What are the other Names for this Condition? (Also known as/Synonyms)

• Neuroendocrine Breast Carcinoma In Situ
• Solid Papillary Carcinoma In Situ of Breast
• Solid Papillary Carcinoma with Invasion of Breast

What is Solid Papillary Carcinoma (In Situ and Invasive) of Breast? (Definition/Background Information)

• Solid Papillary Carcinomas of Breast are special types of malignant breast tumors that are diagnosed under the microscope by a pathologist on examination of the tumor cells. Many of the tumors show neuroendocrine differentiation. These malignancies are of two main types:
  • Solid Papillary Carcinoma In Situ of Breast
  • Solid Papillary Carcinoma with Invasion of Breast
• The cause of formation of Solid Papillary Carcinoma (SPC) of Breast is not well-understood. A few chromosomal and genetic alterations have been reported. These carcinomas are mostly observed in middle-aged and older women post-menopause
• The slow-growing tumor may be present as a palpable mass along-with bloody nipple discharge. It may be detected on a mammography. Complications of Solid Papillary Carcinoma (In Situ and Invasive) of Breast are typically rare but may include progression and spread of the tumor to local/regional sites
• The treatment of both Solid Papillary Carcinoma In Situ of Breast and Solid Papillary Carcinoma with Invasion of Breast may involve a surgical removal of the tumor. This may be followed by other treatment modalities, such as radiation and hormone therapy, based on the healthcare provider’s evaluation
• The prognoses of both the in situ and invasive forms of Solid Papillary Carcinoma of Breast are usually excellent with adequate surgical treatment and regular follow-up. However, in case of recurrences or metastases of the malignancy, the prognosis depends mainly on the stage of the tumor

Who gets Solid Papillary Carcinoma (In Situ and Invasive) of Breast? (Age and Sex Distribution)

• Solid Papillary Carcinomas (In Situ and Invasive) of Breast are uncommon forms of breast cancer that are observed in women following menopause in the 60-70 years’ age group or later (median age 73 years)
• All racial and ethnic groups are affected, and no specific predilection is seen

What are the Risk Factors for Solid Papillary Carcinoma (In Situ and Invasive) of Breast? (Predisposing Factors)

The risk factors for both Solid Papillary Carcinoma In Situ of Breast and Solid Papillary Carcinoma with Invasion of Breast are not well established. In general, the risk factors for developing breast cancer may include:

• Women have a much greater chance of developing breast cancer than men
• Advancing age: The risk increases for women over the age of 55 years
• Family history: Women with a mother, sister, or daughter diagnosed with breast cancer have a higher risk for developing the condition
• Inherited gene mutations: Mutations in certain genes (BRCA1 or BRCA2) can lead to a much higher risk
• Radiation therapy: Receiving radiation therapy to the chest or breast area can also increase the risk. It is noted that the risk for developing breast cancer later in life is the greatest for radiation therapy administered during puberty
• Obesity: Being overweight or obese elevates the risk after menopause
• Alcohol use: Consuming alcohol more than one drink per day; the more the alcohol consumed, the greater is the risk
• Menstrual cycle: Women who got their period before the age of 12 years, and those who reached menopause after age 55 have an increased risk
• Postmenopausal hormone therapy: Women taking hormone replacement therapy medications containing both estrogen and progesterone for menopause have a higher risk of developing breast cancer
• Reproductive history: Having the first child after the age of 35, or never having children
• Physical inactivity: A lack of physical exercise (leading a sedentary life) can increase the risk
• Breastfeeding: Not breastfeeding one's child can increase the risk for developing the condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Solid Papillary Carcinoma (In Situ and Invasive) of Breast? (Etiology)

The exact cause of development of Solid Papillary Carcinoma (In Situ and Invasive) of Breast is currently not well understood.

• Some tumors show specific genetic alterations namely, chromosomal material loss on 16q and gains on 16p and 1q
• PIKC3A gene mutations are found in 43% of the cases

What are the Signs and Symptoms of Solid Papillary Carcinoma (In Situ and Invasive) of Breast?

The signs and symptoms of Solid Papillary Carcinoma (In Situ and Invasive) of Breast may include:

• Presence of a palpable mass, usually on breast exam
• The tumors are generally slow-growing in nature
• Blood nipple discharge may be present
• The tumor can affect any location in the breast, but is more common in the central and sub-areolar portions
• It can be unilateral (involving one breast) or bilateral (involving both breasts)

How is Solid Papillary Carcinoma (In Situ and Invasive) of Breast Diagnosed?

Solid Papillary Carcinoma (In Situ and Invasive) of Breast may be diagnosed in the following manner:

• Complete physical examination with comprehensive medical and family history evaluation
• Breast exam to check for any lumps or unusual signs in the breasts
• Blood tests including complete blood count (CBC) test
• Mammogram: A mammogram uses X-rays to provide images of the breast. The tumor can cause radiological abnormalities on a mammogram
• Galactography: A mammography using a contrast solution, mostly used to analyze the reason behind a nipple discharge
• Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast
• Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast
• Breast biopsy:
  • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

• Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue. FNA may be a helpful tool in diagnosing the tumor
• Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
• Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

Some Mammary Solid Papillary Carcinomas show a mucinous component when the tumor samples are examined under the microscope by a pathologist.

The differential diagnosis of Solid Papillary Carcinoma of Breast to exclude conditions with similar presentations include papilloma with florid usual ductal hyperplasia.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Solid Papillary Carcinoma (In Situ and Invasive) of Breast?

The complications of Solid Papillary Carcinoma (In Situ and Invasive) of Breast may include:

• Emotional distress due to the presence of breast cancer
• Progression of the tumor and metastasis to local (axillary lymph nodes in 6% of the cases) and regional sites in very rare occasions
• Recurrences following surgery; incompletely excised tumors may recur
• Treatment side effects

How is Solid Papillary Carcinoma (In Situ and Invasive) of Breast Treated?

The treatment of is similar to ductal carcinoma in situ (DCIS). Surgery is the most common form of treatment recommended and it involves a complete excision of the tumor. The surgery may be of the following types:

Treatment options available for individuals with Solid Papillary Carcinoma In Situ of Breast and Solid Papillary Carcinoma with Invasion of Breast are dependent upon the following:

• Type of cancer
• The staging of the cancer: If a breast cancer is diagnosed, staging helps determine whether it has spread, and what treatment options are best-suited for the patient
• Whether the cancer cells are sensitive to certain particular hormones, and
• One’s personal preferences

Surgery: Surgery is generally the most common form of treatment for breast cancer. Various types of surgery to remove the malignant tumor include:

• Lumpectomy: Breast-sparing surgery (least invasive breast cancer surgery) in which the tumor, as well as a small portion of the surrounding tissue is removed
• Mastectomy: Surgery to remove all of the breast tissue; it may be simple (removal of the breast, nipple, areola, sentinel lymph nodes) or radical mastectomy (removal of the breast, nipple, areola, all axillary lymph nodes, and underlying muscle of the chest wall)
• Sentinel node biopsy: Procedure done to examine the “sentinel lymph node,” or lymph node(s) closest to the tumor, as this is the most likely location, where cancer cells may have spread to. This lymph node is removed and tested for cancerous cells
• Axillary node dissection: This procedure is performed to remove some axillary lymph nodes in the underarm area, to allow dissection and examination. This helps in establishing whether the cancer has spread to more than one lymph node

Other treatment options may include radiation therapy and hormone therapy.

• Radiotherapy can be used as primary therapy in situations where the tumor cannot be removed completely, or when the tumor reappears after surgery
• Radiotherapy can also be used as additional therapy after surgery, if there is a possibility of tumor recurrence after surgery, or if there are inadequate margins (possibility of tumor left behind) following surgery. In some cases, due to location of tumor, a complete surgical removal of the tumor is difficult
• Hormone therapy to prevent subsequent development of breast cancer; especially for hormone receptor-positive tumors

How can Solid Papillary Carcinoma (In Situ and Invasive) of Breast be Prevented?

Currently, no specific preventive measures are available for both Solid Papillary Carcinoma In Situ of Breast and Solid Papillary Carcinoma with Invasion of Breast. In general, it is important to be aware of the following:

• Learning to do regular ‘breast self-exams’ in order to help identify any unusual lumps or signs in the breast
• Maintain a healthy body weight and exercise regularly
• Implement and follow a well-balanced diet; a high intake of fiber via fresh fruits and vegetables helps in a healthy lifestyle
• Avoid or completely stop smoking
• If taking alcohol, only drink in moderation; limit to one or (maximum) two drinks a day
• Limit combination hormone therapy used to treat symptoms of menopause. It is advised that individuals be aware of the potential benefits and risks of such hormonal medications
• Cancer screenings can help detect any breast cancer during the early stages

What is the Prognosis of Solid Papillary Carcinoma (In Situ and Invasive) of Breast? (Outcomes/Resolutions)

• The prognoses of Solid Papillary Carcinomas of Breast (both in situ and invasive types) is generally excellent with early treatment (surgical excision of the tumor) in a vast majority of cases; these are generally considered to be tumors of low-grade. However, it is important to remain vigilant and hold periodic follow-up screenings
• Some tumors (approximately 7% of the cases) may infrequently metastasize to local and distant sites. In such cases, the prognosis mainly depends on the stage of the tumor

Additional and Relevant Useful Information for Solid Papillary Carcinoma (In Situ and Invasive) of Breast:

The following DoveMed website links are useful resources for additional information:

https://www.dovemed.com/healthy-living/womens-health/

https://www.dovemed.com/diseases-conditions/cancer/