Tubulopapillary Carcinoma of Breast: A Distinct Entity?
Fumiko Konno, Joan Cangiarella, Luis Chiriboga, Stephanie Krauter, Farbod Darvishian. NYU Langone Medical Center, New York, NY
Background: Papillary breast carcinomas comprise 1-2% of all breast cancers. Traditionally, this subtype is categorized as an indolent cancer that carries a more favorable prognosis than the conventional invasive carcinoma. We encountered a group of invasive breast carcinomas with papillary and tubular features in primary and metastatic settings, which were noted to behave aggressively or demonstrate parameters known to be associated with aggressiveness. Our objective was to determine whether tubulopapillary carcinoma merits separate classification.
Design: Our pathology database was queried for primary invasive breast carcinoma with papillary features. The slides were reviewed for tubulopapillary features. The cases with features of ordinary papillary carcinoma were used as control. Biomarker status, ki-67 proliferation index, p53 status, lymphovascular invasion (LVI), mitotic count per 10 high power fields (HPF) and lymph node status were used as parameters associated with aggressive behavior. Only diffuse p53 labeling of more than 70% was considered positive. The biomarker status was classified as hormone receptor positive (HR+), her2 overexpressing (her2+) and triple negative (TN).
Results: We identified 11 breast carcinomas with tubulopapillary features as study group and 14 control cases. In general, the tubulopapillary carcinomas exhibited infiltrating gaping glands with intratubular and broad extratubular papillary growth with an invasive border.
|Study Group||Control Group|
|Mean age (y)||59||68|
|Invasive Border||11 (100%)||3 (21%)|
|Nuclear Grade||G3=6 (55%) G2=5 (45%)||G3=2 (14%) G2=9 (64%) G1=3 (21%)|
|Mean mitotic count /10 HPF||12||2|
|Lymphovascular invasion||5 (45%)||1 (7%)|
|Biomarker category||4 TN (36%), 4 her2+(36%), 3 HR+(27%)||14 HR+(100%)|
|Mean ki-67 (%)||25||8|
|Mean size (cm)||1.8||1.6|
|Positive nodes||4 (36%)||0|