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Papillary Carcinoma



  • [Deleted User]
    [Deleted User] Member Posts: 126

    IS micro papillary the same as papillary breast cancer?

  • barbe1958
    barbe1958 Member Posts: 7,605

    I would think so....can't see how it would be different except smaller.

  • Ricochet
    Ricochet Member Posts: 2

    Had the lumpectomy on Dec. 17.  Checked into radiology at 8:45 am so they could find it on ultrasound and insert a fine wire into the lump so the surgeon could find it.  They also injected a blue dye to help identify the location.  The surgery took about an hour.  

    The next day I felt like I had been run over by a Mac truck.  I think I slept about 18 hours.  Today is day two and my main complaint is swelling.  I have been constantly icing my breast and underarm as my armpit is swelling.  I can remove my bandage later today and take a shower. (Yeah!!)

    FYI I was also told they will X-ray the excised tumor to verify the metal marker that was inserted during the biopsy to locate the tumor is in the excised tissue.

    I asked for the pathology report to be faxed to me.  The surgeon said I should get it by Friday.  Hopefully he is right.

    To be continued....

  • barbe1958
    barbe1958 Member Posts: 7,605

    You will feel better once the tape is off the site. SO many people are allergic to the tape and it's so annoying!! Don't ice the skin for more than 10-15 minutes or you risk damaging the skin. Keep us posted, we are watching for you....

  • Birdsong1
    Birdsong1 Member Posts: 2

    Hi, in early January this year I received the pathology report for core biopsy indicating the fragments of the papillary lesion consistent with papillary carcinoma, may be invasive or in situ. There was insufficient tumor to stromatolites interface to make assessment to determine if it is invasive. The nuclear grade is  2-3. After the first try of the core biopsy, the radiologist cannot find the tumor on screen. She was not able to collect more cells afterwards. Her interpretation was the fluid in the cyst broke out. MRI was done at the end of January. Like the post-biopsy mammograms, the MRI shows the breast mass is no longer clearly visible. Does anyone experience the same situation? I am scheduled for needle localization and wide excision next week. I am not quite sure how they can locate the lesion if it cannot be seen clearly. I called the doctor for the question but have not received any reply. Thanks!

  • barbe1958
    barbe1958 Member Posts: 7,605

    Birdsong, that is a good question!! Perhaps they will just scoop out the area that was involved in the first place. Be sure to ask about "seeding", which is the process of stray cells getting scattered into healthy skin during a biopsy. They may still want to do radiation or chemo. Keep us posted!!

  • Birdsong1
    Birdsong1 Member Posts: 2

    The doctor called back today. She said the mass disappeared because the cyst broke during core biopsy. She will perform the surgery based on the marker placed during the core biopsy. Because it is a wide excision she is confident she will get all the tumor area out. I asked about tumor cells travel due to broken cyst during core biopsy. She said thorough researches had been done and cancer cells does not travel because of such circumstances. Just have to trust the doctors, I guess. I am seeking a second opinion from another doctor on Thursday. Will keep you posted.

  • barbe1958
    barbe1958 Member Posts: 7,605

    Hmmm, unless she has a magic wand....I don't see how she can guarantee that a ruptured cyst didn't spill cells into the local tissue. When you get a solid mass removed, like I did, they take enough tissue so that they don't see ANY cancer cells in the surrounding tissue during the pathological biopsy. That is called a "margin". They want a wide enough clear margin to know they haven't missed stray cells. I didn't get a "clean margin" on my lumpectomy so I moved on to a mastectomy. Maybe she has other plans for you like chemo or rads? Let us know what the second doctor says.

  • Glenfae
    Glenfae Member Posts: 11

     Barbie, I've been newly diagnosed with duct and  papillary cancer in my right breast, both are invasive. Like yours, my papillary tumor is at six o'clock, deep in my breast underneath a separate duct tumor. I have a MRI scheduled to further investigate changes in my left breast. Both tumors are over 2cm each. I am having trouble deciding on a lumpectomy or mastectomy and can't find any info on treatment advice/options for people who have both types of cancer. Do you or anyone else on the forum know where I can find more info? Thanks.

  • annika12
    annika12 Member Posts: 92

    the cancer found in me had papillary features ....treated as IDC !!!  As far as I know its treated as carcinoma but usually responds better to treatment !!

  • barbe1958
    barbe1958 Member Posts: 7,605

    Glenfae, the Papiliary Carcinoma "trumps" the DCIS (the duct one you talk of) so you would be treated as having IDC which only means that the cancer is outside the duct. 

    Papilary features sometimes just mean "finger-like" growth patterns. It's not treated as carcinoma, it IS carcinoma! Papiliary is known to be a fairly slow growing cancer so is relatively "easy" to treat. Now, define "easy".

  • Glenfae
    Glenfae Member Posts: 11

    Thanks for responding, Barbe. 
    I need to decide whether to have a lumpectomy or mastectomy and am beginning to panic. As I mentioned both tumors are over 2cm. The surgeon said if I choose a lumpectomy, the adjunct treatment would only be 7 weeks of radiation.  If I choose mastectomy, I would be given oral chemo. A friend currently being treated for BC said If I didn't undergo radiation after a mastectomy, I'd die. My granddaughter is a nurse in a burn unit and she said I should definitely avoid radiation treatment. My daughter in law has the polar opposite opinion. Neither understand me wanting reconstruction if I choose a mastectomy, perhaps because I'm 70 years old. Emotionally, I was calm until I begin doing research and talking to other people. Now I'm so confused and terrified I'll make the wrong decision.

  • barbe1958
    barbe1958 Member Posts: 7,605

    Glenfae, I can only tell you my thought process. I was 50 at diagnosis and didn't need reconstruction to mess up my work time-line (I needed to get back as quick as possible to be able to pay bills.) My ego is also secure enough that I didn't need my breasts for my self-image. In fact, I live flat. Dead flat. And wear T-shirts and everything with no apology. I'm known for saying "Why should I wear fake breasts to make YOU feel better?" If I have no breasts, why should I fake it? I took both breasts off as I didn't want to go through the surgery twice. They were more interested in architectural changes in my right breast which turned out to be ADHP, a precursor to cancer, though the cancer was found in my left breast. As my cancer was low, at 6 o'clock I didn't want rads to damage my heart or lungs. I didn't qualify for chemo as my cancer was slow growing and chemo only works on fast growing cells - that's why your hair and nails fall out.

    Reconstruction involves moving muscles around and can be quite painful. I didn't want to add to my physical pain burden (I have Fibromyalgia) and perhaps future issues. I've seen ladies in these forums still getting surgeries 3 years later. I couldn't draw the drama of breast cancer out quit that long. I needed to move over (not get over) the cancer and get on with my life.

    Just to ease your angst; you will NOT make the wrong decision, because it is YOUR decision!! Do not let people sway your thinking. Just read and absorb and do what is best for YOU. There will be as many people telling you that your plan was right as telling you your plan was wrong. Talk to your doctor and ask what (s)he would do for his/her mother/sister/wife. Please keep us posted.

  • rowan47
    rowan47 Member Posts: 64

    Hi Glenfae, I too had invasive papillary carcinoma. Mine was a bit more unusual in that it was aggressive and fast growing (grade 3) Tumour was 2.5 cm in right breast. Not a lot of info out there!! Most stuff I read said that it is ALWAYS low grade, and only ever seen in women over 60 (I was dx at 47). After having chemo I was due to start radiation, but didn't want to risk heart/lung damage so opted for BMX. Like Barbe, I didn't want reconstruction so am happily living flat :) You must do what is right for you. All the best with making a decision and try not to stress!

  • curlyowl
    curlyowl Member Posts: 1

    I was diagnosed initially with papillary neoplasm in January 2014. I just had my lumpectomy on Feb 12, 2014, waiting for pathology report for next steps. As far as they have said, no invasion, encapsulated also. My incision is 4 inches in length, started a seroma this week, a bit painful but plugging along.

    I see my surgeon on Thursday and I hope my pathology report is in by then. 

  • barbe1958
    barbe1958 Member Posts: 7,605

    We are here for you curly, please keep us posted!

  • Glenfae
    Glenfae Member Posts: 11

    Thank you so much! In addition to dealing with my emotional issues, family members are now trying to tell me who should and shouldn't accompany me to the doctor. I know they're stressed and worried about me, but I'm beginning to feel like a token up for grabs.

  • barbe1958
    barbe1958 Member Posts: 7,605

    Glenfae, how lucky for you to be fought over like that!!! A lot of us did the whole mess without support. You may find that the support you are getting now will drop off as people get used to the idea, so take what you can now.

  • itsme203
    itsme203 Member Posts: 4

    I was diagnosed with invasive papillary carcinoma with DCIS on a core biopsy. An MRI showed over 9cm of suspicious tissue so I opted for a left mastectomy with immediate reconstruction with DIEP. Pathology showed wide spread DCIS along with invasive papillary carcinoma 2.5cm, grade 3. I am scheduled to start chemo this week. I was offered oncotype dx testing but declined as I am relatively young (50) with a grade 3, large area of involvement. Nodes negative. 

  • Glenfae
    Glenfae Member Posts: 11

    Thanks for the response, barbe1958 and itsme203. My doctor just called. A repeat biopsy on both breasts has confirmed that in addition to  invasive papillary and IDC in my right breast, I have ILC in my left. The papillary in the right has doubled in size over two a 2 week period. After consult with heart and lung doctors, I'll have a double mastectomy.  

  • barbe1958
    barbe1958 Member Posts: 7,605

    Glenfae, glad you have a plan in place. It's nice to be back in some semblance of control, isn't it? I had a double mast and haven't looked back. Use us for info if you need it.

  • Glenfae
    Glenfae Member Posts: 11

    Indeed it is, barbe. Living alone, I'm trying to think ahead and figure our how to deal with practical issues on taking care of myself during recovery. 

  • mellis
    mellis Member Posts: 1

    Hello, I'm new to the site and have been reading through posts to find a situation similar to mine. I've been looking for as much info about papillary neoplasm as possible. I had a core needle biopsy on 2/6. I got the results back via phone on 2/9/15. My next doctors appointment is on 2/20/15. It's hard not to be terrified about this. I was told that the neoplasm was not cancerous but when I spoke with my primary doctor she slipped and said it was....then tried to retract the statement after she realized I was getting upset. At this point, I'm just confused and waiting for my next appointment. After reading through your site, I've made list of questions to take to my first visit. I'm pretty sure that I'll at least need a lumpectomy. My husband and the president of a breast cancer support group that I've volunteered with for a few years now will be joining me at my first doctor's visit.

  • Deb1989
    Deb1989 Member Posts: 1

    Mellis, Hey there.  I see no one has been on this discussion chain in a while.  I also had a core biopsy done on 2/9.  Received my results on 2/11.  Kinda confusing -- something about DCIS and papillary.  Had an appointment with a surgeon and we scheduled a lumpectomy on 2/26.  Today I had met with the surgeon again to go through my Pathology Report from the Lumpectomy.  I am diagnosed with "low grade invasive papillary duct carcinoma" and DCIS.  They removed 4 Sentinel Lymph Nodes and they all came back negative.  The bad news is they did not get "clear margins".  I'm being sent to the radiologist on Tuesday (3/10).  She will decide if we can proceed with radiation or if I need additional surgery to verify they got all the cancer.  I am very upset to say the least -- that there is a chance I will need to have another surgery.  I'm seriously thinking if it comes to having to have another surgery -- I may just get the double mastectomy.  Is that crazy? 

    How did your appointment on the 20th turn out?  What is your plan of attack? 

  • Shayne
    Shayne Member Posts: 524

    I dont think papillary carcinoma is as rare as they say. I remember when i was dx, the doctor told me she had 3 other patients with the same dx. I wish I could tell you more info - but I will say find the best doctors and have faith in them. Bring someone with you to your appointments, because you wont hear all the information. ASK QUESTIONS. That is what you are paying them for. Get a 2nd opinion.

    Keep us posted and good luck

  • Lindamc53
    Lindamc53 Member Posts: 2

    Anybody here? There hasn't been a posting for a couple of weeks so I hope one or more of you will read this. I am joining this group of brave women who have been dx with papillary carcinoma. I had a "normal" mammo, but I have very dense breast so a MRI was recommended. The MRI showed a 1 cm mass. I had a MRI core needle biopsy yesterday, and today, the path report was non-invasive papillary carcinoma, but the nurse told me that could change after surgery. I have an appointment with a surgeon in five days, 3/25. I don't have a copy of the path report. I'm not sure where to start, but I need to educate myself on all the acronyms that most of you use here.

  • obsolete
    obsolete Member Posts: 333

    First, I am sorry that you are being indoctrinated into the club I never wanted to join, but I wish you the best. You are in the very good company of many informed BC patients with big hearts who will give you all the support you need. Unfortunately, there aren't many of us with papillary carcinoma to compare notes. Papillary carcinoma is of the most complicated BC carcinoma diagnoses, still with many unsettled controversies within the medical community.

    You are very fortunate that your MRI found your papillary lesion, as MRI cannot always identify papillary nodes. I've already had the papillary invasive subtype of papillary carcinoma, and I'm still dealing with continued confusion and residual complications. Mammogram could not see my 3 cm papillary tumor that was palpable. It seems most doctors in general hosptals do not have a thorough background on these rare papillary carcinoma subtypes. Please always insist on a 2nd and 3rd opinion.

    Please know that there are different criteria used by pathologists in determining invasive vs non-invasive, so be sure your doctor will define the criteria used to establish your Dx. If invasive, be sure they define the invasive component for you and grade it separately, and always get a 2nd opinion on papillary pathology. Also be sure to obtain treatment based on the invasive component vs the papillary, if invasive.

    Papillary carcinoma (aka "pure" Intracystic Papillary, "pure" Encapsulated Papillary, "pure" Solid Papillary or the invasive subtypes: EPC+MI (microinvasion), SPC+MI, IPC+MI; SPC+I (frank invasion), EPC+I, IPC+I

    Papillary carcinoma is also prone to mechanical detachment and seeding (of cancerous cells) during core needle biopsies, so invasion (into stroma or LVI - lymphatic-vascular system) may not necessarily be biological, but caused by the core needle biopsy itself. Biopsies performed on papillary are best done via FNA (fine needle aspiration) or by full excision biopsy only. There are several m

    As you know, it's only essentially the cancerous stem cells that usually cause recurrences and mets, for which there are no known conventional treatments to "cure" the CSC's. Because papillary carcinoma (CSC) cancerous stem cell markers (eg CD44 & CD24) are enriched at 100%, vs. 45.3% in IDC, papillary carcinoma treatments plans CANNOT be compared to or randomly based on the large medical studies performed on conventional IDC (NOS), whereby IDC (NOS) tested at only 45.3% for CD44/CD24. Hence, all these medical studies published on various treatments & recurrence projections apply only to those CSC markers for conventional histological type IDC (invasive ductal, not otherwise specified), and NOT papillary. "Therefore, prevalence and clinical significance of these CSC markers in breast carcinomas of special histological types (SHT) is largely unknown."


    *** Mechanical detachment: "Clinically, it is possible that local invasion may be related to tumor displacement." Grabowski J, Salzstein SL, Sadler GR, Blair S. Intracystic papillary carcinoma: A review of 917 cases. Cancer 2008;113:916-20. Image(s) of pseudo-invasion due to displacement: ;

    "... that the epithelium of papillary lesions can be dislodged and displaced into the surrounding stroma, often in the needle tract, and even into adjacent lymphatic channels, more frequently than other breast lesions (due to inherent friability of papillary lesions) ...... in this study, 3 patients showed associated events;"

    1. Diagnostic difficulty arising from displaced epithelium after core biopsy in intracystic papillary lesions of the breast. "It is likely that intracystic papillary carcinomas are particularly prone to this artefact because friable tumour fragments escape, accompanied by cyst fluid, when the capsule is punctured by a 14G core biopsy needle.";
    2. Pseudo-invasion may be due to prior core biopsy causing epithelial displacement (J Clin Pathol 2002;55:780); …............ .Douglas-Jones, et al;
    3. "Diagnostic difficulty arising from displaced epithelium after core biopsy in intracystic papillary lesions of the breast"; "It is possible that intracystic papillary lesions are particularly prone to the problem of epithelial displacement because of the delicate friable nature of the tumour. The lesions presented here had a cystic component and a papillary architecture. They were also sampled using 14G core biopsy needles. Once the capsule of such a lesion is punctured, cystic fluid under pressure carrying exfoliated epithelial cells may escape into the surrounding tissues and cells become incorporated into the subsequently forming granulation tissue.... Douglas-Jones, et al; "Diagnostic difficulty arising from displaced epithelium after core biopsy in intracystic papillary lesions of the breast"; "Displacement of tumour fragments has been shown to be a particular problem associated with assessment of stromal invasion in intracystic papillary carcinomas of the breast. This may be the result of the friable nature of the tumour and intracystic pressure, which is released when the tumour is biopsied using 14G core biopsy needle.""in one case this gave rise to pseudovascular invasion."
  • kerlix
    kerlix Member Posts: 1

    hi i was just recently diagnosed with papillary and i would like to know if you had the double mastectomy in 2008?

  • obsolete
    obsolete Member Posts: 333

    Kerlix, a warm welcome to the papillary thread which few belong, given its rare diagnosis. If your papillary tumor is invasive (associated with an invasive component), you would best discuss with your doctor a plan to treat your invasive cell subtype. If there is no invasion, limited to DCIS with an in situ (still within the duct or intraductal) lesion, then your papillary tumor would be the focus of treatment. I'm not a good example because there were misdiagnosis and complications with my dx history, so perhaps one of the few other papillary warriors might wish to chime in here. Please feel free to private message me if you'd like to discuss further. Best wishes and hugs to you.

  • Babby8
    Babby8 Member Posts: 1

    Newbie here, good to read up on others' dxs & experiences. I'm 65, found my own lump, dx 44 mm papillary carcinoma (needle biopsy confirmed). In November 2014 oncologist recommended neoadjuvant chemo (TC type), hoping to shrink tumor prior to surgery.

    I was in the 1% who nearly die from chemo, was in hospital a month with respiratory failure, renal failure, and a perforated colon. Escaped with an ileostomy (permanent) and am coping with my new abdominal stoma ("Tommy") with equanimity and humor.

    So now I've got good news, since I will not have further chemo nor will I tolerate hormone therapy (my tumor is estrogen positive but progesterone neg and the other one neg also, hr2 I think it's called): MRI shows the tumor shrank to 30 mm ... In volume terms it has shrunk to only a quarter of its mass! Guess the chemo knocked it on its ass too! Glad I gave up my guts for SOMETHING!

    I plan to watch and wait, as I am not strong enough to face more surgery yet, and there has been no lymph involvement nor metastases. Another image in 6 months.

    Living with it, every day is a bonus, thanks be to God...