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Case 21  - Discussion

Surgical Pathology Case

 

 

ER             100%         Favorable
PR             100%         Favorable
Her2/Neu   N/A           Borderline
Ki-67         23%          Unfavorable

The tumor is diploid. HER2/Neu is not amplified by FISH.
 

Invasive Papillary  Carcinoma of Breast

Clinical Futures

 
  • 1-2% of breast carcinoma; invasive and metastatic patterns are predominantly papillary structures

  • Mean age, 63-67

  • 50% arise in the central breast, and nipple discharge or bleeding is common

  • Usually ER and PR positive with low mitotic rate

Gross Findings

 
  • Usually well circumscribe with bleeding inside

  • Cystic change is common

  • Mural nodules of residual tumor can usually be found on the luminal surface or in the cyst wall

Microscopic Findings

 
  • Papillae patterns: micropapillary, filiform, cribiform, trabecular, and solid

  • Prominent fibrovascular stroma in papillea

  • High nuclear to cytoplasm ratio with hyperchromasia

Differential Diagnosis

 
 

Papilloma

Papillary Carcinoma

Cell types

Epithelial/myoepithelial

Epithelial

Chromasia

Normal

Hyperchromatic

Apocrine metaplasia

Present

Absent

Glandular pattern

Complex

Cribriform

Stroma

Prominent, fibrosis with epithelial entrapment

Delicate or absent; stroma invasion

Adjacent ducts

Hyperplasia

Intraductal carcinoma

Sclerosing adenosis

Sometimes present in breast

Usually absent

Craus and Neubecker's Criteria

Treatment and Prognosis

 
  • Very favorable, even with axillary node metastases.

Reference

 
  • AFIP, Series III