Case 21 - Discussion

Uploaded: 2007-02-13, Updated: 2007-012-22


- Maximum dimension, 5.2 cm.
- Extensive hemorrhage and cystic necrosis in the tumor.
- The tumor is well differentiated,1/3, (Nuclear grade 1/3, Tubule formation 2/3, Mitosis 1/3).
- Hemorrhage and ulceration of the tumor and overlying skin .
- No tumor involvement of the skin or nipple present.
- Focal lymphovascular invasion noted.
- The deep and lateral surgical margins are free of tumor.
- Metastatic adenocarcinoma, papillary, 4 out of 20 axillary lymph nodes with perinodal infiltration.
- Pathologic staging of tumor: pT4, N2, MX; stage IIIB.

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 Breast Carcinoma

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 growth 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



Papillary Carcinoma

Cell types






Apocrine metaplasia



Glandular pattern




Prominent, fibrosis with epithelial entrapment

Delicate or absent; sroma invasion

Adjacent ducts


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.


  • AFIP, Series III