Papillary Carcinoma
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Hi Irish & Limno, hope you're both enjoying this springtime. In response to both your concerns, as long as your pathology showed the most favorable molecular phenotype Luminal A instead of Luminal B, you have every right to feel the most encouraged.
https://ww5.komen.org/BreastCancer/SubtypesofBreas...
A friend had been diagnosed with IDC at age 32, ER- PR-, grade-3 with a couple positive nodes, and she's alive and well 20 years later without any recurrences. She had undergone about 6 months of chemo due to her age.
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Irish, regarding your question on "seeding", unfortunately, my understanding is that seeding or mechanical displacement are absolutely possible in patients with Papillary Carcinoma who undergo "needle procedures", especially core needle biopsies . There are links to earlier articles on this thread. Here are some links to check out:
https://academic.oup.com/ajcp/article/133/5/781/17...
https://www.archivesofpathology.org/doi/full/10.58... pages 641-642
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC20011...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC17697...
https://www.pathologyjournal.rcpa.edu.au/article/S...(17)30518-4/pdf
REVIEW: 50TH ANNIVERSARY ISSUE Diagnostic challenges in papillary lesions of the breast 2018
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A pilot exploration of clinicopathologic features with solid papillary carcinoma of the breast
https://ascopubs.org/doi/abs/10.1200/JCO.2018.36.1...
A pilot exploration of clinicopathologic features with solid papillary carcinoma of the breast.
Background: Solid papillary carcinoma of the breast (SPC) is classified as a special entity intraductal papillary tumor of breast tumors. Because of its rarity and specificity, its clinical behavior and its optimal treatment still remain controversial. The aim of this study is to analyze the clinicopathogical and immunophenotypic features of SPC, and to explore the choice of treatment options. Methods: A retrospective study of 56 cases of SPC was performed to analyze the clinicopathogical, immunophenotypic features and survival in these cases. All patients were followed up. Results: All cases were female with mean age of 65.36±14.06 years (range from 28 to 89 years), 85.7% of them were post-menopausal. There were 12 cases of in situ SPC, 9 cases of SPC with micro-invasion, 18 cases with invasive SPC, and 3 cases were accompanied by mucinous adenocarcinoma, 14 cases were accompanied with invasive ductal carcinoma. T1 accounted for 62.5% and the others were T2 (37.5%). 3 cases were found with lymph node metastasis. Approximately 62.5% of them were stage Ia, 33.9% were stage IIa, and 3.6% were stage IIb. Immunohistochemical analysis showed that most of the tumor cells expressed ER (96.4%) and PR (94.6%), all cases were CK5/6 negative. HER2 oncoprotein was positive in only 1 case. The average positive index of Ki-67 was 12.5%. About 78.6% of SPC were luminal A, and luminal B, HER-2 enriched and triple negative breast cancer were 17.9%,1.8% and 1.8%, respectively. The positive rates of Syn and CgA were 64.7% and 39.2%, respectively. The positive expression of P63, Calponin were 42.9% and 39.3% in the myoepithelial cells around tumor cell nests. All cases had follow-up data, the time of follow-up ranged from 6 to 61 months (average 18.6 months), 9 cases underwent chemotherapy, 7 cases underwent radiotherapy, 1 case underwent HER2 targeting therapy, and 47 cases underwent endocrine therapy (SERM,11; AI, 35; AI+OFS,1), all patients were disease-free so far. Conclusions: SPC of breast is a rare pathologic type of breast cancer, usually occurs in elderly females, with distinctive pathological features and immunophenotype. SPC often carries an indolent clinical behavior and its prognosis is better.
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I guess because I'm a lay person ( non medical background) I find it difficult to figure out what conclusions this study found. The studies that I read that were much easier to understand indicated the solid papillary carcinoma in situ ( non invasive) had a very good prognosis whether or not they had radiation. Even those with invasive type had little difference in outcome with radiation. I am having partial breast radiation ( Day 7 out of 16) but am not convinced I should be and they are having great difficulty getting me aligned. Once i'm in the radiation room my time there is 25 but usually closer to 50 minutes of a lot of adjusting ! Any insight would be appreciated
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Mary_Liz_Ann - first off, I’m sorry that you are in a position where you would even read studies on breast cancer! That said, the study that obsolete quoted is a descriptive study. Because papillary tumors are rare, not a lot is known about them. This paper looked at several tumor characteristics which are used to determine prognosis and make treatment decisions. Basically, the paper said that generally, but not always, papillary tumors have characteristics that are associated with a good prognosis and more limited treatments (such as your lumpectomy and radiation).
However, the study also shows that about 20% of the time, papillary tumors have more aggressive characteristics which warrant a more aggressive treatment regimen. In my case, my tumor was grade 3, high Ki-67, ER positive, PR negative, HER negative, and I had a screamingly high oncotype score. So, if my treatment team had designed my treatment plan based solely on the morphology, or shape, of my tumor (papillary), I would have been woefully undertreated. As it was, they did look at the other characteristics, and my treatment plan included a lumpectomy, radiation, chemo and AIs.
The take home point of the paper was to look at all the tumor characteristics in making treatment decisions.
Congratulations on making it halfway through your rads! I hope you make it successfully through the rest of your treatments successfully
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Hi ladies. Hope you are well and truly enjoying the spring. My azaleas bloomed beautifully and now the honeysuckle has invited hummingbirds. The irises are blooming, too.
I had a prophylactic mastectomy May 7. I just rec'd path report on-line today. It says "intraductal benign papillomatosis". So my question is,is that the same creature as papillary carcinoma, but it it's earliest stage? This was not found on mammo, ultrasound or MRI, only after a mastectomy. Is it possible I may have dodged another bc diagnosis in the future? Mother's bc symptoms started with nipple seepage and inversion. She passed from bc less then 2 years after diagnosis. She never shared her medical records and a search came up empty as the surgeon's office indicated records are disposed after 15 years. She passed in 1994. Thank you for your words of wisdom and information.
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Hello Irish, I hope you're recovering nicely from your recent mastectomy. I think you made the right choice for yourself. (I also had a bilateral following a lumpectomy, where additional invasive carcinoma (Mucinous) lesions had been observed.) How have you been feeling?
"Having a single (solitary) papilloma does not raise breast cancer risk unless it contains other breast changes, such as atypical hyperplasia. However, having multiple papillomas increases breast cancer risk slightly." https://www.cancer.org/cancer/breast-cancer/non-ca...
My own personal opinion is that you probably had dodged a bullet, too, as one papilloma can sometimes lead to other stuff, benign or malignant. Some say it doesn't, but I think it's better to play it safe than be sorry later. Not enough is understood about these rarer cancers.
Yeah, many of us have had lesions that were not found on imaging, especially standard mammography which is frightening. But now that you've had your bilateral you need NOT worry about that any more.
Big hugs go out to you, and continue enjoying your springtime flowers. I also love gardening.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC30147...
https://www.hindawi.com/journals/pri/2010/540590/
"Papillary lesions of breast represent a range of lesions. Intraductal papilloma and its association with nipple discharge are well known. However, multiple papillomatosis has quite distinct characteristics and decision making can be somewhat challenging. We report a case of multiple papillomatosis in association with ductal carcinoma in situ (DCIS). Patient opted for ipsilateral mastectomy and prophylactic mastectomy of contralateral breast."
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Radiological Case: Diffuse atypical papillomatosis of the breast
https://appliedradiology.com/articles/diffuse-atyp...
"Solitary papillomas occur more commonly in women between 30 to 50 years of age, often complaining of spontaneous serous or serosanguinous nipple discharge. This type of papillary disease is associated with only a slightly increased risk of breast carcinoma (1.5 to 2.0 times). Papillomas may demonstrate a spectrum of atypical features that include atypical ductal hyperplasia (ADH) or low-grade DCIS. Papillary carcinoma is very uncommon and represents only 2% of all breast cancers. There is no consensus on the histologic criteria for diagnosing atypia in papillomas. Some pathologists suggest atypia when papillomas demonstrate epithelial proliferation of 3 mm or greater in size, while others assign the diagnosis when the atypical proliferation exhibits features similar to low- grade DCIS."
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Hi everyone I was just catching on posts and thought I would give an encourage update. I am 5 years! I saw my breast surgeon 2 weeks ago, got the all clear and the option of seeing her annually or my GP. In 2 weeks I see the oncologist who I will be discharged from as well. I've been to tamoxifen for 5 years he suggest last time I was there that I could stop it after 5 years. Wanting to hear what others have done (I was/am post menopausal but AI caused too many side effects so we went Tamoxifen).
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Hello ItsMe,
CONGRATULATIONS on your 5-year mark! I'm also in the 5-6 year group and also had a 3cm Invasive Solid Papillary tumor mixed with some conventional malignancies.
After a year I had been taken off Tamoxifen because it supposedly had contributed to blood clots in both lungs following an auto accident, but I later was put on AI's (anastrazole) which gave me horrible side effects that I could no live with. Instead, I've been seeing a Naturopathic Doctor who had recommended natural remedies and a healthier diet, exercise & lifestyle... which I'm pleased with. I think sometimes we all need to follow our intuition on what's best because everybody is different.
Best wishes to everybody.
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itsMe-Congratulations on reaching the 5 year mark! I’m about a year and a half behind you, and hoping to cruise uneventfully right behibd you.
Best to all
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Just diagnosed today with papillary carcinoma - looking for resources and more info, which seems hard to find. What questions should I ask as I move towards additional tests and consult with surgeon?
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rweeden- I’m sorry that you find yourself here, but am glad that you found us! You will find that the women and men here are extremely knowledgeable and helpful.
There is not a lot of summarized information on papillary carcinomas (because of the rarity?). Obsolete has listed a wealth of citations from the primary literature if you look back over the past 3 or 4 pages of this thread.
A few things to keep in mind:
-papillary carcinomas generally have a pretty good outcome. They are often, but not always, less aggressive than some other tumor types.
-your treatment plan will be based on the characteristics of your tumor (er+/-, pr+/-, her+/-,grade1/2/3, nodes+/-, etc) rather than the morphology. You will get this information after your biopsy, and again, more definitively, after surgery.
-take things one day at a time. This is a bump in the road, a sucky bump for sure, but s bump nonetheless.
Come back and let us know how you are doing
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RWeeden, Hello, I'm sorry to meet you here. I empathize with anybody having to go through this. I send you a big hug, but you need not worry as long as you obtain 2nd opinions before reaching any final decisions.
It's assumed you had a core needle biopsy done, which unfortunately does not always capture any existing invasive cells, which are typically located at the outside periphery of the papillary tumor. Because of your young age of 42, I wound demand that an Excisional Biopsy be performed on the entire tumor before your final decision is made regarding any future surgery(s) and treatment plans. This had been suggested in publications noted on this thread. I had learned the long hard way.
Please let us know how you make out. We're few in number, but we're here for you. Best wishes.
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It's amazingly hard to find anything about papillary carcinoma. "The Breast Book", which is written by a very well-known doctor, doesn't mention papillary cancer in the "little known" section!
After a core needle biopsy gave them a diagnosis, the doctors did a lumpectomy. Afterwards I did a course of radiation. They should excise the tumor and several lymph nodes before working out a treatment plan. The lymph nodes show if the cancer has spread. Papillary carcinoma is a good cancer to get if you're going to get cancer. The outcome is usually good. A year later I had a lumpectomy on my other breast but it was benign.
Best of luck to you!
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Thank you for the welcome! I have gotten a bit more info from the biopsy results (good news, as I understand it, er+ and pr+. Still waiting for MRI and genetic testing to weigh in. It is encouraging to find the experiences and wisdom of others in these forums
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Obsolete, thanks for your response. I will leave more about Excisional Biopsy - I assume that is done after an initial lumpectomy? They have also recommended genetic counseling and testing due to my young (hah, that makes me laugh!) age.
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cuddlyclothes thank you for sharing your response and experience, that means a lot
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https://www.researchgate.net/publication/329868953...
Displaced Epithelium in Breast Pathology: A Review
Pathology Department, Cancer Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Background: Although iatrogenic displacement of epithelial cells after breast instrumentation is a well-documented phenomenon, it is usually underdiagnosed. Misinterpretation of this issue results in overtreatment of patients in some instances. Additionally, the hazard of tumor seeding and dissemination after needling is a concern to both clinicians and patients...
Conclusion: Epithelial displacement is an important issue in breast pathology that should be considered in every patient with a history of breast instrumentation...
In breast tissue, displacement of epithelial component, both benign and malignant, may result in a misdiagnosis of invasive carcinoma or metastasis. Therefore, pathologists and other practitioners in the field of breast diseases should be cognizant of this phenomenon...
Displacement of epithelium is common after needling procedures, including percutaneous core needle biopsy that is commonly used for evaluation of suspected breast lesions. It occurs in any type of breast lesion. In one study, 22 out of 64 excised breast specimens showed displaced neoplastic cells in needle tracks. In a recent systematic review, displacement rate in a total of 927 cases from nine studies on surgically excised breast specimens ranged from 2% to 63%. This wide range can be attributed to the type of breast lesion (more common in papillary lesions), time interval between needling and surgery, type of procedure, and needle gauge...
Epithelial displacement is important from two points of view including correct histopathologic diagnosis and hazard of needle track seeding or even metastasis...
Any type of instrumentation can result in DE, including fine needle aspiration, core needle biopsy, wire localization of lesions, vacuum-assisted breast biopsy (VABB), injections for sentinel lymph node identification, and incisional or excisional biopsies... The least damaging method is fine needle aspiration, where a 22-G needle is employed for entering the tumor. Needles with a larger gauge, such as 11- or 14-G, used for tissue diagnosis, result in more frequent DE...
In benign and malignant papillary lesions, epithelial displacement occurs more commonly in comparison with other neoplasms of the breast because of the fragility of these lesions. In one study in 2005, 50 out of 53 cases with epithelial displacement had an underlying papillary lesion. These epithelia were dislocated to the stroma surrounding the papillary lesions and adjacent lymph-vascular channels imitating invasion. These displaced epithelia can be even transferred to axillary lymph nodes...
DE should be suspected when we observe a major intraductal component (particularly if this component is a papillary proliferation) or a small presumably invasive tumor. The surgeon or radiologist should notify the pathologists, if there has been any history of prior biopsy or other instrumentations. How can DE be differentiated from genuine invasive carcinoma? Apart from being located along needle track with aforementioned histopathologic features, the following characteristics may be helpful: Histopathologic features of DE and how it can be distinguished from authentic invasion or metastasis:
• The displaced epithelial cells are usually arranged in a linear pattern (Figure 5).
•The displaced cells show some degree of degeneration...
•The cells are morphologically similar to the intraductal component.
•Immunostaining for cytokeratin (Figures 7 and 8) and CD68 may be helpful in distinguishing between DE and epithelioid histiocytes (Figures 3 and 6).
•Immunostaining for myoepithelial markers and high–molecular weight cytokeratin may be utilized when the intraductal component is a benign proliferation with preserved myoepithelial cells
•Sometimes the displaced epithelia are seen in lymphatic channels. There are even reports about the transfer of the displaced epithelia to the lymph nodes along the lymphatic channels.
•Fibrosis related to needling, and not a desmoplastic reaction around invasive carcinoma, is very extensive...
•Some displaced epithelial cells may show squamous metaplasia, resulting in its being mistaken as adenosquamous cell carcinoma.
Displacement of the epithelium to regional lymph nodes and even remote organs such as bone marrow is on record. Since most of these cases are misdiagnosed as metastasis by pathologists, the exact frequency of these findings cannot be determined. Some features useful for distinguishing between DE and real metastasis include:
• The displaced cells are usually in the form of isolated cells or small clusters.
• They are usually evenly distributed in the lymph node sinus and do not form expansile masses or nodules.
• They are accompanied by red blood cells, macrophages, and giant cells.
• The invasive component is very small (for instance, when we have a microinvasive carcinoma).
• The grade of tumor and its type are less compatible with metastasis, e.g., a low-grade tumor or a papillary or mucinous carcinoma (in these situations, the likelihood of lymph node metastasis is very low, and if we see epithelial cells in lymph nodes, it should be interpreted cautiously).
• The biomarker results (ER, PR, and HER2) are different from the primary tumor
• The tumor is morphologically different from the invasive carcinoma
• DE is evident in lymphatic channels of the breast tissue...
...As conclusion, we should be aware of the possibility of epithelial displacement after needle aspiration or biopsy to differentiate dislodged epithelial cells from infiltrating tumor cells and lymphatic invasion. Degenerative alteration of neoplastic cell clusters and the absence of desmoplastic stroma around them indicate epithelial displacement.
Jahanbin, et al. Arch Breast Cancer 2018; Vol. 5, No. 4: 150-158
https://www.researchgate.net/publication/329868953_Displaced_Epithelium_in_Breast_Pathology_A_Review
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To obsolete
Thanks for all your useful information on invasive papillary breast carcinoma that was 2nd breast cancer occurring in Dec. 2020 after my first BC of infiltrating ductal Carcinoma... both are stage 1 on the left breast...I am not sure if double mastectomy would make me disabled after the surgery...any ideas or suggestions?
Qins
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Hi Qins, so sorry to hear that a 2nd cancer was found in your breast. I also had your rare Invasive Solid Papillary Carcinoma (grade 2) along with some conventional IDC (grade 2) and DCIS (grade 3) and Mixed Mucinous (grades 1 & 2).
My recommendation would be that you ask for a MRI, if you have not already had one, but also bear in mind that papillary tumors less than 5mm may not be seen.
Then you could also consider the option of obtaining a 2nd opinion pathology because when Papillary possibly becomes mixed with IDC, the papillary is no longer considered safely encased inside the duct, but having Grade-I, like in your situation, is a favorable prognostic feature.
If your papillary tumor is located near the chest wall, I would strongly recommend a mastectomy because papillary tumors along the periphery can sometimes be covert in multiples.
I had both a lumpectomy and a double mastectomy. I found my BMX surgery to be less painful and less complicated than my lumpectomy. And 7 years later I have been fine and have no regrets. I wish the same for you
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Hi All!
I have not had an opportunity to do some readback on everyones sitrep. Not that I have not had my heart lifted above for you all.
Quick update here.....
Surgery Dec 9....went well until post op problems w/anesthesia reaston.
Drain worked off and on for a few weeks....off more than 24 hrs a number of times....on BAM....300cc in 5 minutes......then repeated.....until the incision started to whistle dixie and the bulb puffed up....Played that game for a few weeks due to MDs and ARPN all gone for the holidays. After 2 ED trips and an admission for overnight..........they removed the drain and began a wet/dry pack to the wound which on 1/17/21 is still open.
I give up a boob...end up with 3 new B-cups and a mouth 3"x2" by 2.5" deep 1/2 finger....to my ribs..and it drools.... .not counting tunnelling and new keloids in and out.It was pretty funny watching the MD stick his finger so deep into my chest where my breast formally resided! lol! He was great!
Ok...thanks for a quick vent....There is so much more but.....Question...
I am not getting clear treatment options from my MDs. My health has been suckie my whole life with autoimmune issues....this year the worst likely due reoccurring cancer and lack of available medical care due to covid.....DELAYS and non info have been the biggest pbm this second time around.
For most people with IPC and IDC.....what kind of treatment after MS are you given?
thanks
T
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After my lumpectomy, I had radiation. However, my situation was not nearly as complicated as yours. Can you get a second opinion? Maybe at a teaching hospital?
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Hi, folks!
I'm stopping by to say that I have now been five years cancer free! I didn't take estrogen suppressor meds, and I've been militant about keeping current with mammograms, etc. One problem is that Lenox Hill Hospital has a different breast surgeon every time I've visited. However that turned out to be a good thing. The new one ordered an MRI, mammogram and ultrasound, all on the same day! So I was there for four hours. Everything turned out to be clean.
I hope the rest of you are okay and are having good tests and outcomes!
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Cuddy, CONGRATULATIONS on reaching your 5-year mark and may you have many more. BTW, love your doggie thread & pics.
LittleGram, A warm WELCOME! Hopefully we can all help you in some way, including those who posted on your other threads. So sorry that you find yourself plagued with these issues and autoimmune complications.
Please clarify if your DX is micropapillary or papillary because they're not identical. The following are the links to recent micropapillary carcinoma threads.
https://community.breastcancer.org/forum/137/topic...
https://community.breastcancer.org/forum/137/topic...
https://community.breastcancer.org/forum/137/topic...
To combat coronavirus, my doctor suggested the following: Vitamin-D (emulsion), Vitamin-C, Potassium Iodide, Zinc
Did you have any gene assays run on your tumor? For a DX of Invasive Solid Papillary (3cm, grade-2), IDC (multi, grade-2), Mixed Mucinous (multi, grades 1-2) and DCIS (grade-3) I had been given anti-hormonals, but not chemo due to a low gene assay score. 7 years later, I am well, and the same is wished for all of you. Best wishes!
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Happy Day to All! I am using the first words as a positive to us ALL!
So...with that said...before becoming redundant....I choose to believe at some point I will get off the wrong side of the titer totter and playground spinner on the 1 % of the pop who gets the GREAT nifty stuff!
I am SO HAPPY to see the great outcomes for so many! I pray it stays on the other side of the fence FOREVER.
Well....the kicks keep on kicking....
I stop myself daily and remember....."Every single thing we endure, suffer, overcome and rejoice about has nothing to do with ourselves. It is so we can become a beacon in the darkness so others will see HOPE in the midst of darkness. Knowing if ONE person can OVERCOME....they can too!"
There is a connection between us all....It is very apparent during this time more than ever. So many are alone "trapped" by an unseen little bug....we need human contact but during this time it is not just difficult but deadly for too many. Stay strong! We are all powerful, important persons and can overcome so much more than we think we can. Its important we embrace one another and pass our strength along.
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Okie Dokie..Yeppers...It is a combo smoothie....began 2013 IDC/DCIS.........,7 Years zero........YAHOOO....
Now invasive micropapillary carcinoma/IDC (wont go into the comorbidities....I HATE that word)
MDs having a hard time staging and giving a treatment plan due to bizarre boob injury. Way to many moving parts to bore you with.
So dealing alot of dunnos.....
NOW ADD TO THE smoothie mix.......
They now have found a very nifty BRAIN lesion..(not so little-been growing for awhile and ignored) sooo off to another MD this week.
ALWAYS get copies of your images and reports!!!!(Just a side note!)FYI
Life is BIZARRE at times and all you can do is laugh!!
T
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Little Grammie,
Thank you for sharing your light, wisdom and positive energy. It's amazing how your brightness radiates thru stormy clouds. So sorry to read that you're dealing with brain issues, amidst your other challenges. Thinking of you and sending you a big hug.
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Goodness.......you are so far from obsolete.....change your name...You have SOOOOOOOOOOOOOOOOOOOOOOO much more to give!!!!!!!!!!!!!! You have a great heart!
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Please pray for me.....so much not me to come
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