Intracystic papillary breast carcinoma - Revision history

Michael: redirect to 'Intracystic papillary carcinoma of the breast' -- after it being moved there

2015-04-28T15:40:50Z

redirect to 'Intracystic papillary carcinoma of the breast' -- after it being moved there

← Older revision		Revision as of 15:40, 28 April 2015
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	~~{{ Infobox diagnosis~~		#redirect [[Intracystic papillary carcinoma of the breast]]
	~~\| Name = {{PAGENAME}}~~
	~~\| Image = Breast PapillaryCarcinomaEncysted PA.JPG~~
	~~\| Width =~~
	~~\| Caption = Intracystic Papillary Breast Carcinoma. [[H&E stain]].~~
	~~\| Synonyms =~~
	~~\| Micro = Papillary lesion within a cyst~~
	~~\| Subtypes =~~
	~~\| LMDDx = [[Intraductal papilloma]], papillary [[DCIS]], [[Invasive papillary breast carcinoma]]~~
	~~\| Stains =~~
	~~\| IHC =~~
	~~\| EM =~~
	~~\| Molecular =~~
	~~\| IF =~~
	~~\| Gross =~~
	~~\| Grossing =~~
	~~\| Site = [[breast]]~~
	~~\| Assdx =~~
	~~\| Syndromes =~~
	~~\| Clinicalhx =~~
	~~\| Signs =~~
	~~\| Symptoms =~~
	~~\| Prevalence = Rare~~
	~~\| Bloodwork =~~
	~~\| Rads =~~
	~~\| Endoscopy =~~
	~~\| Prognosis = very good~~
	~~\| Other =~~
	~~\| ClinDDx = other breast tumour~~
	~~\| Tx = surgical~~
	}}
	'''Intracystic papillary carcinoma of the breast''', also known as '''encapsulated papillary carcinoma of the breast''' (abbreviated '''EPC'''), is an uncommon type of [[breast cancer]] with a very good prognosis.

	~~==General==~~
	*Very good prognosis<ref name=pmid21753694>{{Cite journal \| last1 = Rakha \| first1 = EA. \| last2 = Gandhi \| first2 = N. \| last3 = Climent \| first3 = F. \| last4 = van Deurzen \| first4 = CH. \| last5 = Haider \| first5 = SA. \| last6 = Dunk \| first6 = L. \| last7 = Lee \| first7 = AH. \| last8 = Macmillan \| first8 = D. \| last9 = Ellis \| first9 = IO. \| title = Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis. \| journal = Am J Surg Pathol \| volume = 35 \| issue = 8 \| pages = 1093-103 \| month = Aug \| year = 2011 \| doi = 10.1097/PAS.0b013e31821b3f65 \| PMID = 21753694 }}</ref> - it is similar to [[DCIS]].
	*Classically menopausal women.
	*~30% present with bloody discharge.<ref name=pmid21057133>{{Cite journal \| last1 = Rodríguez \| first1 = MC. \| last2 = Secades \| first2 = AL. \| last3 = Angulo \| first3 = JM. \| title = Best cases from the AFIP: intracystic papillary carcinoma of the breast. \| journal = Radiographics \| volume = 30 \| issue = 7 \| pages = 2021-7 \| month = Nov \| year = 2010 \| doi = 10.1148/rg.307105003 \| PMID = 21057133 \| URL = http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=21057133 }}</ref>

	~~==Microscopic==~~
	~~Features:~~
	*Lesion confined to a cyst.
	**May have a thick fibrous capsule
	**The involved space is ''not'' lined by myoepithelial cells.
	*The cyst contains an abnormal epithelial proliferation with cribriform, solid or papillary architecture.
	**Loss of myoepithelial cells within the epithelial proliferation is a '''key feature'''.
	**Scattered large cells with pale eosinophilic cytoplasm may be observed<ref>{{Cite journal \| last1 = Collins \| first1 = LC. \| last2 = Schnitt \| first2 = SJ. \| title = Papillary lesions of the breast: selected diagnostic and management issues. \| journal = Histopathology \| volume = 52 \| issue = 1 \| pages = 20-9 \| month = Jan \| year = 2008 \| doi = 10.1111/j.1365-2559.2007.02898.x \| PMID = 18171414 }}
	~~</ref>.~~
	***These cells are so-called globoid cells or clear cells and are immunoreactive for GCDFP-15.
	***They should not be mistaken for myoepithelial cells.
	**Neoplastic epithelial cells:
	***[[Nuclear atypia]] - including: nucleoli, [[nuclear pleomorphism]].

	~~Notes:~~
	*Many potential pitfalls with papillary breast lesions on needle core biopsy.
	**Complete excision is recommended<ref>{{Cite journal \| last1 = Rizzo \| first1 = M. \| last2 = Linebarger \| first2 = J. \| last3 = Lowe \| first3 = MC. \| last4 = Pan \| first4 = L. \| last5 = Gabram \| first5 = SG. \| last6 = Vasquez \| first6 = L. \| last7 = Cohen \| first7 = MA. \| last8 = Mosunjac \| first8 = M. \| title = Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up. \| journal = J Am Coll Surg \| volume = 214 \| issue = 3 \| pages = 280-7 \| month = Mar \| year = 2012 \| doi = 10.1016/j.jamcollsurg.2011.12.005 \| PMID = 22244207 }}</ref>.
	*Adequately and carefully sample the specimen to exclude an invasive component.
	*Report only the size of the invasive component (if present) to prevent over-estimation of tumor stage.

	DDx<ref>{{Cite journal \| last1 = Collins \| first1 = LC. \| last2 = Schnitt \| first2 = SJ. \| title = Papillary lesions of the breast: selected diagnostic and management issues. \| journal = Histopathology \| volume = 52 \| issue = 1 \| pages = 20-9 \| month = Jan \| year = 2008 \| doi = 10.1111/j.1365-2559.2007.02898.x \| PMID = 18171414 }}
	</ref><ref>{{Cite journal \| last1 = Pathmanathan \| first1 = N. \| last2 = Albertini \| first2 = AF. \| last3 = Provan \| first3 = PJ. \| last4 = Milliken \| first4 = JS. \| last5 = Salisbury \| first5 = EL. \| last6 = Bilous \| first6 = AM. \| last7 = Byth \| first7 = K. \| last8 = Balleine \| first8 = RL. \| title = Diagnostic evaluation of papillary lesions of the breast on core biopsy. \| journal = Mod Pathol \| volume = 23 \| issue = 7 \| pages = 1021-8 \| month = Jul \| year = 2010 \| doi = 10.1038/modpathol.2010.81 \| PMID = 20473278 }}</ref>:
	*[[~~Intraductal papilloma]].~~
	**Absent or scant stroma favors papillary carcinoma over papilloma.
	**Is there a single cell or dual cell population in the lesion?
	***ER staining will be heterologous in a benign lesion.
	***Myoepithelial markers (calponin/p63/SMA +ve)s hould be positive in a benign lesion.
	*[[Papillary ductal carcinoma in situ]]
	**Papillary DCIS shows myoepithelial cells (calponin/p63/SMA +ve) at the periphery of the involved spaces
	**But papillary DCIS should be negative for myoepithelial cells within the focus of DCIS
	**Papillary intracystic carcinoma does not show myoepithelial cells at the periphery of the involved spaces
	*Invasive papillary carcinoma of the breast
	**Similar architecture but no cystic space, frankly invasive.
	**Very rare.
	*Invasive carcinoma arising in association with papillary intracystic carcinoma
	**Epithelial entrapment in the encysting fibrous tissue should not be interpreted as invasion.
	**Carcinoma must be seen in the breast tissue outside the encysting fibrous tissue.
	**Infiltrating carcinoma is usually of the 'no special type' variety.
	*[[Adenoid cystic carcinoma of the breast]]
	**The solid variant looks basaloid - solid adenoid cystic carcinoma or a 'basal-like' carcinoma should be considered in these cases.

	~~===Images===~~
	~~<gallery>~~
	~~Image:Breast PapillaryCarcinomaEncysted 3 PA.JPG\|Breast - Intracystic Papillary Carcinoma - Medium power (SKB)~~
	~~Image:Breast PapillaryCarcinomaEncysted 2 PA.JPG\|Breast - Intracystic Papillary Carcinoma - Medium power (SKB)~~
	~~Image:Breast PapillaryCarcinomaEncysted PA.JPG\|Breast - Intracystic Papillary Carcinoma - High power (SKB)~~
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant LP CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - low power (SKB)~~
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant MP2 CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)~~
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant MP CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)~~
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant HP2 CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)~~
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant HP CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)~~
	~~Image:Breast EncystedPapillaryCarcinoma InfiltratingDuctalCarcinoma PA.JPG\|Breast -~~ Intracystic papillary ~~adenocarcinoma (top) with associated invasive ductal~~ carcinoma ~~(bottom) (SKB)~~
	~~</gallery>~~

	~~==IHC==~~
	*Calponin/p63/SMA/CK5-6.
	**Loss of myoepithelial cells within the tumour.
	**Loss of myoepithelial cells at the cyst wall.
	*ER - Homogeneous staining of the ~~epithelial proliferation.~~

	~~==References==~~
	~~{{Reflist\|2}}~~

	~~[[Category:Diagnosis]]~~
	~~[[Category:Invasive~~ breast ~~cancer~~]]

Michael: /* Microscopic */ remove webpathology.org links --don't link where they should... will need to find links

2015-04-28T14:05:52Z

Microscopic: remove webpathology.org links --don't link where they should... will need to find links

← Older revision		Revision as of 14:05, 28 April 2015
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	Image:Breast EncystedPapillaryCarcinoma InfiltratingDuctalCarcinoma PA.JPG\|Breast - Intracystic papillary adenocarcinoma (top) with associated invasive ductal carcinoma (bottom) (SKB)		Image:Breast EncystedPapillaryCarcinoma InfiltratingDuctalCarcinoma PA.JPG\|Breast - Intracystic papillary adenocarcinoma (top) with associated invasive ductal carcinoma (bottom) (SKB)
	</gallery>		</gallery>
	*WebPathology<http://www.webpathology.com/images/noimage.gif>
	*WebPathology<http://www.webpathology.com/images/noimage.gif>
	*WebPathology<http://www.webpathology.com/images/noimage.gif>

	==IHC==		==IHC==

Michael: some more re-ordering

2015-04-28T14:03:46Z

some more re-ordering

← Older revision		Revision as of 14:03, 28 April 2015
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	\| Rads =		\| Rads =
	\| Endoscopy =		\| Endoscopy =
	\| Prognosis = good		\| Prognosis = very good
	\| Other =		\| Other =
	\| ClinDDx =		\| ClinDDx = other breast tumour
	\| Tx = surgical		\| Tx = surgical
	}}		}}
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	==General==		==General==
	*Very good prognosis<ref name=pmid21753694>{{Cite journal \| last1 = Rakha \| first1 = EA. \| last2 = Gandhi \| first2 = N. \| last3 = Climent \| first3 = F. \| last4 = van Deurzen \| first4 = CH. \| last5 = Haider \| first5 = SA. \| last6 = Dunk \| first6 = L. \| last7 = Lee \| first7 = AH. \| last8 = Macmillan \| first8 = D. \| last9 = Ellis \| first9 = IO. \| title = Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis. \| journal = Am J Surg Pathol \| volume = 35 \| issue = 8 \| pages = 1093-103 \| month = Aug \| year = 2011 \| doi = 10.1097/PAS.0b013e31821b3f65 \| PMID = 21753694 }}</ref> - it is similar to [[DCIS]].		*Very good prognosis<ref name=pmid21753694>{{Cite journal \| last1 = Rakha \| first1 = EA. \| last2 = Gandhi \| first2 = N. \| last3 = Climent \| first3 = F. \| last4 = van Deurzen \| first4 = CH. \| last5 = Haider \| first5 = SA. \| last6 = Dunk \| first6 = L. \| last7 = Lee \| first7 = AH. \| last8 = Macmillan \| first8 = D. \| last9 = Ellis \| first9 = IO. \| title = Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis. \| journal = Am J Surg Pathol \| volume = 35 \| issue = 8 \| pages = 1093-103 \| month = Aug \| year = 2011 \| doi = 10.1097/PAS.0b013e31821b3f65 \| PMID = 21753694 }}</ref> - it is similar to [[DCIS]].
	*~~Classical~~ menopausal women.		*Classically menopausal women.
	*~30% present with bloody discharge.<ref name=pmid21057133>{{Cite journal \| last1 = Rodríguez \| first1 = MC. \| last2 = Secades \| first2 = AL. \| last3 = Angulo \| first3 = JM. \| title = Best cases from the AFIP: intracystic papillary carcinoma of the breast. \| journal = Radiographics \| volume = 30 \| issue = 7 \| pages = 2021-7 \| month = Nov \| year = 2010 \| doi = 10.1148/rg.307105003 \| PMID = 21057133 \| URL = http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=21057133 }}</ref>		*~30% present with bloody discharge.<ref name=pmid21057133>{{Cite journal \| last1 = Rodríguez \| first1 = MC. \| last2 = Secades \| first2 = AL. \| last3 = Angulo \| first3 = JM. \| title = Best cases from the AFIP: intracystic papillary carcinoma of the breast. \| journal = Radiographics \| volume = 30 \| issue = 7 \| pages = 2021-7 \| month = Nov \| year = 2010 \| doi = 10.1148/rg.307105003 \| PMID = 21057133 \| URL = http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=21057133 }}</ref>

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	***[[Nuclear atypia]] - including: nucleoli, [[nuclear pleomorphism]].		***[[Nuclear atypia]] - including: nucleoli, [[nuclear pleomorphism]].

	~~Photos~~:		Notes:
	<~~gallery~~>		*Many potential pitfalls with papillary breast lesions on needle core biopsy.
	~~Image:Breast PapillaryCarcinomaEncysted 3 PA~~.~~JPG~~\|~~Breast - Intracystic Papillary Carcinoma - Medium power (SKB)~~		**Complete excision is recommended<ref>{{Cite journal \| last1 = Rizzo \| first1 = M. \| last2 = Linebarger \| first2 = J. \| last3 = Lowe \| first3 = MC. \| last4 = Pan \| first4 = L. \| last5 = Gabram \| first5 = SG. \| last6 = Vasquez \| first6 = L. \| last7 = Cohen \| first7 = MA. \| last8 = Mosunjac \| first8 = M. \| title = Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up. \| journal = J Am Coll Surg \| volume = 214 \| issue = 3 \| pages = 280-7 \| month = Mar \| year = 2012 \| doi = 10.1016/j.jamcollsurg.2011.12.005 \| PMID = 22244207 }}</ref>.
	~~Image:Breast PapillaryCarcinomaEncysted 2 PA~~.~~JPG~~\|~~Breast - Intracystic Papillary Carcinoma - Medium power (SKB)~~		*Adequately and carefully sample the specimen to exclude an invasive component.
	~~Image:Breast PapillaryCarcinomaEncysted PA~~.~~JPG~~\|~~Breast - Intracystic Papillary Carcinoma - High power (SKB)~~		*Report only the size of the invasive component (if present) to prevent over-estimation of tumor stage.
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant LP CTR~~.~~jpg~~\|~~Breast - Papillary Intracystic Carcinoma, Solid Variant - low power (SKB)~~
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant MP2 CTR~~.~~jpg~~\|~~Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)~~
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant MP CTR~~.~~jpg~~\|~~Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)~~
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant HP2 CTR~~.~~jpg~~\|~~Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)~~
	~~Image:Breast Carcinoma Papillary Intracystic SolidVariant HP CTR~~.~~jpg~~\|~~Breast~~ - ~~Papillary Intracystic Carcinoma, Solid Variant~~ - ~~high power (SKB)~~
	~~Image:Breast EncystedPapillaryCarcinoma InfiltratingDuctalCarcinoma PA~~.~~JPG~~\|~~Breast~~ - ~~Intracystic papillary adenocarcinoma (top) with associated invasive ductal carcinoma (bottom) (SKB)~~
	</~~gallery>~~
	*WebPathology<http://www.~~webpathology~~.~~com~~/~~images/noimage~~.~~gif>~~
	*~~WebPathology<http://www.webpathology~~.~~com/images/noimage.gif>~~
	*~~WebPathology<http://www.webpathology~~.~~com/images/noimage.gif>~~

	DDx<ref>{{Cite journal \| last1 = Collins \| first1 = LC. \| last2 = Schnitt \| first2 = SJ. \| title = Papillary lesions of the breast: selected diagnostic and management issues. \| journal = Histopathology \| volume = 52 \| issue = 1 \| pages = 20-9 \| month = Jan \| year = 2008 \| doi = 10.1111/j.1365-2559.2007.02898.x \| PMID = 18171414 }}		DDx<ref>{{Cite journal \| last1 = Collins \| first1 = LC. \| last2 = Schnitt \| first2 = SJ. \| title = Papillary lesions of the breast: selected diagnostic and management issues. \| journal = Histopathology \| volume = 52 \| issue = 1 \| pages = 20-9 \| month = Jan \| year = 2008 \| doi = 10.1111/j.1365-2559.2007.02898.x \| PMID = 18171414 }}
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	**The solid variant looks basaloid - solid adenoid cystic carcinoma or a 'basal-like' carcinoma should be considered in these cases.		**The solid variant looks basaloid - solid adenoid cystic carcinoma or a 'basal-like' carcinoma should be considered in these cases.

	~~Notes~~		===Images===
	*Many potential pitfalls with papillary breast lesions on needle core biopsy.		<gallery>
	**Complete excision is recommended<ref>{{Cite journal \| last1 = ~~Rizzo \| first1~~ = ~~M. \| last2~~ = ~~Linebarger \| first2~~ = ~~J. \| last3~~ = ~~Lowe \| first3~~ = MC. \| ~~last4 = Pan~~ \| ~~first4 = L~~. \| ~~last5 = Gabram~~ \| ~~first5 = SG~~. \| ~~last6 = Vasquez \| first6 = L~~. \| ~~last7 = Cohen \| first7 = MA~~. \| ~~last8 = Mosunjac \| first8 = M~~. \| ~~title = Management of papillary breast lesions diagnosed on core~~-~~needle biopsy~~: ~~clinical pathologic and radiologic analysis of 276 cases with surgical follow-up~~. \| ~~journal = J Am Coll Surg \| volume = 214 \| issue = 3 \| pages = 280~~-~~7 \| month = Mar \| year = 2012 \| doi = 10~~.~~1016~~/j.~~jamcollsurg~~.~~2011~~.12.~~005 \| PMID = 22244207 }}~~</~~ref>~~.		Image:Breast PapillaryCarcinomaEncysted 3 PA.JPG\|Breast - Intracystic Papillary Carcinoma - Medium power (SKB)
	*Adequately and carefully sample the specimen to exclude an invasive component.		Image:Breast PapillaryCarcinomaEncysted 2 PA.JPG\|Breast - Intracystic Papillary Carcinoma - Medium power (SKB)
	*Report only the size of the invasive component (if present) to prevent over-estimation of tumor stage.		Image:Breast PapillaryCarcinomaEncysted PA.JPG\|Breast - Intracystic Papillary Carcinoma - High power (SKB)
			Image:Breast Carcinoma Papillary Intracystic SolidVariant LP CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - low power (SKB)
			Image:Breast Carcinoma Papillary Intracystic SolidVariant MP2 CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)
			Image:Breast Carcinoma Papillary Intracystic SolidVariant MP CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)
			Image:Breast Carcinoma Papillary Intracystic SolidVariant HP2 CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)
			Image:Breast Carcinoma Papillary Intracystic SolidVariant HP CTR.jpg\|Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)
			Image:Breast EncystedPapillaryCarcinoma InfiltratingDuctalCarcinoma PA.JPG\|Breast - Intracystic papillary adenocarcinoma (top) with associated invasive ductal carcinoma (bottom) (SKB)
			</gallery>
			*WebPathology<http://www.webpathology.com/images/noimage.gif>
			*WebPathology<http://www.webpathology.com/images/noimage.gif>
			*WebPathology<http://www.webpathology.com/images/noimage.gif>

	==IHC==		==IHC==

Michael: some reformating, re-arrangement

2015-04-28T14:01:14Z

some reformating, re-arrangement

← Older revision		Revision as of 14:01, 28 April 2015
Line 30:		Line 30:
	\| Tx = surgical		\| Tx = surgical
	}}		}}
	==Intracystic papillary carcinoma of the breast==		'''Intracystic papillary carcinoma of the breast''', also known as '''encapsulated papillary carcinoma of the breast''' (abbreviated '''EPC'''), is an uncommon type of [[breast cancer]] with a very good prognosis.
	*[[AKA]] ''encapsulated papillary carcinoma of the breast'', abbreviated ''EPC''.
	===General===		==General==
	*Very good prognosis<ref name=pmid21753694>{{Cite journal \| last1 = Rakha \| first1 = EA. \| last2 = Gandhi \| first2 = N. \| last3 = Climent \| first3 = F. \| last4 = van Deurzen \| first4 = CH. \| last5 = Haider \| first5 = SA. \| last6 = Dunk \| first6 = L. \| last7 = Lee \| first7 = AH. \| last8 = Macmillan \| first8 = D. \| last9 = Ellis \| first9 = IO. \| title = Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis. \| journal = Am J Surg Pathol \| volume = 35 \| issue = 8 \| pages = 1093-103 \| month = Aug \| year = 2011 \| doi = 10.1097/PAS.0b013e31821b3f65 \| PMID = 21753694 }}</ref> - it is similar to [[DCIS]].		*Very good prognosis<ref name=pmid21753694>{{Cite journal \| last1 = Rakha \| first1 = EA. \| last2 = Gandhi \| first2 = N. \| last3 = Climent \| first3 = F. \| last4 = van Deurzen \| first4 = CH. \| last5 = Haider \| first5 = SA. \| last6 = Dunk \| first6 = L. \| last7 = Lee \| first7 = AH. \| last8 = Macmillan \| first8 = D. \| last9 = Ellis \| first9 = IO. \| title = Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis. \| journal = Am J Surg Pathol \| volume = 35 \| issue = 8 \| pages = 1093-103 \| month = Aug \| year = 2011 \| doi = 10.1097/PAS.0b013e31821b3f65 \| PMID = 21753694 }}</ref> - it is similar to [[DCIS]].
	*Classical menopausal women.		*Classical menopausal women.
	*~30% present with bloody discharge.<ref name=pmid21057133>{{Cite journal \| last1 = Rodríguez \| first1 = MC. \| last2 = Secades \| first2 = AL. \| last3 = Angulo \| first3 = JM. \| title = Best cases from the AFIP: intracystic papillary carcinoma of the breast. \| journal = Radiographics \| volume = 30 \| issue = 7 \| pages = 2021-7 \| month = Nov \| year = 2010 \| doi = 10.1148/rg.307105003 \| PMID = 21057133 \| URL = http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=21057133 }}</ref>		*~30% present with bloody discharge.<ref name=pmid21057133>{{Cite journal \| last1 = Rodríguez \| first1 = MC. \| last2 = Secades \| first2 = AL. \| last3 = Angulo \| first3 = JM. \| title = Best cases from the AFIP: intracystic papillary carcinoma of the breast. \| journal = Radiographics \| volume = 30 \| issue = 7 \| pages = 2021-7 \| month = Nov \| year = 2010 \| doi = 10.1148/rg.307105003 \| PMID = 21057133 \| URL = http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=21057133 }}</ref>

	===Microscopic===		==Microscopic==
	Features:		Features:
	*Lesion confined to a cyst.		*Lesion confined to a cyst.
Line 50:		Line 50:
	**Neoplastic epithelial cells:		**Neoplastic epithelial cells:
	***[[Nuclear atypia]] - including: nucleoli, [[nuclear pleomorphism]].		***[[Nuclear atypia]] - including: nucleoli, [[nuclear pleomorphism]].

	~~IHC:~~
	*Calponin/p63/SMA/CK5-6
	**Loss of myoepithelial cells within the tumour.
	**Loss of myoepithelial cells at the cyst wall.
	*ER - Homogeneous staining of the epithelial proliferation.

	Photos:		Photos:
Line 100:		Line 94:
	*Report only the size of the invasive component (if present) to prevent over-estimation of tumor stage.		*Report only the size of the invasive component (if present) to prevent over-estimation of tumor stage.

	===IHC===		==IHC==
	*Loss of myoepithelial ~~markers~~ within the ~~lesion~~.		*Calponin/p63/SMA/CK5-6.
			**Loss of myoepithelial cells within the tumour.
			**Loss of myoepithelial cells at the cyst wall.
			*ER - Homogeneous staining of the epithelial proliferation.

			==References==
			{{Reflist\|2}}

	~~===References===~~		[[Category:Diagnosis]]
			[[Category:Invasive breast cancer]]

Sarah at 11:19, 28 April 2015

2015-04-28T11:19:36Z

← Older revision		Revision as of 11:19, 28 April 2015
Line 1:		Line 1:
			{{ Infobox diagnosis
			\| Name = {{PAGENAME}}
			\| Image = Breast PapillaryCarcinomaEncysted PA.JPG
			\| Width =
			\| Caption = Intracystic Papillary Breast Carcinoma. [[H&E stain]].
			\| Synonyms =
			\| Micro = Papillary lesion within a cyst
			\| Subtypes =
			\| LMDDx = [[Intraductal papilloma]], papillary [[DCIS]], [[Invasive papillary breast carcinoma]]
			\| Stains =
			\| IHC =
			\| EM =
			\| Molecular =
			\| IF =
			\| Gross =
			\| Grossing =
			\| Site = [[breast]]
			\| Assdx =
			\| Syndromes =
			\| Clinicalhx =
			\| Signs =
			\| Symptoms =
			\| Prevalence = Rare
			\| Bloodwork =
			\| Rads =
			\| Endoscopy =
			\| Prognosis = good
			\| Other =
			\| ClinDDx =
			\| Tx = surgical
			}}
	==Intracystic papillary carcinoma of the breast==		==Intracystic papillary carcinoma of the breast==
	*[[AKA]] ''encapsulated papillary carcinoma of the breast'', abbreviated ''EPC''.		*[[AKA]] ''encapsulated papillary carcinoma of the breast'', abbreviated ''EPC''.

Sarah: /* IHC */

2015-04-28T10:58:16Z

IHC

← Older revision		Revision as of 10:58, 28 April 2015
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	===IHC===		===IHC===
	*Loss of myoepithelial markers within the lesion.		*Loss of myoepithelial markers within the lesion.

			===References===

Sarah: Created page with "==Intracystic papillary carcinoma of the breast== AKA ''encapsulated papillary carcinoma of the breast'', abbreviated ''EPC''. ===General=== Very good prognosis
2015-04-28T10:54:22Z

Created page with "==Intracystic papillary carcinoma of the breast== AKA ''encapsulated papillary carcinoma of the breast'', abbreviated ''EPC''. ===General=== Very good prognosis<ref name..."

New page
==Intracystic papillary carcinoma of the breast==
[[AKA]] ''encapsulated papillary carcinoma of the breast'', abbreviated ''EPC''.
===General===
Very good prognosis<ref name=pmid21753694>{{Cite journal | last1 = Rakha | first1 = EA. | last2 = Gandhi | first2 = N. | last3 = Climent | first3 = F. | last4 = van Deurzen | first4 = CH. | last5 = Haider | first5 = SA. | last6 = Dunk | first6 = L. | last7 = Lee | first7 = AH. | last8 = Macmillan | first8 = D. | last9 = Ellis | first9 = IO. | title = Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis. | journal = Am J Surg Pathol | volume = 35 | issue = 8 | pages = 1093-103 | month = Aug | year = 2011 | doi = 10.1097/PAS.0b013e31821b3f65 | PMID = 21753694 }}</ref> - it is similar to [[DCIS]].
Classical menopausal women.
~30% present with bloody discharge.<ref name=pmid21057133>{{Cite journal | last1 = Rodríguez | first1 = MC. | last2 = Secades | first2 = AL. | last3 = Angulo | first3 = JM. | title = Best cases from the AFIP: intracystic papillary carcinoma of the breast. | journal = Radiographics | volume = 30 | issue = 7 | pages = 2021-7 | month = Nov | year = 2010 | doi = 10.1148/rg.307105003 | PMID = 21057133 | URL = http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=21057133 }}</ref>

===Microscopic===
Features:
Lesion confined to a cyst.
May have a thick fibrous capsule
The involved space is ''not'' lined by myoepithelial cells.
The cyst contains an abnormal epithelial proliferation with cribriform, solid or papillary architecture.
Loss of myoepithelial cells within the epithelial proliferation is a '''key feature'''.
Scattered large cells with pale eosinophilic cytoplasm may be observed<ref>{{Cite journal | last1 = Collins | first1 = LC. | last2 = Schnitt | first2 = SJ. | title = Papillary lesions of the breast: selected diagnostic and management issues. | journal = Histopathology | volume = 52 | issue = 1 | pages = 20-9 | month = Jan | year = 2008 | doi = 10.1111/j.1365-2559.2007.02898.x | PMID = 18171414 }}
</ref>.
These cells are so-called globoid cells or clear cells and are immunoreactive for GCDFP-15.
They should not be mistaken for myoepithelial cells.
Neoplastic epithelial cells:
[[Nuclear atypia]] - including: nucleoli, [[nuclear pleomorphism]].

IHC:
Calponin/p63/SMA/CK5-6
Loss of myoepithelial cells within the tumour.
Loss of myoepithelial cells at the cyst wall.
ER - Homogeneous staining of the epithelial proliferation.

Photos:
<gallery>
Image:Breast PapillaryCarcinomaEncysted 3 PA.JPG|Breast - Intracystic Papillary Carcinoma - Medium power (SKB)
Image:Breast PapillaryCarcinomaEncysted 2 PA.JPG|Breast - Intracystic Papillary Carcinoma - Medium power (SKB)
Image:Breast PapillaryCarcinomaEncysted PA.JPG|Breast - Intracystic Papillary Carcinoma - High power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant LP CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - low power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant MP2 CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant MP CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant HP2 CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant HP CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)
Image:Breast EncystedPapillaryCarcinoma InfiltratingDuctalCarcinoma PA.JPG|Breast - Intracystic papillary adenocarcinoma (top) with associated invasive ductal carcinoma (bottom) (SKB)
</gallery>
WebPathology<http://www.webpathology.com/images/noimage.gif>
WebPathology<http://www.webpathology.com/images/noimage.gif>
WebPathology<http://www.webpathology.com/images/noimage.gif>

DDx<ref>{{Cite journal | last1 = Collins | first1 = LC. | last2 = Schnitt | first2 = SJ. | title = Papillary lesions of the breast: selected diagnostic and management issues. | journal = Histopathology | volume = 52 | issue = 1 | pages = 20-9 | month = Jan | year = 2008 | doi = 10.1111/j.1365-2559.2007.02898.x | PMID = 18171414 }}
</ref><ref>{{Cite journal | last1 = Pathmanathan | first1 = N. | last2 = Albertini | first2 = AF. | last3 = Provan | first3 = PJ. | last4 = Milliken | first4 = JS. | last5 = Salisbury | first5 = EL. | last6 = Bilous | first6 = AM. | last7 = Byth | first7 = K. | last8 = Balleine | first8 = RL. | title = Diagnostic evaluation of papillary lesions of the breast on core biopsy. | journal = Mod Pathol | volume = 23 | issue = 7 | pages = 1021-8 | month = Jul | year = 2010 | doi = 10.1038/modpathol.2010.81 | PMID = 20473278 }}</ref>:
[[Intraductal papilloma]].
Absent or scant stroma favors papillary carcinoma over papilloma.
Is there a single cell or dual cell population in the lesion?
ER staining will be heterologous in a benign lesion.
Myoepithelial markers (calponin/p63/SMA +ve)s hould be positive in a benign lesion.
[[Papillary ductal carcinoma in situ]]
Papillary DCIS shows myoepithelial cells (calponin/p63/SMA +ve) at the periphery of the involved spaces
But papillary DCIS should be negative for myoepithelial cells within the focus of DCIS
**Papillary intracystic carcinoma does not show myoepithelial cells at the periphery of the involved spaces
Invasive papillary carcinoma of the breast
Similar architecture but no cystic space, frankly invasive.
Very rare.
Invasive carcinoma arising in association with papillary intracystic carcinoma
Epithelial entrapment in the encysting fibrous tissue should not be interpreted as invasion.
Carcinoma must be seen in the breast tissue outside the encysting fibrous tissue.
**Infiltrating carcinoma is usually of the 'no special type' variety.
*[[Adenoid cystic carcinoma of the breast]]
**The solid variant looks basaloid - solid adenoid cystic carcinoma or a 'basal-like' carcinoma should be considered in these cases.

Notes
*Many potential pitfalls with papillary breast lesions on needle core biopsy.
**Complete excision is recommended<ref>{{Cite journal | last1 = Rizzo | first1 = M. | last2 = Linebarger | first2 = J. | last3 = Lowe | first3 = MC. | last4 = Pan | first4 = L. | last5 = Gabram | first5 = SG. | last6 = Vasquez | first6 = L. | last7 = Cohen | first7 = MA. | last8 = Mosunjac | first8 = M. | title = Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up. | journal = J Am Coll Surg | volume = 214 | issue = 3 | pages = 280-7 | month = Mar | year = 2012 | doi = 10.1016/j.jamcollsurg.2011.12.005 | PMID = 22244207 }}</ref>.
Adequately and carefully sample the specimen to exclude an invasive component.
Report only the size of the invasive component (if present) to prevent over-estimation of tumor stage.

===IHC===
*Loss of myoepithelial markers within the lesion.