Solid papillary carcinoma with reverse polarity (SPCRP) is a rare breast cancer subtype with an obscure etiology.
Encapsulated papillary carcinoma, apocrine type, of the breast
A rare case of Grade-III Triple Negative, Encapsulated Papillary Carcinoma
A rare case of breast papillary carcinoma associated with intracystic component in a woman with a long history of autoimmune hypothyroidism and multiple sclerosis.
Papillary carcinoma of male breast is an extremely rare entity with favourable prognosis due to low malignant potential. Treatment modalities in men are similar to women in managing breast cancer. Breast Conserving Surgery (BCS) is the treatment of choice in this type of tumour, however, mastectomy should be considered if BCS jeopardize the surgical oncology margin especially in men with small breast tissue volume. Tamoxifen is the mainstay of adjuvant treatment since most of this disease is oestrogen-receptor positive.
Chemoradiation is reserved for those who are in poor prognostic group or high grade tumours.
( ref page 43) http://bdiap.org/wp-content/uploads/2017/12/Marchi...
When frankly invasive carcinoma is present .....
it is most prudent to report only the size of the frankly invasive component as the tumor size for staging purposes in order to avoid over-treatment.
We do not take the size of the papillary carcinoma itself into consideration in determination of the T stage.
Histopathology 2008, 52, 20 - 29; Histopathology 2015; 66, 671 - 770
Mechanical displacement of epithelium may occur following a variety of needling procedures, including core needle biopsy, ﬁne-needle aspiration, anesthetic injection, suture placement, and wire localization. In more than 90% of cases, artifactual epithelial displacement occurs in association with underlying papillary neoplasms (including pure intraductal papillomas), as these lesions are inherently friable....
... It is of exceptional importance to be aware of its occurrence and to recognize it histologically, as the displaced epithelium may produce a pattern closely simulating an invasive carcinoma and may result in a mistaken diagnosis in patients with benign lesions or in situ carcinoma...
That's interesting. Thanks for all the articles, obsolete!
Yes, very interesting. Thus, do we assume that, as the end of article implies "biologic fates... are left to be determined", whereas in 90% of cases of papillary lesions, which supposedly have displaced epithelium, there is uncertainty about their clinical significance? I have not been able to persuade my oncologist(s) & pathologists to even acknowledge or touch this topic. Has anybody?
"… Deﬁnitive invasion should be concluded only in the context of concurrent desmoplastic stromal reaction, and in an area away from the previous needling procedure ... However, the displaced epithelium typically does not evoke a stromal reaction, in contrast with true invasion.
The epithelium can also be displaced into lymphatic or vascular channels, and may rarely be seen in the initial core needle biopsy tissue. In the absence of unequivocal invasive carcinoma, the presence of epithelial clusters in the lymphovascular spaces should be interpreted with utmost caution. When the focus is limited to the biopsy site, epithelial displacement should be considered in the differential diagnosis.
Further, single or small clusters of epithelial cells can also be found in the regional lymph nodes in the absence of bona ﬁde invasive carcinoma, and thus may cause more diagnostic confusion (Figure 12, D)... Moreover, breast massage in women undergoing sentinel lymph node biopsy may also cause epithelial displacement to lymph nodes.
In this regard, nuclear features of the epithelial cells in the lymph node may provide pertinent information with respect to benign or malignant origin, as the latter are typically larger and pleomorphic. In cases of malignant-appearing epithelial cells in a lymph node, the ﬁndings of associated reactive changes, such as foamy or hemosiderin-laden macrophages and foreign body giant cell reaction, favor displaced epithelium as a potential manifestation of mechanical transport over true metastasis.
In ambiguous cases, it is appropriate to provide an explanatory comment in the pathology report to emphasize this uncertainty, as there is no conﬁrmatory method to determine whether an epithelial deposit in a lymph node is via metastatic spread or by mechanical transport.
Lastly, the biologic fate of displaced epithelium in all sites remains to be determined. Appropriate documentation and long-term clinical follow-up are needed to determine the clinical signiﬁcance of this unique phenomenon.
SUMMARY - Papillary lesions of the breast represent a heterogeneous group of neoplasms sharing many morphologic similarities. These lesions may demonstrate overlapping clinical and radiologic features, but may have diverse clinical outcomes... "
Papillary Lesions of the Breast: An Update Shi Wei , MD, PhD
hello. This is for barbe!!!
Recently diagnosed with papillary carcinoma one 1.1 n one that is .3. I noticed you said you are now Stage IV. Which scares the hell out of me. The doctor said this cancer is extremely treatable. When I look at your profile I do not see hormonal therapy back in 2008. Was this your choice? You are using arimedex now. What is the prognosis
Hi again CS, It is normal for new BC patients to worry about the "what if's", especially when there are so many unknowns. You are never alone in this. We all worry, but usually the typical early negative emotions will start to ease once you have your final pathology report, 2nd opinions and a treatment plan that you're comfortable with.
Patients who have non-Luminal A tumors, low ER/PR %, high grade tumors with very high Mitotic rates, involved vascular & lymph nodes, concurrent conventional cancer (IDC, for example), high OncotypeDX score (or other genomic assay) and tumor locations along the chest wall tend to be somewhat at a higher risk of local and regional recurrence than most Papillary Carcinoma patients. On the other thread you had stated you had HIGH ER/PR%, which is a very positive attribute for treatment success. Please keep us posted. Hugs and best wishes.
I have a very similar diagnosis. I also want to get a second opinion from John Hopkins.
Did you already get your second opinion from JH?
If so, do you mind sharing their recommendations?
I appreciate your help very much.
2019 greetings & wishing everyone improved health & positive energy. Doing well. Update: 6 yrs. since initial dx, grade III DCIS & lumpectomy. 5 yrs since dx Invasive Solid Papillary Carcinoma, grade II, 3cm, 0/3 nodes & DCIS grade III, also IDC microinvasions; Multi-focal Mixed Mucinous Carcinoma, grades I-II, 4mm - 8mm. Lumpectomy followed by BMX. ER+ PR+ HER2- Bilateral mastectomy. Oncotype DX score was 8. 100% ER+ Luminal A. Had high 3/3 mitosis rating, but still doing well. Exercising, watching diet & nutrition. Monitoring estrogen levels.
Failed on Tamoxifen (caused DVT blood clots & pulmonary embolism in both lungs following car accident). Failed Anastrozole with serious SE's & complications. Felt much better following natural protocol. Integrated protocols are best.
Please seek 2nd opinions on both pathological & oncology recommendations. Papillary can be much too complicated & misunderstood. Do not rely on a single source recommendations, please. Think positive, believe in yourself and PEACE to all in 2019.
obsolete-Congratulations! I’ve just passed my 3 year anniversary, and am hoping for many more for both of us. I second your recommendation for second opinions.
Well, here I am, joining this group of rare, unique people. I had a biopsy Jan., and mastectomy Feb. 27th. Just saw the bc surgeon today for the final path report after intial stage 1a IDC diagnosis (after biopsy).Now they restaged me to Stage 0, with encapsulated papillary carcinoma. I just wonder if MS played any roll in this? I posted over in the MS and BC forum, but it's kinda slow over there. I had taken a chemo drug, Mitoxantrone for MS, back in 2005 thru 2008. Hmm, some medical student might find this interesting. Now I don't understand the path report notes: "Shows presence of papillary fronds lined by an epithelial proliferation and there is absence of p63 staining both within and at the periphery of the lesion". Any input?
irishlove-Welcome to the club that nobody really wants to be a part of! We’re glad you found us, but sorry that you had to find us.
The “presence of papillary fronds“ is likely describing the growth pattern of your tumor. P63 is a genetic marker, but I don’t know much more than that. Hopefully someone with a bit more knowledge will come along and chime in...
Hi LimnoGal, Thank you for the warm welcome. As usual once you are diagnosed with something, the search starts for more information. Again thanks.
Hi Limnogal, a belated congratulations to you on your 3rd yearly anniversary! And thank you. It seems that nobody had been around here much until recently, so I was hesitant to leave any personal information out there exposed. There aren't many of us out there.
A warm welcome to IrishLove! That's an interesting history you have, but I'm sorry I don't have any answers regarding your MS question. A friend in Ireland with MS also had undergone chemotherapy some years ago, but I don't have the details, but you pose an interesting consideration.
For P63 expression, please see figure 5 image on page 4 in Papillary Lesions of the Breast, Jorns :
Also on P63 https://www.ncbi.nlm.nih.gov/pubmed/15024707
Because Papillary is a wide spectrum of benign to malignant papillary lesions, there is no "one size fits all". All papillary gals are strongly encouraged to seek 2nd opinions on pathology because of the many complexities. Best wishes to everyone.
Thank you folks for responding. I failed to mention the chemo drug, Mitoxantrone had been explained to me at the time (2005) that it was used years back as a breast cancer treatment. A French woman with MS and BC, discovered her MS had gone into remission. It was then studied and fast tracked to treat aggressive MS. I realize there is no way to know if this potentially delayed BC, but it is an interesting theory. I am the 4th generation with BC, but I am not Braca1/2 positive. I am however, RAD 50 positive. Wish I could find more info on family history of bc, other then it is very prevalent (including Mom's first cousin, my second cousin, Mother, Mat.Gr.Mother, Mat. Great Gr.Mother). This would help me in a decision to remove the other breast.
Hi everyone. Hope you all are doing good and spring brings warmer days ahead. I am struggling with decision on Tamoxifen or A.I. due to side effects. I already have very high cholesterol, recently diagnosed even though my b.m.i. is 22. Plus I have high b.p., controlled with spiro (spelling?). I have M.S. 18 years now and believe that lesions are responsible for some of these problems as I'm 63 and never had either until recently. Fatigue is so overwhelming at times, so that factors into what to do. Plus I do have a hole in my heart, possible born with this condition or developed when I was on chemo years back. I am asymptomatic. So I know I have the RAD 50 gene, which has been shown to increase risk of b.c. and ovarian. I did have a hysterectomy years ago. I know I have to do something going forward due to family history (4th generation of b.c., all have passed from b.c.). Plus I am rather small breasted and have dense breasts per yearly mammos. So here's my question...What about a prophylactic mastectomy? Would that give me the insurance I need to lower the risk of another diagnosis in the remaining breast? It's a difficult surgery for me. I am 3 weeks from last mastectomy and still struggling. Thanks for your input.
I'm so sorry you're suffering from all of those health problems! Have you consulted with a breast surgeon about a prophylactic mastectomy? I don't take an estrogen suppressor because of a LOT of reasons. That's an individual decision.
In your place, I might consider a double mastectomy without breast reconstruction. Are you on chemo and/or radiation? I did raditation and it turned out well.
Hi cuddyclothes, Thanks for your response. I am only 3 weeks post mastectomy, no recon. I haven't had a call as of yet from the MO's office for an appt. To the best of my knowledge, no chemo, no radiation is warranted. It's the tamoxifen or a.i. I did briefly, prior to the proper diagnosis, approach the surgeon about double mastectomy, but she didn't feel a healthy breast should be removed. I'm the one struggling with the decision about those estrogen drugs. It would be good to know other folks opinions. It's hard to make this decision when you are still trying to heal and adjust to a new body. When I reread my post it sounds like I'm physically in bad shape, but honestly I don't view myself that way. Just living my life to the best of my ability. I exercise, eat fruit and plant based foods, along with some organic meats, alot of fish and try to keep stress down to a minimum. I rescue dogs and have for over 40 years. Cats, too. A beautiful granddaughter, visiting right now. A great husband, who was a police officer for those same 40 years.
My decision not to take an estrogen suppressor was based on several reasons. The main reason was that it didn't significantly decrease my risk of a recurrence. Another reason was the side effects. I've been on many, many drugs over the last 20 years. If there's a side effect to be had, I'll have it! The final reason was that the drugs can have a marked effect on your brain. I already have a compromised brain, so that decided me.
What does your oncologist think about a double mastectomy? Not for nothing, but you don't know if a healthy breast can suddenly become unhealthy.
Cuddyclothes: Oh thank you so much for your response. I guess I'll need to call the surgeon's office to make sure they didn't forget to contact the oncologists office for an appt. I do have an appt. end of April with the surgeon. I don't think chemo is recommended since I have encapsulated papillary and they restaged me to 0. I assumed no rads either since I the mastectomy. That drug sensitivity you have is my exact problem, too. These heat flashed knock me to the floor since MS and heat do not go together at all. Trying to imagine an increase in that activity and I can picture me splayed out on the floor as my legs give out. One thing I've been able to hold onto after years of MS is the ability to walk. You also have concerns about your brain, as do I. Enough lesions in my brain that I'm not sure there's anymore room for cognitive decline. Now how do you know about the limited benefit of a.i and or tamoxifen? What determines that?
It's been a while since I've checked in on this forum. It's exactly 2 years since my diagnosis and I'm thinking back to how I felt at the time--so overwhelmed with the choices, and wondering which was the "right" one. I think mentally, its one of the toughest times so I'm sorry that you're having to deal with it at all. The best advice I got from a doctor was to make the decision that I felt was best for me. In my case, I had the option of lumpectomy+rads+tamox, or DMX (with or without tamox). As I, too, do not handle medications well (even the contrast MRI left me with side effects of a blinding migraine and dizziness), I knew the tamox was not a good option for me. I consulted with 3 doctors at the time, including my long-time OBGYN, and all were very supportive and encouraging of my decision of the BMX. 2 of the doctors are female and confessed that given the same diagnosis, they would make the exact same decision. Yes, it's a major surgery, and yes, in the eyes of some it is over treatment, but it is the one decision with which I have zero regrets. I am 18 months past recon and just had another yearly exam. Although I do still hold my breath a tad each time I go (I think we all do), I go in feeling mostly confident. When I was making the decision, I really tried to think about 6 months and 1 year and 2 years from that point. I knew that if I chose another route, I would still need 6 month check ups including mammo and possibly MRI (extremely dense, small breasts and the cancer was not detected by a 3D mammo). When I did the math and thought about how often I would be scheduling visits, testing and/or waiting on results and follow ups, that helped in the decision making process. I do not have a family history of breast cancer, was not considered high risk, and was not BRCA positive. As one doctor said. "There is absolutely no reason we can find as to why you have this, which means we can not predict when or whether it will show up again." I hope this gives you a little more information to work with. Whatever you decide, there is no right or wrong; it's just what feels best for you. Good luck to you.
It's just as noodlesmom says, there is no right or wrong. I didn't need chemo, so I had radiation. I do make the appointments, even though they are a royal pain in the ass. I try to schedule them all at the same time. My oncologist and my breast surgeon are at different hospitals (long story) so I end up having to advocate for myself quite a bit. Not everyone was onboard with my decision not to take meds. I've felt fine about it. There's no guarantee I won't get it again if I take meds. I also have a multi-generational history of BC. I try to make my appointments and tests, etc, and hope for the best.
How did I know? I talked at length with my doctors, researched things here on this board, talked to other women who were taking it. There were women who had no discernible side effects. Everyone is different. Some of it came down to my chances of getting cancer again. The difference between if I didn't take a.i. or did take a.i. was too small to convince. I already read some medical articles in respectable journals that said there was a definite effect on the brain, including cognitive decline. My doctors were okay about my decision. I also had a friend who is a real wonk and who researched everything down to the last detail.
Hi everyone. I hope you are doing well tonight and looking forward to spring. Might get snow here tomorrow night and I worry about my lilacs. They are heavily budding.
Today was an upsetting day and then a rewarding end. I went out and about with DH for lunch. Two hours later pain hit my lower right side that was unrelenting. I went to the hospital after an hour of trying to hold out. I am 4 1/2 weeks post-mastectomy on the left side. Slow healing, probably due to my age and MS.
My thought was a bowel blockage, and after CT scan, that's what they believed, also. The RN said sometimes after surgery this will happen. It could also be due to MS as I am in a flare right now. So after a uncomfortable treatment, relief. The RN suggested in the future use dulcolax prior to surgery. She lost a few points though as I told her repeatedly not to do anything to my left arm. Well she hooked up the bp cup and I caught it just as it started to inflate. She kinda downplayed the situation, but I reinforced the risk and time element wasn't just a few weeks as she suggested. I lost my day out and spent 7 hours in ER, but feel much better.
When we arrived home and picked up mail and I had rec'd my first billing for the hospital. I have crappy Medicare Advantage HMO BCBS with a high deductible. The only breakdown says: Observation $27,000! Wow, that got my attention. The insurance paid $5000, and the hospital adjusted $21,725 leaving me with $275. I wonder why? I was misdiagnosed by their pathology dept. with IDC stage 1a and after mastectomy it became Encapsulated Papillary Carcinoma, Stage 0. I have not raised a fuss, but did mention to the nurse it was sad that I could have had that lumpectomy had the MRI not shown two "suspicous" areas, that turned out to be nothing and of course the misdiagnosis. I get it that this is a tricky cancer and with dense breasts, even trickier. Well, guess I'll wait and see what other bills come in and maybe I'm celebrating a little to early.
Have a good one,
Irishlove (my beloved Plott/Shep who passed in June and I'm still grieving).
Oh, so sorry for all your recent health troubling experiences. I wish to send you a gentle bear hug! Please just take baby steps easing into each day at a time. I'm thinking of you, wishing you many better days ahead.
It never hurts getting a 2nd opinion, if your insurance will cover it. If you can get yourself to a teaching hospital, if you're not already being treated at one, it may be helpful.
Below is some info on 501C3 requirements at hospitals that participate in Obamacare & Medicare. An attorney had advised me that there are loopholes in paying off debt to such hospitals, so you may wish to investigate their policy.
The problem is that many pathologists are trained differently, which adds more complexity to an already confusing Papillary Carcinoma diagnosis. I had Invasive Solid Papillary with additional invasive components, which can be either Luminal A or Luminal B molecular phenotype. This is an example how wide the possible spectrum for Papillary Carcinoma is.... from benign to local malignancy to regional mets.
So very sorry on the loss of your precious fur baby. It's so hard to lose our lovable furry companions, on top of having BC surgery, health complications and treatments. I don't think we ever stop grieving. You might want to check out these wonderful pet threads, one of which was started by one of our papillary sisters:
Hello Obsolete. Our local path lab sends slides down for second opinion to Wake Forest Medical Center. That is one fine institution. In 2001 they diagnosed me with Multiple Sclerosis after I had seen two other neurologists. In all honesty the first neuro did diagnose me with MS, but I felt it was a fast diagnosis after one event and negative O bands. The second neuro said it was female hysteria. He doesn't know how lucky he was that the spouse (sitting in the waiting room in full police officer uniform), was sitting in the waiting room and not exam room. Not that DH would have said anything, it's just the equipment he carried could have been misused. Ok, just kidding.
Our local hospital is part of a large unit and does offer financial assistance. Waiting on final bills, but the paperwork required is overwhelming. Waiting on one retirement award letter from husband's prior workplace. I've requested it twice now. Grr
Since I'm a newbie, I've been trying to absorb info on papillary carcinoma. I have a few questions since the diagnosis. With biopsy is it possible that there could be seeding? I read these types of tumors are freeble and crumble. Since it was encapsulated, but we didn't know this at the time, is it possible that puncturing the protective wall allowed cells to escape? Thank you for your informative postings.
Irishlove-I’ve wondered about seeding, too. But then, my oncotype score was so high that I was headed down the chemo path no matter what. I decided to quit worrying about it.
Obsolete has a much better handle on the literature. Maybe she will chime in ....
Thanks LimnoGal for your response. I had my first visit with the MO today. She was brilliant, compassionate, and has short pink hair. Ok, I adored her as I'm sure this is one of the ways she can relate to her cancer patients. Worked for me.
No chemo, no radiation and no a.i.'s and no tamoxifen, but....I will be having a prophalactic mastectomy. With the family history, my risk for a new primary cancer in the other breast is exceptionally high. With MS, she agreed with me that the side effects would be even more difficult to handle. Now the hard part is to get insurance to agree. It's not a slam dunk as I am on Medicare Advantage BCBS. I see the surgeon end of April.
A bit of bad news, she does feel I have lymphadema. It's truncal and quite painful. In and under the ribs, angel wing and where the breast use to be. sigh. Waiting on a referral. A dear friend, who had prostate cancer, developed lymphadema. He contacted me to say we are so lucky to have a certified specialist in the area that is excellent in the field.
I got the answer on seeding. Since I had a mastectomy, the tissue is studied carefully and would have shown seeding issues. Surprised that it would show in that short of a period of time. A PubMed article showed that seeding is rare, but when it is proven, 94 percent of the cases are breast cancer patients. Of course if it's rare, then statistically that number would be exceptionally low. I believe the current methods of biopsy have proven to reduce the risk even further. Interesting and valid concern for any patient undergoing a biopsy.
One bit of more info I inquired was the program used to calculate risk assessment for recurrence or new primary b.c. She said the program has been determined to be flawed and was shut down. Now she didn't say which way is skewed. But I hope that b.c. patients looking for those stats are aware of this. It's indefenseable and a betrayal to those that used the program to make what we thought were informed decisions.