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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*

The American Journal of Surgical Pathology: August 2011 - Volume 35 - Issue 8 - p 1093–1103
doi: 10.1097/PAS.0b013e31821b3f65
Original Articles

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.

Departments of *Histopathology

Surgery, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham

§Department of Histopathology, Leicester University Hospitals NHS Trust, Leicester, UK

Pathology Department, Hospital de Bellvitge, Barcelona, Spain

Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands

This study was approved by Nottingham Research Ethics Committee 2 under the title of “Development of a molecular genetic classification of breast cancer.”

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Emad A. Rakha, PhD, FRCPath, Department of Histopathology, Nottingham University Hospital NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK (e-mail: emadrakha@yahoo.com; e-mail: Emad.rakha@nuh.nhs.uk).

© 2011 Lippincott Williams & Wilkins, Inc.