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Papillary Carcinoma

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  • LittleGrammieTre
    LittleGrammieTre Member Posts: 13
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    Hello.....Yepper....we do not know alot about this 1-2 percent of stuff. What I can say is do no try to think too deep. Trust by faith...

    t

  • cuddyclothes
    cuddyclothes Member Posts: 98
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    What's going on? What do they intend to do about your brain lesion?

  • LittleGrammieTre
    LittleGrammieTre Member Posts: 13
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    Hey CC and all,

    In reg. to your question...thanks for asking....After I get thru the BC surgery complication issues (SLOW healing and the surprise Christmas gift of dehiscence-still wet/dry packing but almost healed-....) Next is proton precise beam treatment for at least a month) And praying the rad does not reopen the wound.....Add the uncertainty of did it spead from and where after the "ping pong" ball and adjustable bed bizarreness....with all the extra autoimmune baggage....

    At some point soon after they will need to do brain surgery...which is high risk with the location. So....one foot in front of the other and I am KEEPING THE FAITH!


    I have survived since the womb despite the opposition~lol~ The whole thing just is getting crazier~

    My FAITH holds me up!

    Be well!

    Thanks!


  • luv2walk2
    luv2walk2 Member Posts: 8
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    I don't totally understand all I have read here. I am 68 and i was diagnosed with papillary cancer size about 1 1 cm. It became IDC as it had a 7mm invasive aspect. I was told I am Stage 1A, Grade 2, ER+100%/PR+13%/HER2-, oncotype 36 where it needed to be <38. I had a lumpectomy and sentinel node removal (which was clear). This game of test and wait is driving me a little over the edge.

    Tomorrow I finally get to see a radiologist oncologist. I do not know what to expect. I have read that radiation can do more harm than good. I also have to take Arimidex for 10 years. Everyone else only seems to need 5 yrs. I guess I will be losing some of what little hair I have so I guess I will need a wig if I ever want to leave home without a bag over my head. I look awful in hats or scarves. Did this happen to any of you?. I hear papillary cancer is not common and very slow growing so I am not sure why all of the overkill treatment

  • l8blmr
    l8blmr Member Posts: 90
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    Hi luv2, I agree, not much information on papillary BC and treatments can be different. Just a suggestion, it would be easier to understand & discuss your situation if you would enter your BC data on your profile page so it shows up when you post on the blog site.

    I was diagnosed at age 57 with papillary BC. Stage 1A, Grade 2, ER+ 95% PR-3% HER2-(FISH). Oncotype 24-pre Tailor X study.

    MO recommended chemo, arimidex for 5 years (that has since been changed to 7 years-because my bone density is doing ok), no radiation b/c I had a BMX.

    For whatever reason papillary BC's hormone numbers seem to be very high ER, very low PR....not sure why that is? Anyone have an information on that? I'm hoping that eliminating stress in my life will help balance out my hormones.

    Don't sweat the hair loss, it comes back; maybe not exactly perfect, but that's ok. All the best with your treatments going forward.

  • limnogal
    limnogal Member Posts: 100
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    luv2walk2-welcome! Sorry you had to join the club, but glad that you found us. Here are a few things that may help you. “Papillary” describes the shape of your tumor- kind of leafy looking, often inside a round capsule. “IDC” (intraductal cancer) describes where your tumor was located-in the milk ducts rather than in the lobes at the end of the ducts. Your stage, grade, hormone receptor status and oncotype score are used to determine your treatment plan. Your tumor was early stage (stage 1-good), not really aggressive (grade2-not bad), your ER percentage is high (AIs, like arimidex, are generally an effective treatment), your PR percentage is low (nobody really knows what that means, but it is often associated with more aggressive tumors), your HER2 was negative (no targeted treatments are necessary) and your oncotype was in the high end of the gray zone (chemo is not strictly necessary). Your treatment plan looks pretty standard for your stats.

    My stats were similar to yours, only with a much lower ER percentage (around 35%) and a stunningly high oncotype of 49. So, I had chemo in addition to surgery, rads and femara (another AI)/tamoxifen. I’m almost 5 years out now.

    Many women do just fine right through rads and AIs. You probably won’t lose your hair. It may thin some, though.

    Best to you!

  • LittleGrammieTre
    LittleGrammieTre Member Posts: 13
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    How are you!!!! I have not been able to respond....wont bore you with the info...I am sending prayers for you!

  • LittleGrammieTre
    LittleGrammieTre Member Posts: 13
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    Sorry for delay.....I am overcoming with the grace of God....broken finger....ribs....Pretty much feeling like I am on a far planet alone....Yet.....I KNOW I am NOT!!!!


    Do NOT feel alone! There is POWER in the unity of the Spirit.....not religion.....in the SPIRIT!!!!

    forgive typos....broken finger does not help....plus fake teeth makes it joking matter!

    Much love and prayers to you alll.....so many want to hear GODS ....His Hope and life!!! More than ever. ...]

    I am a whom so ever will.......I also need prayer support

    Blessings

  • obsolete
    obsolete Member Posts: 333
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    Hi LittleGram, Luv2, L8 & Limno,

    Hoping everyone is ready for spring and hanging in there. Yes, I can also relate to low PR (+30% here). It's the molecular heterogeneous drivers that are claimed to be a strong prognostic factor, but bear in mind that tumors in the Papillary spectrum are activated by different pathways in comparison to conventional subtypes of BC.

    https://www.komen.org/breast-cancer/diagnosis/mole...

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC32470...

    LittleGram, sorry to read about your broken bones in addition to your autoimmune and brain tumor issues. When you're ready to share more details, we're here for you. You're never alone because we're here and we all care. Sending special prayers and blessings back to you. Please keep your beautiful spirit refreshed with plenty of fresh air and sunshine.

    Hugs and positive thoughts to all.

    Edited for spelling

  • obsolete
    obsolete Member Posts: 333
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    FYI... Please note activated mutations recently observed with "Invasion" on the Papillary spectrum.

    https://www.sciencedirect.com/science/article/pii/...

    "Molecular Analysis of Encapsulated Papillary Carcinoma of the Breast with and without Invasion"

  • obsolete
    obsolete Member Posts: 333
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    "INSM1 IMMUNOSTAINING IN SOLID PAPILLARY CARCINOMA OF THE BREAST"

    "At least 50% of SPC show neuroendocrine differentiation.... SPC is frequently associated with type B, or hypercellular mucinous carcinoma, and mucinous carcinoma has been observed in the invasive parts of 33.3–68.8% invasive SPC cases."

    https://onlinelibrary.wiley.com/doi/10.1111/pin.13...

    Please note that several other ôstudies on SPCi (with invasion) had noted that approximately 75% SPC cases had an invasive component, and most Grade-III SPC had invasion. Hence, 2nd opinions are encouraged on this rare & controversial dx. Note case profiles in above study.

  • obsolete
    obsolete Member Posts: 333
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    Next-generation sequencing revealed recurrent ZFPM1 mutations in encapsulated papillary carcinoma of the breast

    "We reveal that recurrent somatic ZFPM1 mutation is characteristic of EPC and concurred with mutations in the PI3K-AKT-mTOR pathway."

    https://www.nature.com/articles/s41698-021-00180-5

  • obsolete
    obsolete Member Posts: 333
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    "Spectrum of Papillary Breast Lesions According to World Health Organization Classification of Papillary Neoplasms of Breast"

    https://www.cureus.com/articles/42481-spectrum-of-...

    "DIAGNOSTIC CHALLENGES IN PAPILLARY

    LESIONS OF THE BREAST"

    "Some authors even tried to DEFINE STROMAL INVASION IN EPC BY THE PRESENCE OF MALIGNANT PAPILLARY CLUSTERS 10mm OR MORE BEYOND THE CAPSULE, which may emphasise our old perception of the biological value of the capsule in EPC. Typical EPC may also be associated with focal conventional type non-papillary invasive carcinoma ..."

    https://www.sciencedirect.com/science/article/pii/...

  • 1986Laurajjj
    1986Laurajjj Member Posts: 2
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    hi wondering if you had any adv

  • obsolete
    obsolete Member Posts: 333
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    Laura, Please be advised that an "in situ" dx is very favorable within the papillary family because the tumor cells would be located inside the duct. This is a good type to have.

    I noticed your other post to which I'm replying.

    Most of the time any invasive papillary cells or conventional invasive (IDC-nst) cells would be located in the nearby outside stroma or peripheral areas of the papillary tumor with minimal extension, IF an invasive component even exists. Some doctors classify invasive cells as "invasive" only if the malignant cells extend >10mm beyond tumor and some pathologists rely on staining, so please ask your own pathologist to define "papillary invasion".

    So the chances of any invasive cells would have been observed in your initial biopsy pathology. But there's only a slight chance there might be minimal micro-invasions or small clusters of invasions which the biopsy missed, which can rarely occur. After your surgical pathology is completed, you can also ask for 2nd opinion pathology reviews.

    Generally, If it's invasive, your treatment plan would likely not change, but treatment would be based on the invasive component. Papillary invasive cells are extremely rare, so the odds are in your favor.

    I had a 3cm invasive papillary carcinoma, and I'm fine more than 7 years out.

    Good luck with your surgery, and please keep us posted. Hugs & Best Wishes!

  • obsolete
    obsolete Member Posts: 333
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    ATYPICAL PAPILLARY LESIONS AFTER CORE NEEDLE BIOPSY AND SUBSEQUENT BREAST CARCINOMA

    https://researchexperts.utmb.edu/en/publications/atypical-papillary-lesions-after-core-needle-biopsy-and-subsequen

    "Conclusion: Due to the high upgrade rate of atypical papillary lesions to carcinoma (42%), excision of all ATYPICAL PAPILLARY lesions with wide excision margin is recommended for cases with pathologic diagnosis of atypical papillary lesion on core-needle biopsy."

  • obsolete
    obsolete Member Posts: 333
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    (2022) Solid Papillary Carcinoma Of The Breast

    "Mammography detection rates of this tumor range around 50%. Thus, many of the tumors may be mammographically occult."

    "The magnetic resonance imaging (MRI) is another radiological investigation tool with high sensitivity for detecting SPCs"

    "The tumor nodules appear non-invasive due to their circumscription, and the demonstration of invasion becomes difficult at times."

    "Recently, there have also been reports of invasive lobular carcinomas (ILC) with a solid-papillary growth pattern mimicking SPC, known as Invasive lobular carcinoma with solid and encapsulated papillary carcinoma growth pattern. These cases typically showed focal merging of solid-papillary areas with classic invasive lobular carcinoma at the periphery, coupled with the presence of in situ lobular carcinoma and absent neuroendocrine differentiation, which supported a diagnosis of ILC over SPC."

    "These neoplastic cells are monomorphous and present low-grade cytological features along with neuroendocrine differentiation. Most of these tumors show increased cellular proliferation, thereby masking the basic papillary properties, hence the name."

    "SPC characteristically shows intracellular mucinous differentiation, which, when present, clinches its diagnosis. Extracellular mucin production can also be seen; however, such foci need to be differentiated from invasive mucinous carcinoma. Mucinous carcinoma, Capella type B, characterized by large sheets of tumor cells with mucin production and neuroendocrine features, may resemble SPC to a large extent, especially when associated with less mucin production (≤50% mucinous component; a poor prognostic factor)."

    "There are two types of invasion patterns seen in SPC: SPC associated with conventional type of invasive carcinoma, where the invasive component may be composed of a pure invasive ductal carcinoma (IDC), or a mixed morphology composed of mucinous, neuroendocrine-like, IDC, or uncommonly, lobular and tubular subtypes. The invasive carcinoma component is usually low to intermediate-grade in these cases and often shows cytological features similar to the adjacent SPC. The second pattern predominantly shows SPC but with features of stromal invasion, most commonly associated with stromal desmoplasia. In such cases, SPC is often multinodular and shows multiple duct-like structures. SPC is considered invasive when the tumor nests show a characteristic jigsaw growth pattern with ragged and irregular margins."

    "The other helpful immunohistochemical feature for the definite diagnosis is the neuroendocrine differentiation (NED) reported in more than half of all SPC cases.3,15 Even though NED in other types of breast carcinomas has been regarded as a poor prognostic marker, the same is not true for SPC.15,16 The NED demonstrable in SPCs may therefore be considered more of a diagnostic rather than a prognostic marker."

    "The solid papillary variant of invasive lobular carcinoma (ILC), which has been found to have a subclonal origin from the classical ILC, also may cause a diagnostic dilemma.19 Therefore, the subtle histomorphological features of solid lobules of monomorphic cell population with areas of papillary architecture, intra and extra-cellular mucin along with the immunohistochemical profile showing NED helps establish a diagnosis of SPC."

    "A separate study, which also reported a similar case, demonstrated that both the tumor's solid-papillary and classic lobular components shared a common CDH1 mutation and a number of copy number alterations. In addition, the solid-papillary component had an additional 20q gain and 1p loss that have been reported to occur in the solid variant of invasive lobular carcinoma. It, therefore, concluded that both the solid-papillary and a classic lobular component of the tumor shared a common clonal ancestry."

    "The tumor size of SPC with invasion is determined by the invasive component only. The National Comprehensive Cancer Network (NCCN) guidelines mention the consideration of adjuvant endocrine therapy for smaller tumor size SPC (pT1-T3) without lymph node involvement or pN1mi. Adjuvant chemotherapy is definitely indicated in node-positive tumors."

    "It has a morphological overlap with various benign and malignant lesions."

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796863/