恶性乳头状病变，特别是乳腺包裹性乳头状癌（EPC），继续给执业病理学家带来诊断挑战。除了这些病变相对罕见之外，缺乏基于证据的诊断标准、原位和侵袭形式的生物学特征和临床行为的差异、免疫组织化学标记物的不同使用以及与其他肿瘤类型的重叠，包括高浸润性乳腺癌的分级限制形式导致了诊断不一致，并具有潜在的重大临床和治疗意义。病理学家应熟悉在恶性乳头状肿瘤、EPC 和 EPC 样肿瘤中观察到的形态范围以及具有重叠特征的肿瘤的存在。在这篇综述中，我们总结了恶性乳头状肿瘤的常见诊断陷阱，并提供了一种对这些神秘实体进行诊断评估和分类的方法。© 2024 作者。组织病理学由约翰·威利出版

Malignant papillary lesions, and in particular, encapsulated papillary carcinoma (EPC) of the breast, continue to present diagnostic challenges for the practising pathologist. In addition to the relative rarity of these lesions, the lack of evidence-based diagnostic criteria, differences in the biological characteristics, and the clinical behaviour of in situ and invasive forms, variable use of immunohistochemical markers, and overlap with other tumour types including high-grade circumscribed forms of invasive breast carcinomas has resulted in diagnostic discordance with potentially significant clinical and management implications. Pathologists should be familiar with the range of morphology observed in malignant papillary tumours, EPC, and EPC-like tumours and the existence of tumours with overlapping features. In this review we summarize the common diagnostic pitfalls in malignant papillary tumours and provide an approach to the diagnostic evaluation and categorisation of these enigmatic entities.© 2024 The Author(s). Histopathology published by John Wiley & Sons Ltd.