SOLID PAPILLARY CARCINOMA OF THE BREAST – A RARE ENTITY

To study the clinicopathologic features and immunophenotype of solid papillary carcinoma (SPC) of breast. Clinical and pathologic features of 21 cases of SPC, with or without stromal invasion, were analyzed. Immunohistochemical study (LSAB method, for cytokeratins, myoepithelial markers, chromogranin A, synaptophysin, Ki-67, estrogen receptor, progesterone receptor, c-erbB-2 and pS2) and alcian blue staining were performed. All the patients were females with a mean age of 66.1 years. The clinical features were similar to those of classic papillary tumor. Metastasis was not observed in patients who had undergone axillary lymph node dissection. Histologically, the tumor displayed solid papillary growth pattern, with mucin production demonstrated in 19 cases. The tumor cells were oval, polygonal, spindled or signet ring-like and contained mildly to moderately pleomorphic nuclei. The mitotic count measured less than 5 per 10 high-power fields in 15 cases. Seven cases contained foci of invasive carcinoma which showed similar cytologic features as those of the in-situ component. Immunohistochemical study showed that the tumor cells expressed CK8 but not basal cell cytokeratin. Positivity for smooth muscle actin-alpha, calponin and p63 was demonstrated in the myoepithelial layers of fibrovascular cores, as well as around the expanded ductolobular units. Most cases also showed cytoplasmic positivity for chromogranin A (88.2%) and synaptophysin (82.4%). The proliferation index, as highlighted by Ki-67 immunostain, was 8.1%. The tumor expressed estrogen receptor, progesterone receptor and pS2. The staining for c-erbB-2 oncoprotein was negative. Follow up of 16 patients showed no evidence of recurrence or metastasis. SPC predominantly affects elderly females and has distinctive pathologic features and immunophenotype. Some cases of SPC are associated with mucinous and neuroendocrine components. Follow-up data suggest that SPC often carries an indolent clinical behavior and favorable prognosis.

We report a case of solid papillary carcinoma (SPC) of the breast, of which the cytologic findings of the nipple discharge and the fine needle aspiration (FNA), and the pathology of the resected tumour are described in detail. Imaging studies demonstrated an intra-ductal tumour of the breast, which seemed responsible for the bloody nipple discharge. The cytologic features of the nipple discharge and the FNA targeted to the intra-ductal tumour suggested low-grade carcinoma. Additional findings of mucin production and rosette-formation (possibly neuroendocrine differentiation) indicated SPC as a major differential diagnosis. Histologically, the lesion consisted of mainly ductal proliferation of low-grade carcinoma associated with prominent rosette formation within the tumour and mucin production. Permeation of mucin with cancer cell clusters into the adjacent adipose tissue was also noted. Immunohistochemically, the tumour cells, especially those forming rosettes, were partially positive for CD56. Histological diagnosis was SPC with invasion. SPC is a rare tumour, and its cytologic and pathologic features have only been sporadically reported. Our case was unique in that there was a good correlation between cytologic and histologic findings. The cytologic findings that are important to predict the histologic diagnosis are emphasized. A brief review of the relevant literature is also included.

We report a case of solid papillary carcinoma (SPC) that developed at the site of a previous intraductal papilloma (IDP) with atypical ductal hyperplasia. This case supports IDP as a potential precursor lesion to SPC.

Solid papillary carcinoma (SPC) is rare, accounting for less than 1% of all breast cancers. According to the 5th edition of the WHO Classification of Breast Tumors (2019), SPC is divided into invasive (ISPC) and in situ (SPC in situ) subtypes. ISPC is characterized by an irregular or jigsaw pattern lacking myoepithelial cells, while SPC in situ is well-circumscribed, regardless of myoepithelial cell presence. Metastasis is infrequently reported, with most patients involving lymph nodes and arising from ISPC. Metastases from SPC in situ without myoepithelial cells have rarely been reported. We present a 66-year-old woman with a 28 × 13 mm hypoechoic breast mass detected on ultrasound. Microscopic examination revealed well-circumscribed nests of SPC, positive for ER, PR, and synaptophysin, with a Ki-67 proliferation index of 10%. HER2 was negative. Myoepithelial markers, including p63, smooth muscle actin, keratin 5/6, p40, and CD10, were all negative, confirming the absence of a myoepithelial layer. Axillary lymph node dissection revealed metastasis in three of eighteen lymph nodes, with the metastatic foci demonstrating the same well-circumscribed SPC architecture as the primary tumor in the breast. Additionally, a lung biopsy exhibited metastatic SPC with identical histomorphology and immunohistochemical profile to the primary tumor. Although rare, SPC presenting a well-circumscribed morphology, and classified as in situ according to the WHO, should be approached with caution when myoepithelial cells are absent, as the in situ histomorphology does not necessarily exclude the potential for metastasis.

Solid papillary carcinoma (SPC) is a histological subtype of breast carcinomas. At least 50% of SPC show neuroendocrine differentiation. Insulinoma-associated protein 1 (INSM1) is a transcription factor now employed as a useful neuroendocrine marker. It is suppressed by the Notch signaling pathway in other neuroendocrine tumors. However, the usefulness of INSM1 as a neuroendocrine marker and the relationships between INSM1 and NOTCH receptors in SPC of the breast currently remain unclear. To clarify the usefulness of INSM1 as a neuroendocrine marker and the relationships between INSM1 and NOTCH receptors in SPC, we performed immunohistochemistry using 19 tissue specimens of SPC of the breast. We complementarily analyzed public RNA sequencing data on breast carcinomas. Immunohistochemical examinations revealed that the staining intensity of INSM1 was significantly higher in the neuroendocrine group than in the non-neuroendocrine group. Positive correlations were observed between INSM1 and synaptophysin (SYP), or chromogranin-A (CHGA). In all cases, NOTCH 2 and 3 were positive, while NOTCH 1 and 4 were negative. According to public RNA data analyses, there were positive correlations between INSM1 and SYP, or CHGA, and negative correlations between INSM1 and NOTCH1-3. INSM1 is useful as a diagnostic marker for SPC with neuroendocrine differentiation in the breast.

Two cases of solid papillary carcinoma of the breast were pathologically studied. Subjects included two female patients: a 76-year-old (Case 1) and a 43-year-old (Case 2). Both cases showed solid and papillary proliferation of spindle cells in expanded ducts, perivascular pseudorosettes, eosinophilic fine granules in an abundant cytoplasm, intracellular mucin production, and positivity for chromogranin A. Case 1 showed an aggregation form involving multiple ducts, admixture of signet-ring like cells, mucin pools, and small and large electron-dense granules and flocculent granules in electron microscopy. Case 2 showed a solitary and compact form in a dilated duct and an interlacing bundle pattern.

Fine needle aspiration cytological criteria for predicting solid papillary intraduct carcinoma of the breast

Papillary carcinoma is a rare malignant tumour of the breast with an incidence of 1-2% in the general population. The clinical behaviour of solid papillary carcinomas is generally indolent unless it is associated with invasion. Here, we are reporting two cases of solid invasive papillary carcinomas of the breast, who were 2 female patients aged 44 years and 55 years., with breast masses which were diagnosed by FNAC and confirmed by histopathology. The exact incidence and the clinical behaviours of such cases need to be ascertained by further research.

Primary neuroendocrine neoplasms (NENs) of the breast are extremely rare and diagnostically challenging tumors. We are reporting a female patient in her 40s with progressively enlarging, painless lumps measuring 30 mm and 15 mm in the upper and lower inner quadrants of the right breast for three months. Mammography reported it as the Breast Imaging Reporting and Data System (BIRADS) IVC lesion. A fine needle aspiration cytology (FNAC) done on the right breast lump and right axillary lymph node was reported as carcinoma with metastasis. Subsequent biopsy and immunohistochemistry (IHC) were reported as carcinoma with neuroendocrine differentiation. A right modified radical mastectomy with axillary lymph nodal dissection confirmed a multifocal primary neuroendocrine tumor (NET) of the breast with nodal metastasis. Accurate diagnosis of a primary NET of the breast requires clinico-radiological exclusion of a metastatic tumor. Other breast carcinomas, such as solid papillary carcinoma and hypercellular mucinous carcinoma, which are known to express NE differentiation, also need exclusion.

Objective: Breast intraductal papillary tumors are clinically common diseases derived from the ducts. The aim of this study is to investigate the clinicopathological characteristics of intraductal papillary tumors and risk factors for carcinogenesis. Methods: The clinicopathological data of 674 patients with breast intraductal papillary tumors, who underwent surgery in the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences from January 2010 to July 2015, were retrospectively analyzed. Results: The median follow-up time was 46 months. The 674 cases were classified into 547 intraductal papilloma, 88 cases of intraductal papillary carcinoma, 32 cases of intracystic papillary carcinoma, and 7 cases of solid papillary carcinoma of breast. After a median follow-up time of 46 months, 13 out of 547 (2.4%) intraductal papillomas had local recurrence in the original dissected quadrat, another 10 cases developed breast cancer in the original dissected quadrat. The 3-year recurrence-free survival rates in intraductal papilloma and intraductal papilloma accompanied with atypical ductal hyperplasia were 97.7% and 93.5%, respectively, the recurrence-free survival curves showed a significant difference (P=0.011). Multivariate analysis indicated that atypical ductal hyperplasia was a major prognostic factor affecting the recurrence-free survival of intraductal papilloma (RR=0.183, 95%CI=0.054 to 0.777, P=0.020). Four cases (3.1%) of intraductal papillary carcinoma had local recurrence. The logistic analysis showed that patient aged >45 years, clinical manifestations of a breast lump, maximum tumor diameter greater than 2 cm are possible clinical manifestation of malignant breast intraductal papillary tumors (RR=1.735, 95%CI=1.007-2.990, P=0.047; RR=2.849, 95%CI=1.207-6.711, P=0.017; RR=3.792, 95%CI=2.162-6.653, P<0.001). Conclusions: Intraductal papillary tumors have a certain recurrence rate. Age, clinical features and tumor size may be predictive factors of intraductal papillary carcinoma.

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid is a rare, low-grade adnexal neoplasm with neuroendocrine differentiation, primarily affecting the periocular skin of elderly individuals [1,2]. This review provides an in-depth analysis of the histopathological features, immunohistochemical profile, clinical presentation, and differential diagnosis of EMPSGC, with a comparative perspective against solid papillary carcinoma (SPC) of the breast. The aim is to equip pathologists with the knowledge necessary for accurate diagnosis and to highlight the importance of recognizing this entity in the context of other eyelid and breast lesions.

Pleomorphic solid and cystic papillary carcinoma of the breast: two cases occurring in young women.

Challenges in papillary tumors of breast.

Carcinoma Breast is a common occurrence in women. Most common pathological type being invasive ductal carcinoma: No Special Type. Carcinoma breast is a systemic disease and its management requires a multimodal treatment including surgery, chemotherapy, radiotherapy, hormonal therapy and immune therapy based on the type and stage of the disease. Here we are presenting a case series of rarer pathological types of carcinoma breast namely. 1: Solid papillary carcinoma with neuroendocrine differentiation, 2: Metaplastic carcinoma of breast, 3: Invasive carcinoma breast mimicking as sclerosing adenosis.

Neuroendocrine Neoplasms of the Breast: Evolving Concepts and Reappraisal of Classification.