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Topic: Papillary Carcinoma

Forum: Less Common Types of Breast Cancer — Meet others with less common forms of breast cancer, such as Medullary carcinoma, Inflammatory breast cancers, Mucinous carcinoma (colloid carcinoma), Paget's disease, Papillary carcinoma, Phyllodes tumor, Tubular carcinomas, Metaplastic tumors, Adenoid cystic carcinomas and Angiosarcoma.

Posted on: Apr 13, 2012 06:34PM

BD74 wrote:

Hi everyone,

     My mother was recently diagnosed with a 12mm papillary carcinoma.  Apparently the imaging suggested no definite signs of invasion (but included an encapsulated cycstic papillary carcinoma). A lumpectomy is scheduled in the next two weeks, at which point I guess we'll hear more.  They're already planning to do a sentinal lymph node biopsy.

My understanding is that this is a pretty rare form of DCIS.  Are there any differences in treatment plans that any of you know of that are associated with papillary carcinomas?  I guess I'm just trying to compare the parts of the story I've heard on my end from what I read on the internet, which ranges from hopeful to scary...

Best wishes to all of you.

-BD  

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Aug 23, 2018 04:03PM obsolete wrote:

Solid papillary carcinoma with reverse polarity (SPCRP) is a rare breast cancer subtype with an obscure etiology.

http://cancerres.aacrjournals.org/content/canres/e...


Encapsulated papillary carcinoma, apocrine type, of the breast

The apocrine type of encapsulated papillary carcinoma (ECP-A), of the breast is a rare neoplasm and there are only eight cases reported to date. Herein, we report the ninth case.

http://www.mjpath.org.my/2014/v36n2/encapsulated-p...

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Aug 23, 2018 04:12PM obsolete wrote:

A rare case of Grade-III Triple Negative, Encapsulated Papillary Carcinoma

An unusual case of encapsulated papillary carcinoma of breast

http://jcmtjournal.com/article/view/1536

Intracyctic Papillary Carcinoma of the Breast: Report of a Rare Case and Literature Review

A rare case of breast papillary carcinoma associated with intracystic component in a woman with a long history of autoimmune hypothyroidism and multiple sclerosis.

http://intjcancermanag.com/en/articles/7259.html


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Aug 23, 2018 04:23PM obsolete wrote:

Papillary Carcinoma of Male Breast: The Uncommon Pathology of Breast Cancer

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.

https://www.omicsonline.org/open-access/papillary-...

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Aug 23, 2018 05:18PM obsolete wrote:

( 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

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Aug 24, 2018 04:02PM obsolete wrote:

Papillary Lesions of the Breast: An Update Shi Wei , MD, PhD

http://www.archivesofpathology.org/doi/pdf/10.5858...

http://www.archivesofpathology.org/doi/full/10.585...

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...

Epithelial Displacement in Breast Lesions: A Papillary Phenomenon Chandandeep Nagi, MD, Ira Bleiweiss, MD, and Shabnam Jaffer, MD

http://www.archivesofpathology.org/doi/pdf/10.1043...

http://www.archivesofpathology.org/doi/full/10.104...

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Aug 24, 2018 04:59PM Pi-Xi wrote:

That's interesting. Thanks for all the articles, obsolete!

Oncotype 12 Dx 4/7/2016, DCIS, Left, 2cm, Stage 0, Grade 1, ER+/PR+ Surgery 7/11/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Dx 8/3/2016, DCIS/IDC/IDC: Papillary, Left, 1cm, Grade 2, ER+/PR+, HER2- Hormonal Therapy 8/31/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 26, 2018 07:48PM obsolete wrote:

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

http://www.archivesofpathology.org/doi/pdf/10.5858...

http://www.archivesofpathology.org/doi/full/10.585...
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Sep 1, 2018 06:27AM - edited Sep 1, 2018 06:28AM by cs1522

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

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Sep 4, 2018 04:37PM - edited Sep 14, 2018 06:43PM by obsolete

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Oct 27, 2018 07:42PM - edited Oct 27, 2018 07:49PM by Zupozi99

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Feb 15, 2019 12:17AM - edited Feb 22, 2019 02:40PM by obsolete

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Feb 22, 2019 03:51PM LimnoGal wrote:

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.

Moving on.... Dx 11/2016, DCIS/IDC: Papillary, Left, 1cm, Stage IA, Grade 3, 0/6 nodes, ER+/PR-, HER2- Surgery 2/11/2016 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy Balloon-catheter: Breast
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Mar 14, 2019 04:50PM Irishlove wrote:

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?

Dx 3/14/2019, DCIS/IDC: Papillary, Left, 1cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Mar 14, 2019 10:29PM LimnoGal wrote:

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...

Moving on.... Dx 11/2016, DCIS/IDC: Papillary, Left, 1cm, Stage IA, Grade 3, 0/6 nodes, ER+/PR-, HER2- Surgery 2/11/2016 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy Balloon-catheter: Breast
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Mar 15, 2019 02:19PM Irishlove wrote:

Hi LimnoGal, Thank you for the warm welcome. As usual once you are diagnosed with something, the search starts for more information. Again thanks.

Dx 3/14/2019, DCIS/IDC: Papillary, Left, 1cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Mar 15, 2019 03:40PM obsolete wrote:

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.

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Mar 15, 2019 04:01PM obsolete wrote:

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 :

https://www.archivesofpathology.org/doi/pdf/10.585...

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.


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Mar 16, 2019 08:53PM Irishlove wrote:

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.

Dx 3/14/2019, DCIS/IDC: Papillary, Left, 1cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Mar 22, 2019 08:40PM - edited Mar 22, 2019 08:47PM by Irishlove

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.


Dx 3/14/2019, DCIS/IDC: Papillary, Left, 1cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Mar 23, 2019 03:21PM cuddyclothes wrote:

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.

Dx 6/30/2015, IDC: Papillary, Left, 1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 7/22/2015 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 11/11/2015 Dx 6/5/2016, LCIS, Right, <1cm
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Mar 23, 2019 07:29PM Irishlove wrote:

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.

Dx 3/14/2019, DCIS/IDC: Papillary, Left, 1cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Mar 23, 2019 08:41PM cuddyclothes wrote:

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.

Dx 6/30/2015, IDC: Papillary, Left, 1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 7/22/2015 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 11/11/2015 Dx 6/5/2016, LCIS, Right, <1cm
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20 hours ago Irishlove wrote:

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?

Dx 3/14/2019, DCIS/IDC: Papillary, Left, 1cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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11 hours ago noodlesmom wrote:

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.

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7 hours ago cuddyclothes wrote:

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.

Dx 6/30/2015, IDC: Papillary, Left, 1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 7/22/2015 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 11/11/2015 Dx 6/5/2016, LCIS, Right, <1cm

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