Papillary lesion of the breast

by Adnan Karavelic MD FRCPC
November 15, 2022

What is a papillary lesion in the breast?

Papillary lesion of the breast is a term pathologists use to describe a group of breast tumours that look similar when examined under the microscope. This term includes both non-cancerous tumours and cancers. Papillary lesion is a preliminary diagnosis. Typically, the entire tumour needs to be removed and examined before a final diagnosis can be made.

When do pathologists make the diagnosis of a papillary lesion in the breast?

Pathologists typically only use the term 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.

Why is a papillary lesion considered a preliminary diagnosis?

Papillary lesion is considered a preliminary diagnosis because several different non-cancerous and cancerous tumours can show a papillary pattern of growth when examined under the microscope. 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.

What are the types of papillary lesions in the breast?

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.

Intraductal papilloma

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 (DCIS)

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

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 sees small groups of cancer cells moving away from the tumour into the surrounding tissue or cancer cells inside blood vessels and/or lymphatic channels, 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 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.

What additional information should I look for in my pathology report after the entire tumour is removed?

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.