Variant Of Ductal Carcinoma Research Articles

Encapsulated papillary carcinoma of the breast: A clinicopathological study of 49 cases

BackgroundEncapsulated papillary carcinoma (EPC) has been considered as a variant of ductal carcinoma in situ (DCIS). Recent studies suggest that EPC could be invasive, as it often lacks myoepithelial cells (MECs) at their periphery. The current study was performed to investigate the biological features of EPC. MethodsForty-nine EPC patients admitted to the Tai′an Central Hospital and Qilu Hospital of Shandong University from January 2004 to December 2014 were included in this study. We retrospectively analyzed the clinicopathological findings, the presence and distribution of MECs, as well as the outcomes. ResultsThe mean age at diagnosis was 68.5 years. The mean tumor size was 2.0cm. MECs were completely absent in all the 49 cases, Most tumors were estrogen receptor (ER) and progesterone receptor (PR) positive (95.9%). HER2 1+ immunoreactivity was seen in only 8 cases. Twenty-five patients underwent lumpectomy and twenty-four underwent mastectomy. Thirty-nine received evaluation of lymph node, and three (7.7%) patients had lymph node involvement. Follow-up information was available in 29 patients (8 to 104 months, mean 47 months), among which 5 developed local recurrences and 2 distant metastases. ConclusionEPC is an indolent invasive carcinoma with biological features between in DCIS and invasive carcinoma, with predominance of the latter. EPC rarely showed lymph node involvement and was characterized by favorable prognosis. EPC can be treated with adequate local therapy and hormonal therapy, whereas, the benefit of radiation after lumpectomy remains uncertain.

Secretory carcinoma of breast mimicking an abscess: A diagnostic dilemma

Secretory carcinoma is a rare type of breast carcinoma usually seen in the young females, and it is also called as Juvenile carcinoma. We report here a case of secretory carcinoma in an elderly female with an unusual clinical presentation. She had a painful swelling in left breast of 6 cm × 5 cm size for the past 6 months. Skin over the swelling was inflamed and ulcerated. Mammogram findings favored a chronic infected hematoma/abscess. Fine needle aspirate (FNA) is a murky fluid admixed with blood and was reported as acute inflammatory lesion. 2 weeks later she developed nipple retraction and an increase in size of the swelling. Fine needle aspiration cytology (FNAC) was repeated again from firm areas and in multiple points of swelling. To our surprise, FNA smears revealed dysplastic ductal epithelial cells with minimal atypia. Modified radical mastectomy was planned. Histopathological examination confirmed the mass as secretory carcinoma, a rare variant of ductal carcinoma of the breast. Postoperative chemotherapy and radiotherapy was started. We report this case to emphasize that FNAC can be repeated in suspicious cases and should be correlated clinico-radiologically to give a preoperative diagnosis.

Abstract P5-16-07: Intracystic papillary carcinoma of the breast: Implications for therapy from the surveillance epidimiology and end results database

Abstract Intracystic papillary carcinoma is a rare breast neoplasm that has been classified as a variant of ductal carcinoma in situ. However, patients can develop metastatic disease. The indication for radiation and lumpectomy versus mastectomy as far as survival is unknown. Methods: We identified 2,649 female patients with intracystic papillary carcinoma from the Surveillance, Epidemiology, and End Results (SEER) registry. Differences in demographics, clinical features and survival of patients were assessed using the Kaplan-Meier method and Cox regression. Results: The median patient age was 66 years. The majority of patients were white and those who presented with Stage 0 disease. Most patients did not have their lymph nodes examined and only 34% received radiation therapy treatments. Using a log-rank test, survival was significantly different by race, with whites having a better survival than black patients (p<0.001). Furthermore, early stage disease (p<0.001) and those who received radiation (p<0.0001) had improved survival. In a Cox regression survival model adjusting for age, stage, and grade, patients who were black (hazard ratio [HR], 1.85) had a significantly higher risk of death than whites. Patients who received radiation therapy (HR, 0.49) had an improved survival over those who did not undergo radiation therapy treatments. There was no difference in survival in patients who received either a lumpectomy or mastectomy. Conclusion: Intracystic carcinoma of the breast has a good overall survival. Survival is improved in white patients and in patients who receive radiation therapy. This suggests that radiation therapy should be offered to women with intracystic papillary cancer who undergo breast conserving surgery. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-16-07.

Clear Cell Variant of Ductal Carcinoma in situ of the Breast

Clear Cell Variant of Ductal Carcinoma in situ of the Breast

Intracystic papillary carcinoma of the breast: Report of two cases

Intracystic papillary carcinoma (IPC) of the breast has traditionally been considered to be a variant of ductal carcinoma in-situ (DCIS). It is an uncommon tumor accounting for less than 3% of all breast cancers and predominantly affects elderly women. IPC is extremely rare in men and only few cases have been reported in the literature. The tumor has excellent prognosis regardless of whether it is in-situ or invasive. Hence an accurate diagnosis plays a crucial role in the management of patients with IPC. We report two cases of IPC, one in a 68-year-old woman and the other one in a 70-year-old man. The diagnosis was suspected on fine needle aspiration cytology (FNAC) and was confirmed by histopathology.

Breast Intracystic Papillary Carcinoma: An Update

Intracystic papillary carcinoma (IPC), a breast tumor mainly occuring in the elderly, has long been considered as a variant of ductal carcinoma in situ (DCIS). This is now debated since metastatic cases have been reported. In this study, surgical pieces of 20 IPCs were reassessed, and markers of myopepithelial layer (p63, CD10 and Smooth Muscle Actin) as well as estrogen receptors (ER) and progesterone receptors (PgR) and C-erb-B2 oncoprotein expression were systematically performed and quantified. In 10 cases, an associated unequivocal invasive component was found. In all 20 cases, no myoepithelial layer was found. Eighteen tumors were ER positive, 14 were PgR positive. Moreover, none of the tumors over-expressed C-erb-B2 oncoprotein. Therefore this study showed that in all cases of IPC there were microscopic features of invasive carcinoma despite good clinical prognostic indicators, and that precise characterization of tumors requires extensive paraffin embedding of surgical pieces.

Solid Papillary Carcinoma of the Breast

Abstract: Solid papillary carcinoma (SPC) is an uncommon breast tumor that occurs mainly in elderly women. It is composed of well-circumscribed large cellular nodules consisting of low-grade cells with neuroendocrine differentiation (rosette-like formation and expression of synaptophysin and chromogranin), and are separated by hyalinized fibrovascular cores. Mucin production is another characteristic feature of this lesion. SPC has been considered a noninvasive breast lesion ie, a variant of ductal carcinoma in situ involving larger ducts, and can be associated with invasive carcinoma in more than half of the cases. The invasive carcinoma arising in the background of SPC is typically of low grade, either colloid or “neuroendocrine-like” type, positive for estrogen receptor and progesterone receptor and negative for Her-2. Overall, SPC tends to exhibit an indolent behavior. Lymph node and distant metastases can occur rarely but are generally limited to cases of SPC with invasive carcinoma or SPC with areas suspicious for invasion.

Flat Ductal Intraepithelial Neoplasia of the Breast: A Review of Diagnostic Criteria, Differential Diagnoses, Molecular-Genetic Findings, and Clinical Relevance—It Is Time to Appreciate the Azzopardi Concept!

More than 25 years ago, John G. Azzopardi described a distinctive intraepithelial neoplastic breast lesion, which he designated "clinging carcinoma in situ"; he considered it as another variant of ductal carcinoma in situ, an early lesion that can easily be missed because the changes are mainly cytologic rather than architectural. The lesion remained widely unrecognized and/or ignored until recent years when its neoplastic nature was confirmed at the molecular-genetic level. To deal with historical aspects of the evolving concept of "clinging" and to focus on several important issues such as characteristic morphologic features with particular attention to the diagnostic criteria and differential diagnoses, recent molecular-genetic findings, appropriate terminology and classification, as well as the significance of this type of lesion for both surgical pathologists and clinicians. A thorough search of the literature was performed and publications using a variety of designations including "clinging carcinoma in situ," "flat epithelial atypia," "ductal intraepithelial neoplasia-flat type," "atypical cystic lobules," "columnar cell change with atypia," "columnar cell hyperplasia with or without atypia," "columnar alteration with prominent apical snouts and secretion," and so forth were reviewed. This distinctive lesion represents one of the earliest morphologically recognizable neoplastic alterations of the breast that is commonly associated with mammographically suspicious microcalcifications. It is characterized by mildly to severely atypical cells simply replacing the single layer of native epithelial cells in a flat fashion without appreciable proliferation; tufting, intraluminal bridging, micropapillary structures, and so forth are typically absent or very focal and minimal, if present at all. Based on the degree of cytologic atypia, low- and high-grade flat ductal intraepithelial neoplasia need to be separated. Although additional studies are needed to better understand the clinical significance of flat ductal intraepithelial neoplasia, several lines of evidence strongly support the concept of clinging. Indeed, as pointed out by Azzopardi, surgical pathologists need to pay more attention to the cytologic alterations of the breast lesions by analyzing the involved cell populations using high-power magnification.

Are Encapsulated Papillary Carcinomas of the Breast In Situ or Invasive?

Encapsulated papillary carcinoma (EPC) of the breast is traditionally considered a variant of ductal carcinoma in situ (DCIS). However, recent studies show EPCs lack myoepithelial cells at their periphery, leading some to conclude that EPCs are invasive. We used a robust collagen type IV immunohistochemical procedure to assess invasion in 21 cases of pure EPC and 6 EPCs with adjacent invasive ductal carcinoma (IDC) and compared these results with those for papilloma, DCIS, and IDC. Moderate to intense collagen type IV expression was seen in all EPCs and was absent or decreased in all IDCs. All patients with pure EPC had negative axillary nodes with the exception of 1 who had a micrometastasis, and all were alive with no evidence of disease at follow-up (mean, 40.4 months). EPCs are in situ carcinomas with an excellent prognosis and can be managed with local therapy with or without sentinel lymph node biopsy.

Intestinal type adenocarcinoma: a previously unrecognized histologic variant of ductal carcinoma of the pancreas

Intestinal type adenocarcinoma: a previously unrecognized histologic variant of ductal carcinoma of the pancreas

Ultrastructural Study of Apocrine Differentiation in Human Mammary Carcinoma: Correlation of Granule Content With Sex Steroid Binding

A variant of ductal carcinoma of the human breast which has been designated apocrine carcinoma has distinctive light and electron microscopic features. Such tumors comprise approximately 0.5% of breast carcinomas. Abundant cytoplasmic membrane bound vesicles (400-600 nm) with dense homogeneous osmophilic cores characterize these tumors. These granules are also seen in apocrine metaplastic breast epithelial lesions1 and appear to be responsible for the finely granular eosinophilic cytoplasm observed by light microscopy. A high content of intermediate affinity non-saturable 4S progesteroneestrogen binding protein (PEBP) in apocrine carcinoma has been reported.2 The present ultrastructural study evaluates the presence of apocrine granules in infiltrating ductal carcinoma (NOS) to determine if a correlation exists between apocrine granule content and the quantity of PEBP present.