Intracystic Tumor Research Articles

Synchronous Bilateral Solid Papillary Carcinomas of the Breast

We herein report a case of synchronous bilateral solid papillary carcinoma of the breast. A 73-year-old female had a mass that was detected in the right breast on mammography. An ultrasound examination revealed one intracystic tumor in the right breast and two tumors in the left breast. A fine-needle aspiration biopsy of these three tumors was performed, which revealed a diagnosis of malignancy. A magnetic resonance imaging examination of the breasts showed diffuse small nodules surrounding these tumors bilaterally. Bilateral partial mastectomy and a sentinel lymph node biopsy were performed. Lymph node metastasis was detected in the right axilla, and additional lymph node dissection was performed. The pathological diagnosis was synchronous bilateral breast cancer, invasive ductal carcinoma NOS of the right breast, mucinous carcinomas of the left breast, and bilateral SPCs. A wide range of surgical margins were positive for SPCs, and additional bilateral total mastectomy was then performed. To the best of our knowledge, little is known about synchronous bilateral SPCs. Our case indicates that some SPCs can be widely scattered and make up a variety of invasive carcinomas. It is difficult to make a correct preoperative evaluation in such cases.

Giant Epidermoid Cyst of the Spleen with Elevated CA 19-9 Production Managed Laparoscopically: Report of a Case

True splenic cysts are uncommon and are associated with elevated serum and intracystic tumor marker CA 19-9 levels. A 33-year-old woman presented to our hospital with a chief complaint of epigastralgia. Computed tomography of the abdomen showed a 10-cm cystic lesion in the spleen. The serum carbohydrate antigen (CA) 19-9 level was 3,347 U/mL (normal, <37 U/mL). Total laparoscopic splenectomy was performed, and the serum level of CA 19-9 had normalized 2 weeks later. Pathological examination showed a benign true epidermal cyst of the spleen with strong immunohistological staining for CA 19-9. Splenic epidermoid cysts most often occur in young women, and laparoscopic surgery to remove cysts of this type is minimally invasive. Thus, laparoscopic surgery should be the method of first choice for most cases of splenic benign true cyst.

Intracystic Papillary Carcinoma of the Breast in Males: A Case Report and Review of the Literature

Carcinoma of the male breast is a relatively rare disease that accounts for less than 1% of all the cases of cancer in men. Intracystic Papillary Carcinoma (IPC) is an extremely rare disease of the male breast, with a few case reports. The prognosis is excellent for the patients who are diagnosed with IPC, regardless of whether the tumour is in-situ or of an invasive type. We are reporting the case of a 50 year old man who presented with a painless cystic lump in the left breast. Ultrasonography revealed an intracystic tumour. Fine needle aspiration suggested a papillary tumour. The patient underwent simple mastectomy without a sentinel lymph node biopsy. The final pathologic examination revealed an intracystic papillary carcinoma of a low nuclear grade without an invasion.

Pure Primary Squamous Cell Carcinoma of the Breast Presenting as an Intracystic Tumor

Pure Primary Squamous Cell Carcinoma of the Breast Presenting as an Intracystic Tumor

乳腺嚢胞内腫瘍に対する吸引式針生検の有用性

乳腺嚢胞内腫瘍に対する吸引式針生検の有用性

Benign intracystic phyllodes tumor of breast

Benign intracystic phyllodes tumor of breast

Carcinoma in a solitary intraductal papilloma of the breast

Herein is reported a rare case of carcinoma arising from papilloma of the breast. A 63-year-old postmenopausal woman noticed a nodule approximately 1 cm in diameter in her left breast. Ultrasonography indicated a mass with a solid pattern within an intracystic tumor measuring 1.5 x 1.5 x 1.4 cm in diameter located near the left nipple. On total image analysis malignancy could not be denied, therefore lumpectomy with resection of the surrounding tissue was performed. Histologically the tumor consisted of cancerous and papilloma components. The cancer cells had high-grade nuclear atypia, were irregular, and contained abundant eosinophilic cytoplasm with a thin vascular stalk. In contrast, the tumor cells had no atypia, and had a thick stroma in the papilloma components. Both lesions could be distinguished clearly from each other. In addition, a transition from papillary to cancerous elements in some areas was seen. An additional partial mastectomy was performed after the lumpectomy but no carcinoma foci were noted in the excised tissue. Possible occurrence of cancerous change in solitary intraductal papilloma of the breast was suspected.

Cystic pancreatic neuroendocrine neoplasms with uncertain malignant potential: Report of two cases

Neuroendocrine tumors of the pancreas (NETP) represent only 1%-2% of all pancreatic neoplasms. They can be classified as functioning or non-functioning, respectively, according to the presence or absence of paraneoplastic syndrome. Case 1 concerned a 70-year-old woman with a cystic lesion of the pancreatic head and body. All tumor markers were negative. The patient underwent a distal pancreatectomy. The histology revealed a well-differentiated endocrine tumor with uncertain malignant potential. Case 2 was a 61-year-old man with chronic polyserositis. The serum tumor markers were negative, while he was strongly positive for intracystic tumor markers carcinoembryonic antigen, carbohydrate antigen (CA) 19-9, and CA 125. The patient underwent a cephalo-pancreatic duodenectomy. The preoperative differential diagnosis of cystic NETP is still a challenge due to the high rate of the nonfunctional variant. Although cystic NETPs are well differentiated, they are still tumors with a malignant potential, and therefore an early diagnosis and radical surgical resection could be associated with a better long-term survival.

Intracystic papilloma of the breast forming a giant cyst

Intracystic tumors of the breast prove to benign more often than malignant, and most intracystic lesions are benign papillomas. Generally, the cyst with intracystic papilloma of the breast is small, and there are few cases of intracystic papilloma of the breast forming a giant cyst in the literature. We report the case had the intracystic papilloma of the breast with a giant cyst (diameter of 15.0 cm). Imaging examinations showed two intracystic components in the cyst, and suggested that they were malignancy. Cytological examinations revealed no malignant cell. In spite of many aspirations of the cyst fluid, the size was not changed finally. The surgical resection was performed, and histological examination revealed two intracystic papillomas. In review of the literatures, it is difficult to distinguish between intracystic papilloma and intracystic papillary carcinoma by imaging or cytologic examinations preoperatively. Surgery should be recommended to confirm diagnosis and treatment.

Intracystic adenomyoepithelioma of the breast — case report and review

A case of an intracystic adenomyoepithelioma of the breast mimicking intracystic carcinoma is described. Preoperative examination with mammography, sonography, computed tomography, and magnetic resonance imaging showed an intracystic tumor with an indistinct margin and several swollen lymph nodes in the ipsilateral axilla. Because the results of fine-needle aspiration cytology of the tumor were interpreted as carcinoma, partial mastectomy with dissection of the axillary nodes was performed. Histopathologic and immunohistochemical examination revealed an intracystic adenomyoepithelioma without nodal involvement. The imaging features of this rare tumor may vary widely, which may result in an incorrect diagnosis of breast carcinoma. Indeed, adenomyoepithelioma has metastatic potential; however, lymphatic spread is rare and axillary intervention may be over-treatment for most cases. While the imaging descriptions of intracystic adenomyoepitheliomas are very limited, this tumor should be considered in the differential diagnosis to avoid unnecessarily aggressive treatment.

Clear cell hidradenoma of the breast: a case report with review of the literature

Clear cell hidradenoma of the breast is rare. A 55-year-old woman demonstrated a left breast tumor during follow-up examination of the right breast. Focal asymmetric density was shown on mammogram, and ultrasonography showed an intracystic tumor. Since the diagnosis was not clear on aspiration cytology, excisional biopsy was performed. The lesion was an intracystic tumor macroscopically. Histological examination demonstrated characteristic histological features of clear cell hidradenoma, such as proliferation of uniform epithelial cells, clear or slightly eosinophilic cytoplasm, and cuboidal cell-lined ductal structures. Immunohistochemically, these proliferating epithelial cells were negative for myoepithelial markers, such as alpha-smooth muscle actin, CD10 and anti-muscle actin, but positive for p63. These features were consistent with clear cell hidradenoma.

Percutaneous endoscopy-guided biopsy of an intracystic tumor with a mammary ductoscopy

Intracystic abnormalities of the breast may result from debris, intracystic papilloma, or rarely breast cancer. Intracystic tumors cannot be diagnosed based on imaging examinations or fine needle aspiration alone, and therefore excisional biopsy must be performed. We have treated many cases who had nipple discharge with mammary ductoscopy since 1992, and we have used this method to diagnose intracystic tumors. An endoscope was inserted into the cyst percutaneously, and the intracystic tumor was biopsied using forceps. Six intracystic tumors were biopsied with the endoscope. Four of six cases were cancer, and two were benign papillomas. We were able to visualize and accurately biopsy intracystic tumors of the breast using mammary ductoscopy.

Squamous cell carcinoma of the breast in the form of an intracystic tumor

Squamous cell carcinoma of the breast is thought to arise through metaplasia of ductal carcinoma cells. We report a case of pure squamous cell carcinoma of the breast with features of intracystic tumor, which was considered to have arisen from metaplastic squamous epithelial cells lining the cyst wall. A 71-year-old woman presented at our hospital with a 40 x 30-mm mass in the lower outer quadrant of the right breast. Mammography revealed a round, high-density mass, which had a mostly regular but partially irregular margin. Ultrasonography demonstrated a solid tumor with an irregular shape protruding into a cystic space, suspicious of intracystic carcinoma. Aspiration cytology confirmed squamous cell carcinoma. A modified radical mastectomy was performed. Histopathologically, the intracystic tumor was a pure squamous cell carcinoma. The epithelial cells lining the inner cyst wall showed mostly squamous metaplasia, and there was continuity between these cells and the squamous cell carcinoma. 13 months later, the patient is free of disease with no adjuvant therapy.

Sonographic Findings of an Intraductal Mucinous Carcinoma

Cystic lesions of the breast are commonly seen on mammographic images. Although simple cysts are very common, intracystic tumors are rare. Intracystic growth is typically a finding associated with papillary carcinoma; however, to our knowledge, the literature does not show an association with mucinous carcinoma of the breast. We report a case of a mucinous carcinoma with an unusual intraductal growth and show sonographic and macroscopic findings.

Autoimplants in Serous Borderline Tumors of the Ovary

The clinical and pathologic features of serous borderline tumors (SBTs) with autoimplants (AIs) were studied with emphasis on their relation to survival, ovarian SBT with a micropapillary pattern, and their distinction from serous adenocarcinoma. The 30 patients ranged in age from 17 to 70 years (mean, 35.8 years). Two had stage I disease, 10 had stage II disease, and 18 had stage III disease. Twenty-five patients had bilateral ovarian tumors. In 28 cases, AIs were present on the surface of the neoplasm or between exophytic surface tumor papillae; in 2 cases, AIs were between papillae within intracystic tumor. The AIs consisted of single cells or glands and clusters of cells with mild to moderate nuclear atypia within a fibroblastic stroma; the stroma dominated over the epithelium in extent within the AI. In many cases, the epithelial cells in the AI had abundant eosinophilic cytoplasm. All but 2 of the patients had coexisting noninvasive peritoneal implants; 3 of them also had invasive peritoneal implants. Six of the SBTs had a micropapillary pattern; 3 of these were stage III and 3 stage II tumors. Clinical follow-up was available for 11 patients. Eight were alive and well after 4 to 7 years (mean, 5 years); 3 of these patients had stage II disease and 5 had stage III disease. Three were dead of disease after 7 to 12 years (mean, 9 years). Two patients who died of disease had stage III disease, and 1 of them had invasive implants. The third patient had stage II disease, invasive implants, and the tumor was of the micropapillary type. Our study indicates that the majority of patients with SBT with AI have stage II or III disease and abundant exophytic tumor. SBTs with AI had a micropapillary pattern in 20% of the cases. AIs do not appear to have an adverse impact on survival when controlled for peritoneal implant type and for this reason must be distinguished from true stromal invasion in serous carcinoma, a misdiagnosis sometimes made, or seriously entertained, initially in these cases. Features that favor AI over carcinoma arising in an SBT are 1) a location between tumor papillae or on the ovarian surface 2) a predominance of stroma over epithelial cells, and 3) the "borderline" cytologic appearance of epithelial cells.

Synchronous liver metastases of intracystic papillary carcinoma with invasion of the breast

A rare case of intracystic papillary carcinoma (IPC) with invasion had synchronous metastases to the liver at presentation. A 57-year-old postmenopausal woman noticed a right breast tumor 7 months prior to admission. Mammography showed an oval mass measuring 3.1 cm in diameter with no calcification, and ultrasonography showed an intracystic tumor with a papillary growth pattern. Fine-needle aspiration cytology revealed adenocarcinoma. Excisional biopsy revealed intracystic solid papillary carcinoma with invasion. The tumor was a clear-cell type with extracellular mucin. Two months after the initial biopsy, a screening ultrasonographic examination of the liver showed multiple hyperechoic masses. Abdominal contrast-enhanced CT scan and magnetic resonance imaging (MRI) showed multiple hypervascular masses compatible with metastatic tumors. No suspicious lesions were detected on examinations for malignancy in other organs. Distant metastases in cases of IPC with invasion are very rare. The potential of distant metastasis in IPC with invasion and the difficulty of evaluating invasive foci should be recognized. Careful evaluation of distant metastases is recommended.

Breast Ultrasound: Advances in Imaging With Tissue Harmonic Imaging

Tissue harmonic imaging (THI) uses the harmonic signal that is generated by tissue itself. THI contains minimal noise and clutter compared with conventional B-mode ultrasound. The narrowed beam width improves lateral resolution; the shorter wavelength of the return harmonic signal also improves the axial resolution. THI improves the breast image quality, which is especially evident for showing the contours, margins, internal echo features, calcifications, and edge shadows when compared with conventional ultrasound. Cystic tumors, such as small cysts, intraductal tumors, and intracystic tumors, are well visualized by THI. By providing superior image quality of sonographic findings of contours, margins, and internal microcalcifications, THI may allow a more confident diagnosis of solid tumors of the breast. Although the decreased sound transmission observed in the lesion has a large amount of interstitial fibrosis, it is more striking on THI than with conventional ultrasound. Nevertheless, THI may provide more accurate breast tissue characterization than conventional sonography. THI promises to improve the diagnostic confidence for breast tumors.

INTRACYSTIC ATYPICAL CARCINOID (ENDOCRINE CELL CARCINOMA) OF THE BREAST-A CASE REPORT-

Atypical carcinoid (endocrine cell carcinoma) of the breast which is a rare entity is reported. A 76-year-old woman had a palpable tumor 3.2×2.7cm in size in the ABC area of the left breast. Echography revealed a broad-based intracystic tumor. Dynamic MRI mammography revealed early enhanced intracystic tumor. A aspiration cytology resulted in class IV. Intraoperative frozen section diagnosis was intracyctic solid-tublar carcinoma, and a modiffied radical mastectomy (Auchincloss's method) was performed. Hematoxylin and eosin (HE) stain showed carcinoid like appearance. Grimerius silver staining demonstrate numerous argyrophillic granules in the cytoplasm of many tumor cells. And chromogranin A stain was positive. Mucin stain also revealed mucin in the cytoplasm. Electron microscopy of the tumor showed numerous neurosecretory granules. At last, from the figure of tumor cells, diagmosis was atypical carcinoid (endocrine cell carcinoma) of the breast. Lymph node metastasis was not seen. Estrogen receptor (ER) was positive, but progesterone receptor (PgR) was negative. No distant metastasis was found at the time of operation. She died of multiple liver metastasis 10 months after the operation. Carcinoid syndrome was not found.

STUDY OF INTRACYSTIC TUMOROUS LESIONS OF THE BREAST EXPERIENCED AT THE DEPARTMENT

Three cases of intracystic breast cancer and 11 cases of intracystic papilloma experienced at the department in a recent 2-year period were subjected to a study of comparing their clinical features and evaluating the diagnostic outcomes of intracystic tumors lesions. Of all 110 cases diagnosed as having a cyst by ultrasonography, intracystic breast cancer represented 2.7% (3 cases) and intracystic papilloma, 10.0% (11 cases). A verage ages of breast cancer and papilloma patients were 52.7 and 40.7 years old respectively, with a significant difference. There was a tendency to greater tumor diameter in breast cancers than papillomas. Mammography, ultrasonography, fine needle aspiration cytology, cytodiagnosis of secrete from the nipple, and mammotec were employed for differential diagnosis between benign and malignancy. Specific findings to breast cancer included microcalcification on X-P (2.13 cases), more than class IV on fine needle aspiration cytology (2/13), and mammotec positive (2/5). The correct diagnostic rate was not favorable. There were no any specific findings to papilloma. It is clarified that we have few clues for differential diagnosis of intracystic tumorous lesions. The best way is to make the definite diagnosis by biopsy for lesions suspected of possible malignancy, even if it appears trifling.

CLINICOPATHOLOGICAL IMAGES OF INTRACYSTIC BREAST CARCINOMA

For the purpose of clarifying the clinicopathological characteristics of intracystic breast carcinomas, we have examined 31 cases of intracystic breast carcinoma and 23 cases of intracystic papilloma in terms of the age, cyst diameter, and ultrasonic image. With regard to the progress of intracystic reast carcinoma into the lactiferous ducts, the extension of carcinoma was mapped by generating holoblastic tissue slices of 5mm width. Intracystic breast carcinomas were more commonly found in elderly patients than intracystic papillomas. The intracystic tumors in the patients of sixty years or older were often found to be cancer. For differentiating intracystic breast carcinoma from intracystic papilloma by ultrasonic images, the shape of the peripheral tumor in the cyst is important, and in many cases, those having an uneven periphery were found to be cancer. Most of the intracystic breast carcinomas are non-invasive and metastasis to the axillary lymph nodes is not common. As for progress into the lactiferous ducts, about 40% cases indicated progress of 2cm or more in the lactiferous ducts from the wall of the cyst.