Papillary lesion

This article was reviewed and updated on December 18, 2018

by Adnan Karavelic, MD FRCPC

Quick facts:

  • Papillary lesion of the breast is a common category of disease that includes several related diagnoses.
  • Papillary is a word pathologists use to describe a small finger like projection of tissue that has epithelial cells on the outside and stroma with blood vessels on the inside.
  • Papillary lesions include both non-cancerous conditions and cancers.

Normal breast tissue

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.

What does papillary mean?

Papillary is a word pathologists use to describe a small finger like projection of tissue that has epithelial cells on the outside and stroma with blood vessels on the inside.

When is the diagnosis of papillary lesion made?

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 papillary changes.

Rather than being a final (definitive) diagnosis, “papillary lesion” is a partial (preliminary) diagnosis that describes several different tumours that can all look very similar in a very small sample of tissue.  A more complete diagnosis will usually be provided after the entire tumour is removed in an excision or resection specimen.

Once the tumour is removed, your pathologist will carefully examine it under the microscope and provide you with a more specific and final diagnosis. Depending on what your pathologist sees under the microscope, the final diagnosis can include both non-cancerous tumours and cancers.

Papillary lesions include:

Intraductal papilloma

This is a very common, benign finding in a breast tissue specimen. 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 (DCIS)

Papillary ductal carcinoma in situ (papillary DCIS) is considered a non-invasive cancer (a non-invasive malignant tumour). Pathologists refer to these types of tumours as carcinoma in situ. Depending on the size, extent, and grade of the papillary DCIS, an additional surgery, radiation and/or hormonal therapy may be required.

Intracystic papillary carcinoma and solid papillary carcinoma

Intracystic papillary carcinoma and solid papillary carcinoma are both cancers 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

Invasive papillary carcinoma is a cancer that grows with a papillary architecture. It has a better prognosis than other, more common types of breast cancer. The treatment includes surgery, hormonal therapy, radiation and chemotherapy.

Your final pathology report

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 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.

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