PBT): benign (grade 1), borderline (grade 2) and malignant (grade 3). For grade 1 PBT, the risk of local recurrence after surgical excision increases when PBT lesion is in contact with surgical limits (not in sano). After in sano resection, there is no correlation between margin size and the risk of recurrence (LE4). For grade 2 PBT, local recurrence after surgical excision increases for margins under 10mm margins (LE4). For grade 1-2 PBT, in sano excision is recommended. For grade 2 PBT, 10-mm margins are recommended (Grade C). No lymph node evaluation or neither systematic mastectomy is recommended (Grade C). Breast papillary lesion (BPL) without atypia, complete resection of radiologic signal is recommended (Grade C). For BPL with atypia, complete excisional surgery is recommended (Grade C).
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Affiliation(s)
- S Bendifallah
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, université Pierre-et-Marie-Curie, Paris-6, 75005 Paris, France; UMRS 1136, institut Pierre-Louis et de santé publique (IPLESP), 56, boulevard Vincent-Auriol, 75646 Paris cedex 13, France.
| | - G Canlorbe
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, université Pierre-et-Marie-Curie, Paris-6, 75005 Paris, France; UMRS 938, université Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75012 Paris, France
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Menes TS, Rosenberg R, Balch S, Jaffer S, Kerlikowske K, Miglioretti DL. Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium. Am J Surg 2014; 207:24-31. [PMID: 24112677 PMCID: PMC3865063 DOI: 10.1016/j.amjsurg.2013.05.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/24/2013] [Accepted: 05/16/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Upgrade rates of high-risk breast lesions after screening mammography were examined. METHODS The Breast Cancer Surveillance Consortium registry was used to identify all Breast Imaging Reporting and Data System category 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women. RESULTS High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (n = 685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia, and 2% in papillary lesions). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, and those associated with lobular neoplasia were mostly (56%) invasive. During a further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery. CONCLUSIONS Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on Breast Imaging Reporting and Data System category 4 mammograms among asymptomatic women do not justify surgical excision.
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Affiliation(s)
- Tehillah S Menes
- Department of Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239 Tel Aviv, Israel.
| | - Robert Rosenberg
- Radiology Associates of Albuquerque, Albuquerque, NM, USA; Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Steven Balch
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - Shabnam Jaffer
- Department of Pathology, The Mount Sinai Medical Center, New York, NY, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Diana L Miglioretti
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA; Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
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Reisenbichler ES, Adams AL, Hameed O. The predictive ability of a CK5/p63/CK8/18 antibody cocktail in stratifying breast papillary lesions on needle biopsy: an algorithmic approach works best. Am J Clin Pathol 2013; 140:767-79. [PMID: 24225742 DOI: 10.1309/ajcpxv64gxlzciga] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Immunohistochemical markers have been shown to assist in the stratification of breast papillary lesions. We evaluated the ability of different cytokeratin (CK) and p63 expression profiles on needle biopsy specimens to predict excision diagnoses. METHODS A CK5/p63/CK8/18 antibody cocktail was applied to 58 needle biopsy specimens (32 papillomas, 7 atypical papillomas, 19 papillary carcinomas on excision). RESULTS p63 expression was greater in papillomas than in atypical papillomas (P = .044) and papillary carcinomas (P< .0001). Papillary carcinomas and atypical papillomas showed greater CK8/18 expression (and conversely less CK5 expression) than did papillomas (P < .0001). Negative or focal p63 expression was 96% sensitive for diagnosing any atypical lesion (atypical papilloma or papillary carcinoma) on excision, whereas CK8/18 predominant expression (≥80% cells) was 100% sensitive. In contrast, the sensitivity of the original diagnosis was only 81%. The greatest accuracy for the diagnosis of atypical papillary lesions (95%) was achieved when both p63 and cytokeratins were used in combination in an algorithmic fashion. This method also correctly identified all cases that had papillary carcinoma (100% sensitivity) on excision. CONCLUSIONS Although a single stain or combination cannot independently stratify papillary lesions, a CK5/p63/CK8/18 antibody cocktail is a useful adjunct to morphology for evaluating breast papillary lesions in needle biopsy specimens.
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Affiliation(s)
| | - Amy L. Adams
- Department of Pathology, University of Alabama at Birmingham, Atlanta, GA
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Omar Hameed
- Department of Pathology, University of Alabama at Birmingham, Atlanta, GA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, TN
- Department of Surgery, Vanderbilt University, Nashville, TN
- The Vanderbilt Ingram Cancer Center, Vanderbilt University, Nashville, TN
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Mulligan AM. Encapsulated Papillary Carcinoma of the Breast. Surg Pathol Clin 2009; 2:319-50. [PMID: 26838325 DOI: 10.1016/j.path.2009.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Papillary lesions of the breast include a broad spectrum of entities, many of which can be diagnostically challenging for the pathologist. This article focuses on encapsulated papillary carcinoma, a recently proposed term used to describe papillary carcinoma occurring within a cystically dilated duct. Previously considered a variant of papillary ductal carcinoma in situ, the finding that these lesions typically lack myoepithelial cells at their periphery has raised questions about their true nature. This article presents a practical approach to the diagnosis of encapsulated papillary carcinoma with a review of its histologic mimics and clinical significance.
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Affiliation(s)
- Anna Marie Mulligan
- Department of Laboratory Medicine, St. Michael's Hospital and University of Toronto, 30 Bond Street, Room 2-089 CCW, Toronto, Ontario M5B 1W8, Canada.
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