Papillary Carcinoma

Papillary carcinoma is a very uncommon from of infiltrating breast cancer. Papillary literally means 'nipple-like', and this cancer is characterized by a well-defined margin and many small projections, which look like little fingers or nipples, or like the bumpy surface of taste-buds on the tongue. Papillary breast cancer is commonly discovered as a palpable lesion or as a cyst of about 2-3 cm in diameter, containing a brownish mixture of neoplastic tissue and blood clot. About 1/2 of all cases occur beneath the nipple, resulting in a bloody nipple discharge. Sometimes it is called 'intracystic' papillary carcinoma, which simply means the tumor is found 'inside' a cyst, and is therefore somewhat more fluid and 'cyst-like' than a solid mass.

 

papillary breast cancer invasive ductal carcinoma

 

There is a heterogenous collection of breast cancers that have cyst-like presentations. In cancers such as papillary carcinoma, the tumor presents more or less as a cyst, while in other types of breast cancer it presents as a mass and 'decays' into a cyst. This latter 'ductal carcinoma with cystic degeneration' tends to be associated with a more serious, aggressive breast cancer.

Statistical prevalence of papillary carcinoma

Papillary breast cancer is diagnosed in 1% to 2% of all patients. Occassionally the disease is found in men as well. Papillary carcinoma most frequently occurs in older, post-menopausal women, and commonly presents as a moderate or 'grade 2' tumor in terms of perceived aggressiveness.

Invasive papillary carcinoma usually occurs following the development of papillary ductal carcinoma in situ (DCIS). once again underlining the benefits of early breast cancer screening. If the cancer is 'just beginning' to affect the ducts it might be called 'infiltrating' papillary carcinoma, and if it is cleary in the ducts and moving beyond it would be termed 'invasive' papillary carcinoma. Mammography and sonograph can usually identify papillary carcinoma, but a fine-needle aspiration biopsy may not be sufficient to distinguish between in situ, infiltrating, and invasive forms. This is due to the fluid nature of the carcinoma, and because the invasion tends to occur at the edge of the tumor. Because of this, a surgical excision of the mass is often undertaken.

Prognosis and treatments

Papillary carcinoma is a slow-growing form of breast cancer, and 10 year survival rates have been reported between 85% to 100%, with 10 year 'disease-free' rate of just under 75%. Non-invasive papillary carcinoma has a similar prognosis to most other ductal carcinomas. However, the invasive presentation of papillary carcinoma is thought to have a better prognosis than other invasive ductal carcinomas. Negative axillary lymph note involvement significantly improves 5 year survival rate. Tumor size and cancer grade also play a role, but there is no statistically significant difference is this regard between papillary and other ductal breast carcinomas. The outlook for papillary breast cancer is also more positive for younger women (under 50).

Segmental mastectomy is the most common treatment for papillary breast carcinoma

As for treatment and follow-up options, segmental mastectomy is the most frequent course of action. Less commonly, patients undertake hormonal and radiation therapies. Axillary sampling at regular intervals is usually performed for women at higher risk or where invasion is felt to be likely.


References

  1. Rosen PP, Oberman H. Tumors of the Mammary Gland.Washington, AFIP, 1993, pp. 209-218.
  2. Dogan BE, Whitman GJ, Middleton LP, Phelps M. Intracystic papillary carcinoma of the breast. Am J Roentgenol 2003;181:186
  3. Devitt JE, Barr JR. The clinical recognition of cystic carcinoma of the breast. Surg Gynecol Obstet 1984;159:130-2
  4. Liberman L, Feng TL, Susnik B. Case 35: Intracystic papillary carcinoma with invasion. Radiology 2001;219:781-4
  5. E. Ergul, B. Korukluoglu, A. Celik & A. Kusdemir : Invasive Papillary Carcinoma of the Breast Presenting as Post-Traumatic Hemorrhagic Cyst . The Internet Journal of Surgery. 2007 Volume 11 Number 1
  6. Lefkowits M, Lefkowits W, Wargots ES. Intraductal (intracystic) papillary carcinoma of the breast and its variants: a clinicopathological study of 77 cases. Hum Pathol1994; 25:802 —809
  7. Park, S., Kim, J.H., Kim, S., Park, BW, Lee, KS. Clinicopathological Characteristics and Prognostic Factors of Papillary Carcinoma of the Breast. Journal of Breast Cancer Research.. 2008 Jun;11(2):77-82.

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Copyright Steven B. Halls, MD Last edited 03-August-2011

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