Qap (Anatomical Pathology) 

QAP Peer Review

AP249
Case History: F/84, Left breast mass 2 cm from nipple
Intended diagnosis: Dx: Solid papillary DCIS, breast. Contributed by:USK
Code Diagnosis Comment Score
anonymous Intraductal papillary carcinoma (100%) Immunostains for muscle specific actin and p63 show abscence of myoepithelial cells in the papillae.  95
anonymous Intraductal papilloma nil  50
anonymous Solid papillary carcinoma Immunostain (p63, actin) to demonstrate an intact layer of myoepithelial cells at the periphery of the tumor.  100
anonymous Endocrine DCIS arising/ involving ductal papilloma Immunostaining for neuroendocrine markers e.g. Chromogranin, synaptophysin  100
anonymous DUCTAL CARCINOMA IN SITU arising from INTRADUCT PAPILLOMA. 100% The DCIS is predominantly cribriform, low grade(Van Nuys). ER stain can highlight the clonal pattern in DCIS.  95
anonymous Solid papillary ductal carcinoma-in-situ.(100%) Do CK5/6 and p63 to confirm diagnosis and exclude small invasive foci.  100
anonymous Breast - Atypical Intraductal papilloma / Papillary Neoplasm 100% Immunostains required: 1.Actin to highlight myoepithelial cells in the papillary lesion 2.CK14 to assess intensity of staining of the ductal cells If both are lacking / reduced, need to suspect DCIS involving intraductal papilloma.  80
anonymous Ductal carcinoma in-situ (suggestive of neuroendocrine subtype) complicating intraductal papilloma. Performing neuroendocrine immunostain (e. g. synaptophysin, chromogranin) to confirm / exclude the neuroendocrine nature of the DCIS.  100
anonymous Ductal carcinoma in-situ 70% Intraductal papilloma 30% Special stain for myoepithelial cells  70
anonymous Intraductal papillary neoplasm, consistent with Papilloma with atypia (Atypical papilloma) IHC for ER, CK5/6 and 34betaE12 to rule out Papilloma with Ductal carcinoma in situ.  80
anonymous Ductal carcinoma in situ, low grade (Van Nuys) nil  95
anonymous Ductal carcinoma in situ, low grade Need to rule out endocrine ductal carcinoma in situ  95
anonymous endocrine DCIS To confirm with immunostaining for neuroendocrine markers and to differentiate from florid epitheliosis in papilloma by pattern of ER and CK5/6 staining  100
anonymous Breast: Papillary intraductal carcinoma, suggestive of neuroendocrine differentiation, perform neuroendocrine markers, like synaptophysin and chromogranin, also p63 to rule out invasion (100% probability) nil  100
anonymous Intraductal carcinoma with intraductal papillomas 100% nil  95
anonymous Intraductal papillary carcinoma to look for neuroendocrine differentiation with neuroendocrine markers (synaptophysin and chromogranin)  95