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5 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Papillary carcinomas are rare breast cancers, about one in a hundred, that grow as finger-like fronds on stalks, often inside a cyst, mostly in older women. The encapsulated and solid forms behave almost like non-invasive disease and have an excellent outlook; the truly invasive papillary form is treated like ordinary hormone-driven breast cancer.
The 2019 WHO classification groups four entities under papillary neoplasms: encapsulated papillary carcinoma (a papillary carcinoma within a cystic space surrounded by a fibrous capsule, with no myoepithelial layer), solid papillary carcinoma (in situ and invasive forms, often with neuroendocrine differentiation), invasive papillary carcinoma, and the new tall cell carcinoma with reversed polarity (Tan 2020). Papillary carcinoma makes up 0.5 to 1 percent of breast cancer; in 302 cases, solid papillary carcinoma was more often accompanied by conventional invasive carcinoma than the intracystic form, and lesions lacking a myoepithelial layer are regarded as a special low-grade form of invasion whose behaviour is nonetheless indolent (Rakha 2011). Tall cell carcinoma with reversed polarity (solid papillary carcinoma with reverse polarity) has cuboid or tall cells with eosinophilic cytoplasm at the basal pole, grooved nuclei, Ki-67 under 5 percent in seven of nine cases, CK5/6 and calretinin expression, and a favourable prognosis (Modern Pathology 2018).
How it differs from its parent: papillary carcinomas are cancers of older women, hormone-receptor positive and HER2-negative in the encapsulated and solid forms, with an outlook close to that of ductal carcinoma in situ; the pathology question (in situ or invasive) decides the treatment more than the stage.
| Setting | Approach | Guideline |
|---|---|---|
| Encapsulated or solid, no conventional invasion | Managed as ductal carcinoma in situ: excision, with radiotherapy and endocrine therapy considered. | not mapped |
| With conventional invasive carcinoma | Treated as HR-positive breast cancer. | not mapped |