Papillary Neoplasm of the Breast-Dr.dr. Berti J Nelwan, M.Kes, Sp.PA(K), Sp.F.pptx

1. PAPILLARY NEOPLASM
OF THE BREAST
Pembimbing :
Dr.dr. Berti Julian Nelwan, M.Kes., Sp.PA(K)
Nama Mahasiswa : dr. Rahman Firmansyah
NIM : C075212001
Program Studi Ilmu Patologi Anatomik
Departemen Ilmu Patologi Anatomik
Program Pendidikan Dokter Spesialis -1
Fakultas Kedokteran Universitas Hasanuddin
2023

2. VISI MISI PROGRAM STUDI PATOLOGI ANATOMI
PROGRAM PENDIDIKAN DOKTER SPESIALIS-1
FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
Visi
Menjadi program studi yang unggul bertaraf internasional dalam bidang akademik, riset, publikasi, pengabdian masyarakat dan
menghasilkan Dokter Spesialis Patologi Anatomi yang profesional, berdaya saing tinggi dan menghayati nilai-nilai etika, agama dan
kemanusiaan.
Misi
Mengembangkan sistem Pendidikan belajar sepanjang hayat (long life learning) yang unggul dan berbasis kompetensi dalam domain
kognitif, afektif dan psikomotor (MISI PENDIDIKAN)
Menyelenggarakan penelitian dan menerbitkan publikasi yang bertaraf nasional maupun internasional (MISI RISET)
Menyelenggarakan pengabdian masyarakat yang relevan dengan kebutuhan masyarakat (MISI PENGABDIAN MASYARAKAT)
Mengadakan dan mengembangkan sumber daya manusia pendidik dan kependidikan dalam hal jumlah dan mutu sesuai kebutuhan
program studi (MISI KETENAGAAN)
Menyelenggarakan kegiatan-kegiatan yang bersifat kesejawatan dan pengembangan profesionalisme berkelanjutan (Continuing
Professional Development) (MISI ALUMNI)

3. 5th eds, 2019 vol.2
WHO classification of epithelial tumours of the breast
Papillary neoplasms
8503/0 Intraductal papilloma
8503/2 Ductal carcinoma in situ, papillary
8504/2 Encapsulated papillary carcinoma
8504/3 Encapsulated papillary carcinoma with invasion
8509/2 Solid papillary carcinoma in situ
8509/3 Solid papillary carcinoma with invasion
8503/3 Intraductal papillary adenocarcinoma with invasion

4. INTRODUCTION OF THE BREAST
Histology of The Breast
Component of the Breast :
• Skin
• Subcutaneous adiposa tissue
• Functional glandular tissue

5. INTRODUCTION OF THE BREAST
Histology of The Breast
Component of the Breast :
• Two major structures : Two types of epithelial cells : Two types of stroma:
Duct Lobules Luminal Myoepithelial Interlobular Intralobular

6. INTRODUCTION OF THE BREAST
Histology of The Breast
Component of the Breast :
• Structuture of Ducts
Collecting duct
(lactiferous sinus)
Segmental Ducts
Sub-Segmental Ducts
Terminal duct-lobular unit
(TDLU)

7. INTRODUCTION OF THE BREAST
Histology of The Breast
Component of the Breast :
• Divided into 15-25
lobes which is
made up 20-40
lobules/acinus/alveoli
• Epithelial cells :
• Luminal / Secretory Cell
• Myoepithelial

8. INTRODUCTION OF THE BREAST
Histology of The Breast

9. INTRODUCTION OF THE BREAST
Histology of The Breast

10. INTRODUCTION OF THE BREAST
Histology of The Breast

11. PAPILLARY NEOPLASMS OF THE BREAST
Introduction
Myoepithelial cells may sometimes be difficult to identify in H&E staining, but can be
visualized by immunohistochemistry staining on myoepithelial antigens : Calponin, SMA,
SMMHC, and p63.
Reactive myofibroblasts adjacent to papillary carcinoma nodules often express myoepithelial
antigens such as : calponin and SMA.
Myoepithelial marker panels (e.g. calponin and p63) can be used to evaluate myoepithelium
in papillary lesions.
Perisites associated with capillaries inside the fibrovascular nucleus and on the periphery of
papillary lesions can express actin, calponin, and SMMHC, should not be mistaken for
myoepithelial cells.

12. PAPILLARY NEOPLASMS OF THE BREAST
Introduction
Scattered neoplastic epithelial cells, especially in papillary neoplasms, can express p63
should not be mistaken for myoepithelial cells.
Antibodies to myoepithelial/basal antigens (p63, CK5, CK14) and luminal cytokeratin (CK8
and CK18) to assess the presence and distribution of myopithelial cells in papillary lesions, as
well as epithelial proliferation properties

13. INTRADUCTAL PAPILLOMA
Intraductal papilloma
ICD-O coding
8503/0 Intraductal papilloma
Definition : Intraductal papilloma is a benign breast lesion arising within a
duct in a central (solitary) or peripheral (multiple) location, composed of
papillary projections with fibrovascular cores, covered by an epithelial and
myoepithelial layer.
Etiology & Pathogenesis: Activating point mutations in the PIK3CA/AKT1
pathway
- Hilangnya heterozigositas pada 16p13 ditemukan pada lesi papiler jinak
serta karsinoma papiler
- Heterozigositas pada 16q23 dengan penanda D16S476 hanya ditemukan
pada lesi papiler ganas
Localization : large ducts near the nipple or
peripherally in smaller ducts, in any quadrant.

14. INTRADUCTAL PAPILLOMA
Intraductal papilloma
Staging :
Histopathology :
1. Papiloma intraduktal NOS
2. Intraductal papilloma with ADH (atypical ductal hyperplasia) and (ductal
carcinoma in situ) DCIS
3. Papillary DCIS
4. Intraductal papilloma with atypical lobular hyperplasia and lobular
carcinoma in situ
Cytologi :

15. INTRADUCTAL PAPILLOMA
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16. PAPILLARY DUCTAL CARCINOMA IN SITU
Papillary ductal carcinoma in situ
ICD-O coding
8503/2 Ductal carcinoma in situ, papillary
Definition : Papillary ductal carcinoma in situ (DCIS) is a morphological
subtype of DCIS composed of filiform arborizing fibrovascular cores lined by
neoplastic ductal epithelium, devoid of myoepithelium and contained within
central or peripheral ducts with retained myoepithelium at the periphery.
Etiology & Pathogenesis:
Localization : Papillary DCIS is usually associated with DCIS having other
architectural patterns, and it may involve central or peripheral ducts.
Papillary DCIS in central/subareolar ducts may be associated with
encapsulated papillary carcinoma.

17. PAPILLARY DUCTAL CARCINOMA IN SITU
Papillary ductal carcinoma in situ
Staging :
Histopathology :
Cytologi :

18. PAPILLARY DUCTAL CARCINOMA IN SITU
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19. ENCAPSULATED PAPILLARY CARCINOMA
Encapsulated Papillary Carcinoma
ICD-O coding
8504/2 Encapsulated papillary carcinoma
8504/3 Encapsulated papillary carcinoma with invasion
Definition : Encapsulated papillary carcinoma is a carcinoma characterized
by fine fibrovascular stalks covered by neoplastic epithelial cells of low or
intermediate nuclear grade, typically present within a cystic space and
surrounded by a fibrous capsule. There are usually no myoepithelial cells
along the papillae or at the periphery of the lesion.
Etiology & Pathogenesis:
Localization : Most tumours are central and subareolar.

20. ENCAPSULATED PAPILLARY CARCINOMA
Encapsulated Papillary Carcinoma
Staging :
Histopathology :
Cytologi :

21. ENCAPSULATED PAPILLARY CARCINOMA
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22. SOLID PAPILLARY CARCINOMA (IN SITU AND INVASIVE)
Solid Papillary Carcinoma (in situ and invasive)
ICD-O coding
8509/2 Solid papillary carcinoma in situ
8509/3 Solid papillary carcinoma with invasion
Definition : Solid papillary carcinomas (in situ and invasive) are tumours
characterized by a solid growth pattern with delicate fibrovascular cores.
They frequently show neuroendocrine differentiation and are biologically
indolent.
Etiology & Pathogenesis:
Localization : Any part of the breast may be affected, but the
central/subareolar area is affected most commonly.

23. SOLID PAPILLARY CARCINOMA (IN SITU AND INVASIVE)
Solid Papillary Carcinoma (in situ and invasive)
Staging :
Histopathology :
Cytologi :

24. SOLID PAPILLARY CARCINOMA (IN SITU AND
INVASIVE)
Expansile nodules with a solid growth pattern
have inconspicuous, delicate fibrovascular cores,
with no convincing evidence of invasion.
High-power view of solid nodules with
inconspicuous delicate fibrovascular stalks
and a monotonous population of round
epithelial cells with low-grade nuclear atypia.

25. SOLID PAPILLARY CARCINOMA (IN SITU AND
INVASIVE)
Intracellular mucin
(goblet cells) may be
prominent in the
neoplastic population.
Irregular neoplastic glands and trabeculae
infiltrate the breast parenchyma adjacent to
solid papillary carcinoma.
Intracellular mucin (goblet cells) may be
prominent in the neoplastic population.

26. INVASIVE PAPILLARY CARCINOMA
Invasive Papillary Carcinoma
ICD-O coding
8503/3 Intraductal papillary adenocarcinoma with invasion
Definition : Invasive papillary carcinoma is an invasive carcinoma with
fibrovascular cores covered by neoplastic epithelium.
Etiology & Pathogenesis:
Localization : Any part of the breast may be affected, but the
central/subareolar area is affected most commonly.

27. INVASIVE PAPILLARY CARCINOMA
Invasive Papillary Carcinoma
Staging :
Histopathology :
Cytologi :

28. INVASIVE PAPILLARY CARCINOMA
Low-power view of carcinoma with invasion of
breast parenchyma.
Mildly dilated invasive ducts and glands
containing papillary cores and necrotic
material

29. 8503/0 Intraductal papilloma
8503/2 Ductal carcinoma in situ, papillary
Papillary neoplasms
8504/2 Encapsulated papillary carcinoma
8504/3 Encapsulated papillary carcinoma with invasion
8503/3 Intraductal papillary adenocarcinoma with invasion
8509/2 Solid papillary carcinoma in situ
8509/3 Solid papillary carcinoma with invasion
WHO classification of epithelial tumours of the breast

30. Papillary neoplasms
Myoepithelial Cells
Normal Duct
8504/2 Encapsulated papillary carcinoma 8504/3 Encapsulated papillary carcinoma with invasion

31. 8503/0 Intraductal papilloma
Papillary neoplasms
Myoepithelial Cells
Normal Duct

32. HISTOPATHOLOGICAL CHARACTERISTICS OF
BREAST PAPILLARY NEOPLASMS
Histopathological characteristics of breast papillary neoplasms

33. HISTOPATHOLOGICAL
COMPARISON OF
BREAST PAPILLARY
LESSIONS
Histopathological comparison of breast papillary lessions

34. IMMUNOHISTOCHEMICAL CHARACTERISTICS
OF BREAST PAPILLARY NEOPLASMS
Immunohistochemical characteristics of the breast papillary neoplasm

35. MYOEPITHELIAL ANTIGENS
OF BREAST PAPILLARY NEOPLASMS
Myoepithelial antigens

36. TERIMA KASIH