This article will help you read and understand your pathology report for papillary lesion of the breast.
by Adnan Karavelic, MD FRCPC, updated on April 30, 2020
Adult female breast tissue is composed of small structures called glands which are organized into groups called lobules. Under certain conditions, these glands can produce milk, which is transported to the nipple by a series of small channels called ducts.
The inside of both glands and ducts is lined by two types of cells called epithelial cells and myoepithelial cells. The tissue surrounding glands and ducts is called stroma and contains long, thin cells called fibroblasts.
Pathologists typically only make a diagnosis of papillary lesion after examining a small sample of tissue called a biopsy. The diagnosis is made if some of the tissue examined under the microscope shows a papillary pattern of growth.
Papillary lesion is a preliminary diagnosis because several different non-cancerous and cancerous tumours can show a papillary pattern of growth when examined under the microscope (see Types of papillary lesions in the breast below). Pathologists make this diagnosis when they do not have enough tissue to tell which type of papillary tumour they are looking at. A final diagnosis will usually be provided after the entire tumour is removed in a procedure called an excision or resection.
There are several different types of breast tumours that can show a papillary pattern of growth when examined under the microscope. These tumours include both non-cancerous growths and cancers. The following list describes some of the most common types of tumours that may be first diagnosed as a papillary lesion.
This is a very common type of non-cancerous tumour in the breast. Intraductal papillomas may be single or multiple, and may cause a discharge from the nipple, especially if they are large and located inside the tissue below the nipple (subareolar area).
Papillary ductal carcinoma in situ (papillary DCIS) is considered a non-invasive type of breast cancer. Depending on the size, extent, and grade of the papillary DCIS, additional surgery, radiation and/or hormonal therapy may be required.
Intracystic papillary carcinoma and solid papillary carcinoma are both types of breast cancer but they tend to be relatively well defined and localized. A small surgical procedure may be enough to remove the entire tumour in some cases.
If your pathologist see small groups of cancer cells moving away from the tumour into the surrounding tissue (invasion) or cancer cells inside blood vessels and/or lymphatic channels (lymphovascular invasion), a more extensive surgery followed by hormonal therapy and/or radiotherapy and/or chemotherapy may be required.
Invasive papillary carcinoma is a type of breast cancer that shows an extensive papillary pattern of growth. It has a better prognosis than other, more common types of breast cancer. Treatment for invasive papillary carcinoma includes surgery, hormonal therapy, radiation and chemotherapy.
Your pathology report provided for you by your pathologist after the entire tumour has been removed and a final diagnosis has been reached will include additional information such as the type of tumour, the size of the tumour, and whether the tumour cells have spread to other parts of the body.
If your final diagnosis describes a type of breast cancer, your report will also include important additional information that will help you and your medical team decide which treatment options are best for you.