Skip to content
DraconiticResearch
Search Sources API
220,618 studies31 sourcesUpdated 5 min ago
Peer-reviewedCC BY 4.0Histopathology

Long‐term outcome of high‐grade encapsulated papillary carcinoma of the breast: implications for staging and management

  • Milena Stevanovic1
  • Emad Rakha2
  • Ian O. Ellis3
  • Umberto Maccio1
  • Bärbel Papassotiropoulos4
  • Hisham Fansa5
  • Lidija Stevanovic6
  • Heike Frauchiger‐Heuer6
  • Isabell Witzel6,7,8
  • Zsuzsanna Varga1,7
8 affiliations
  1. 1Department of Pathology and Molecular Pathology University Hospital Zurich Zurich Switzerland
  2. 2School of Medicine University Nottingham Nottingham UK
  3. 3Department of Histopathology Nottingham University Hospitals NHS Trust Nottingham UK
  4. 4Breast Center Seefeld Zurich Switzerland
  5. 5Breast Center, Hospital Zollikerberg Zollikerberg Switzerland
  6. 6Breast Center, Department of Gynecology University Hospital Zurich Zurich Switzerland
  7. 7Comprehensive Cancer Center University Hospital Zurich Zurich Switzerland
  8. 8University of Zurich Zurich Switzerland
Read full textDOICite

Abstract

Background: Encapsulated papillary carcinoma (EPC) of the breast is an uncommon tumour with controversial biological behaviour and staging. Emerging evidence suggests that EPC with adverse pathological features (EPC‐A) may exhibit invasive potential. The absence of uniform staging criteria contributes to management variability. This study evaluates the clinicopathological characteristics and clinical course of high‐grade EPC (HG‐EPC), including EPC‐A.

Materials and methods: This retrospective multicentre study (2000–2025) included 25 HG‐EPC cases, irrespectively of ER/PR and HER2 status. Tumours with frank stromal invasion beyond microinvasive foci were excluded. Histopathological re‐evaluation was performed in accordance with 2019 WHO classification criteria.

Results: Of 38 cases reviewed, 25 fulfilled the inclusion criteria as EPC (mean age 57.2 years, mean tumour size 2.9 cm). Six cases (24%) demonstrated conventional‐type microinvasive components. A subset of 16 cases fulfilled criteria for EPC‐A, defined by high‐grade morphology in combination with ER/PR‐negative (or ER <30% positive) and/or HER2‐positive status. Staging and management were variable. Initial pathological stage varied: pTis (n = 13) to pT1 (n = 4) or pT2 (n = 7), and pT3 (n = 1). Adjuvant chemotherapy and radiotherapy were administered in 7 and 12 patients respectively. During follow‐up, four local recurrences (three invasive and one in situ) were observed. One of the locally recurrent patients subsequently developed distant metastasis, and one breast cancer‐related death occurred 200 months after diagnosis. Recurrence or death occurred in 20% (5/25) of patients despite therapy. Microinvasion was seen only in the EPC‐A tumours.

Conclusion: HG‐EPC and EPC‐A overlap morphologically and diagnostically with frankly invasive carcinomas and demonstrate a non‐negligible risk of recurrence. Clinical outcomes and more frequent microinvasion in EPC‐A support the view that EPC‐A is more appropriately regarded as an indolent form of invasive carcinoma rather than a purely in situ lesion and demonstrate a non‐negligible risk of recurrence and highlight the need for standardized staging criteria.

Related

  1. Encapsulated papillary carcinoma associated with mucinous carcinoma in the male breast: a case report
    Vimpattra Tragoolwananon
    International Journal of Surgery Case ReportsPeer-reviewedCC BY-NC-ND 4.0Full textOncologyPMCEurope PMC
  2. Prediction of early postoperative hypocalcemia and hypoparathyroidism after thyroidectomy for papillary thyroid carcinoma: dual-outcome prediction models
    Cuiping Zhou, Qian Chen, Shuyan Liu +8
    Frontiers in endocrinologyPeer-reviewedCC BYFull textSurgery & anaesthesiaEurope PMCCrossref
  3. Synchronous laryngeal squamous cell carcinoma and papillary urothelial carcinoma of the bladder: a case report and literature review
    Oxford medical case reportsPeer-reviewedCC BY-NCFull textGeneral medicineEurope PMC
  4. Treatment strategies for unilateral papillary thyroid carcinoma with ipsilateral cervical lymph node metastasis: a narrative review
    Gland SurgeryPeer-reviewedCC BY-NC-NDFull textGeneral medicineEurope PMC
  5. Synchronous medullary and papillary thyroid carcinoma with mixed-component lateral cervical lymph node metastases: a case report
    Yifan He, Cheng Fu, Yawen Bai +1
    Gland SurgeryPeer-reviewedCC BY-NC-NDFull textGeneral medicineEurope PMC

Cite

BibTeXRIS
BibTeX
@article{stevanovic2026longterm,
  title = {{Long‐term outcome of high‐grade encapsulated papillary carcinoma of the breast: implications for staging and management}},
  author = {Milena Stevanovic and Emad Rakha and Ian O. Ellis and Umberto Maccio and Bärbel Papassotiropoulos and Hisham Fansa and Lidija Stevanovic and Heike Frauchiger‐Heuer and Isabell Witzel and Zsuzsanna Varga},
  journal = {Histopathology},
  year = {2026},
  month = aug,
  doi = {10.1111/his.70240},
  url = {https://doi.org/10.1111/his.70240},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Long‐term outcome of high‐grade encapsulated papillary carcinoma of the breast: implications for staging and management
AU  - Milena Stevanovic
AU  - Emad Rakha
AU  - Ian O. Ellis
AU  - Umberto Maccio
AU  - Bärbel Papassotiropoulos
AU  - Hisham Fansa
AU  - Lidija Stevanovic
AU  - Heike Frauchiger‐Heuer
AU  - Isabell Witzel
AU  - Zsuzsanna Varga
PY  - 2026
DA  - 2026/08/03
JO  - Histopathology
DO  - 10.1111/his.70240
UR  - https://doi.org/10.1111/his.70240
AB  - Background: Encapsulated papillary carcinoma (EPC) of the breast is an uncommon tumour with controversial biological behaviour and staging. Emerging evidence suggests that EPC with adverse pathological features (EPC‐A) may exhibit invasive potential. The absence of uniform staging criteria contributes to management variability. This study evaluates the clinicopathological characteristics and clinical course of high‐grade EPC (HG‐EPC), including EPC‐A.  Materials and methods: This retrospective multicentre study (2000–2025) included 25 HG‐EPC cases, irrespectively of ER/PR and HER2 status. Tumours with frank stromal invasion beyond microinvasive foci were excluded. Histopathological re‐evaluation was performed in accordance with 2019 WHO classification criteria.  Results: Of 38 cases reviewed, 25 fulfilled the inclusion criteria as EPC (mean age 57.2 years, mean tumour size 2.9 cm). Six cases (24%) demonstrated conventional‐type microinvasive components. A subset of 16 cases fulfilled criteria for EPC‐A, defined by high‐grade morphology in combination with ER/PR‐negative (or ER <30% positive) and/or HER2‐positive status. Staging and management were variable. Initial pathological stage varied: pTis (n = 13) to pT1 (n = 4) or pT2 (n = 7), and pT3 (n = 1). Adjuvant chemotherapy and radiotherapy were administered in 7 and 12 patients respectively. During follow‐up, four local recurrences (three invasive and one in situ) were observed. One of the locally recurrent patients subsequently developed distant metastasis, and one breast cancer‐related death occurred 200 months after diagnosis. Recurrence or death occurred in 20% (5/25) of patients despite therapy. Microinvasion was seen only in the EPC‐A tumours.  Conclusion: HG‐EPC and EPC‐A overlap morphologically and diagnostically with frankly invasive carcinomas and demonstrate a non‐negligible risk of recurrence. Clinical outcomes and more frequent microinvasion in EPC‐A support the view that EPC‐A is more appropriately regarded as an indolent form of invasive carcinoma rather than a purely in situ lesion and demonstrate a non‐negligible risk of recurrence and highlight the need for standardized staging criteria.
SN  - 0309-0167
SN  - 1365-2559
ER  -