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American Journal of Surgical Pathology:
doi: 10.1097/PAS.0b013e31821b3f65
Original Articles

Encapsulated Papillary Carcinoma of the Breast: An Invasive Tumor With Excellent Prognosis

Rakha, Emad A. PhD, FRCPath*; Gandhi, Nirav MBA*; Climent, Fina MD; van Deurzen, Carolien H.M. PhD; Haider, Syeda Asma FRCPath§; Dunk, Louisa FRCPath§; Lee, Andrew H.S. FRCPath*; Macmillan, Douglas FRCS; Ellis, Ian O. FRCPath*

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Abstract

Papillary carcinoma (PC) of the breast, which accounts for 0.5% to 1% of breast cancer, is a distinct histologic subtype that is characterized by malignant epithelial proliferation supported by fibrovascular stalks. However, the classification of PC (whether they are in situ or invasive), its behavior, and management remain a matter of debate.

Methods: In this study, we reviewed 302 PCs including 247 pure PCs without coexisting conventional non-PCs collected from 3 institutions. This included 208 (84%) intracystic PCs (IPC), 30 (12%) solid PCs (SPC), and 9 (4%) papillary ductal carcinoma in situ (DCISs). In addition, previous studies of PC were reviewed. This included 339 pure PCs of a total of 521 PC patients. Clinical and outcome analyses were carried out to assess nature and behavior of these lesions and to determine their optimal outcome-based management.

Results and Conclusions: SPC is more frequently associated with coexisting conventional invasive carcinoma than IPC (P<0.05). Although the majority of papillary DCIS and some cases of IPC and SPC (both called encapsulated PC) that are surrounded by an intact layer of myoepithelial cells are considered to be true in situ lesions, PC lacking a peripheral layer of myoepithelial cells can be regarded as a special type of invasive carcinoma associated with low incidence of stromal/skeletal muscle invasion, low frequency of lymph node metastasis (3%), and infrequent development of local or distant recurrence. These lesions are therefore characterized by indolent behavior and extremely favorable prognosis. Encapsulated PC can be treated with adequate local therapy. Routine use of adjuvant therapy, particularly chemotherapy, is clearly not appropriate in view of the very low risk of subsequent events. However, hormonal therapy may be indicated in certain cases such as recurrent PC.

© 2011 Lippincott Williams & Wilkins, Inc.

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