Intracystic papillary carcinoma of the breast.

Abstract

57-year-old woman presented witha palpable abnormality in the upperouter right breast. Findings onmammography showed a 1.4-cm well-circum-scribed round mass in the right breast at the 10-o’clock position (Fig. 1A). On sonography, themass had internal echoes and gently lobulatedborders with some through-transmission (Fig.1B). Sonographically guided core biopsy (Fig.1C) revealed atypical papillary proliferationsuggesting intracystic papillary carcinoma. Thepatient underwent right segmental mastectomy.The histopathologic diagnosis was intracysticpapillary carcinoma (Fig. 1D). Intracystic papillary carcinoma of the breast isa rare malignant tumor, constituting 1–2% of allbreast carcinomas [1]. Intracystic papillary carci-noma, which may be unifocal or multifocal, has apropensity to occur in postmenopausal women.Women with intracystic papillary carcinoma mayhave no symptoms, a palpable mass, or maypresent with bloody nipple discharge. On mammography, intracystic papillarycarcinoma is often seen as a round or oval cir-cumscribed mass, most frequently in the ret-roareolar region [2, 3]. Sonography usuallyreveals a cystic mass, with or without septa-tions, with solid papillary masses projectinginto the cyst lumen [2, 3]. Although most pap-illary carcinomas are cystic masses, some maybe mixed in composition with predominantlysolid components. In some patients, such asthis one, a cyst is not seen on sonography, andthe term “solid papillary carcinoma” may beappropriate. Sonography may be useful forshowing wall thickening and adjacentanechoic and hyperechoic areas that may rep-resent hemorrhage resulting from rupturedcapillaries within the cyst wall or hemorrhagicinfarction of the tumor cells [4].Fine-needle aspiration and core needle bi-opsy may be unable to distinguish between insitu and invasive papillary lesions because thecenter of the lesion is often targeted, and in-vasion is often identified at the periphery ofthe tumor. Therefore, in general, excision issuggested when papillary lesions are sus-pected or diagnosed at fine-needle aspirationor core needle biopsy. At pathologic exami-nation, intracystic papillary carcinoma isusually a well-circumscribed mass with acystic component containing a nodular or apapillary inner surface. The most commonhistologic feature is arborization of the fi-brovascular stroma. A monotonous cell pop-ulation, the presence of mitoses, and thelack of myoepithelial cells confirm the diag-nosis of intracystic papillary carcinoma. Intracystic papillary carcinoma has a slowgrowth rate and an excellent prognosis. The10-year survival rate has been reported to be100% [5]. Segmental mastectomy is usuallyperformed, and axillary lymph node sampling(axillary lymph node dissection or sentinellymph node mapping) is suggested in patientsin whom invasion is likely.