A Clinical Pathology Study Of Papillary Neoplasms Of The Breast

Objective ((World Health Organization classification of tumors. Pathology and genetics, tumors of breast and female genital)) update the definition and category of intraductal papillary neoplasms(IPNs) in 2003. How to apply the definition and category need more research.The expression and diagnostic significance of basal type cytokeratin (CK), myoepithelial cell markers, such as calponin et al, which are using in diagnosis of intraductal proliferative lesions,are lack of system investigation. The purpose of this series is to promote our knowing and confirm diagnosable histological changes,immunohistochemical markers.Materials and methods Base on the new definition and category of papillary neoplasms combine with the criterion suggested by Tavassoli,78 cases of IPNs and 10 cases of invasive papillary carcinoma(IPC) were identify by retrospective review of surgical pathology files of 1998-2007 by two pathologists .Clinical information and pathological changes of all cases were collected and summarized. Immunohistochemical analysis was performed with74 cases of IPNs and 10 cases of IPC for CK14, CK5/6, CK34βE12, SMAα,calponin, p63, CD44s, ER,, PR and Ki67。14 cases of central type of papillary neoplasms and 9 cases of peripheral type of papillary neoplasms conducted elastic fibers stain.Follow-up were performed within 55 cases. Results1. This study includes 22 cases of central papilloma, 5 cases of peripheral papilloma, 6 cases of mixed papilloma (central unite peripheral papilloma). 32 cases of atypical papilloma, 13 cases of intraductal papillary carcinoma and 10 cases of invasive papillary carcinoma. All patients were women with the average being 43.9 years. The first complains of the patients were presented nipple discharge or noting a breast lump.2. Among 49 patients with follow-up information, follow-up times are from 8 to 88 monthes after surgery,with the average of 34.7 monthes. None of the IPNs and IPC arise recrudescence or metastasis in homonymy; In the period of the follow-up ,4 cases of intraductal papilloma and 2 cases of atypical papilloma noted a breast lump or presented nipple discharge in opposite side.3. Usually,the central type of papillary neoplasms are bigger than the peripheral type.Hyaline degeneration can de observeed in the wall of duct and/or fibrovascular stalks.Pseudo-infiltrative is often appear in intraductal papilloma. The peripheral type of papillary neoplasms are smaller, circumfused with lodular stromal and pushed lumina. Elastic fibers stain confirm that elastic fibers exist in all central type of papillary neoplasms but absent in all peripheral type of papillary neoplasms.4.There are two kinds of histological structure of intraductal papillary neoplasms: type I is similar to intraductal proliferative lesions(from usual ductal hyperplasia to ductal carcinoma in situ); type II present as arborescent structure covered by multilayer columnar cells, they may concomitant in same case. The invasive portion of invasive papilloma carcinoma preserve the papillary structure or present as invasive ductal carcinoma (not otherwise specified) .5.The expression of CK14, CK5/6 and CD44s among intraductal papilloma, atypical papilloma, intraductal papillary carcinoma and IPC have statistical difference.CK14 is most specific when differenttiate the intraductal papilloma and atypical papilloma. The sensitivity of CK5/6,the specificity and accuracy of CK14 are best in differentiate the intraductal papilloma and intraductal papillary carcinoma. Only CK5/6 has a significance in different tiate the atypical papilloma and intraductal papillary carcinoma. The value of CD44s in differential diagnosis resemble CK14.6. Calponin is most sensitivity and p63 is most specificity in mark the myoe-pithelial cell.ER and PR have a high expression in intra ductal papillary carcinoma and invasive papillary carcinoma. The positive percent of Ki67 in invasive papillary carcinoma is higher than intraductal papilloma carcinoma.Conclusion1. The new category of IPNs has instructional significance and it is doable in clinical pathologic diagnosis, but the criterion need to be more particular. Classify intraductal papillary neopl asms as type I and type II by pattern of hyperplasia can help to estimate the nature IPNs.2. Size of the lesion, hyaline change ,pseudo-invasion, whether the lodular stromal and pushed lumina are existed, elastic fibers stain can help to differentiate central type of papillary neopl asms and peripheral type of papillary neoplasms.3. Basal type cytokeratin(CK14, CK5/6) and adhesion molecule CD44s are helpful in differentiate intraductal papilloma, atypical papilloma and intraductal papillary carcinoma Unite calponin and p63 to mark myoepithelial cell can improve the sensitivity and specificity of diagnosis. 4. The area of proliferative lesions may affect the prognosis of IPNs.