Evaluation of the management of intracystic papillary carcinoma.

INTRODUCTION: Intracystic papillary carcinoma is defined as papillary carcinoma located in a dilated or cystic duct. There is no consensus regarding the management of this lesion. The aim of our study is to evaluate the frequency of associated invasive lesions and the need to perform an axillary staging during surgery. MATERIAL AND METHODS: This is a retrospective study concerning intracystic papillary carcinomas diagnosed at the Georges-François Leclerc Cancer Center between January 2010 and December 2021. Inclusion criteria were an age superior to 18 years and a histologic diagnosis confirmed at biopsy. RESULTS: Fifty-nine patients were included in this study. All but one patient underwent surgery: 39 patients (67.2%) underwent lumpectomy, and 18 patients (31.1%) underwent total mastectomy. An axillary staging was performed in 51 patients (86.4%). On final histologic analysis, 31 patients (52.5%) had pure intracystic papillary carcinoma and/or associated with in situ and 27 patients (45.8%) had invasive and/or microinvasive lesions. After univariate analysis, the only variable significantly associated with the presence of invasive lesions on final histologic analysis was the palpation of the lesion with a P-value of 0.09. DISCUSSION: Through this study, it appears necessary to discuss the realization of an axillary staging by conducting an axillary sentinel node procedure because of the high frequency of invasive lesions associated with intracystic papillary carcinoma.

Encapsulated Papillary Carcinoma in a Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Case Report.

We report a case of a 45-year-old female who developed multi-focal encapsulated papillary carcinoma (EPC) in her left breast. This was on a background of previous left breast high-grade ductal carcinoma in situ, for which she had a skin-sparing mastectomy and deep inferior epigastric perforator (DIEP) reconstruction five years ago. Papillary carcinoma is a rare pathology, and its occurrence in autologous breast reconstruction is even rarer. This is the second reported case of papillary carcinoma in a DIEP reconstruction. Although surgery remains the gold standard for EPC, debate remains with regard to adjuvant endocrine therapy and radiotherapy. We discuss the diagnosis and current management of an EPC.

Oncological outcomes for encapsulated papillary carcinoma of the breast: Multicentric study of Turkish Society for Radiation Oncology breast cancer study group (TROD 06-014 study).

BACKGROUND: Encapsulated papillary carcinoma (EPC) is a rare malignant papillary breast cancer accounting for approximately .5%-2% of all breast tumors. The aim of this multicenter study was to evaluate clinicopathologic features of EPC in addition to oncological outcomes and radiotherapy (RT) details. METHODS: From 10 different academic hospitals in Turkey, we obtained pathology reports of 80 patients with histologically confirmed EPC between 2005 and 2022. Demographic, diagnostic, and treatment data were collected from medical records, retrospectively. Local failure, distant progression, toxicity-adverse effects, overall survival (OS), and disease-free survival were evaluated, and survival analyzes were performed using the Kaplan-Meier method. RESULTS: Eighty patients with the diagnosis of misspelled sorry (ECP) were retrospectively evaluated. The median age of the patients was 63 (range, 35-85). After a median follow-up of 48 (range; 6-206) months, local recurrence was observed in three patients (4%). Local recurrence was less common in the patients who received whole breast RT with a tumour bed boost (p = .025). There were not any distant metastasis or disease-related death. RT was applied to 61% of the cases, and no treatment-related grade 3 or higher toxicity was reported in any of the patients. Five year OS, cancer-specific survival (CSS), and  were observed as 85%, 100%, and 96%, respectively. CONCLUSIONS: ECP is a rare, slow-progressing breast carcinoma associated with good prognosis, it is a disease of elderly patient, and usually occurs in postmenopausal women. It responds extremely well to optimal local treatments and appropriate adjuvant treatments on a patient basis, and has excellent OS and CSS ratios.

Intracystic Papillary Carcinoma: A Case Report.

Intracystic papillary carcinoma (IPC) of the breast is a rare form of in-situ carcinoma, which is contained within a dilated duct. Mammography and ultrasound may provide clues to its presence, but formal diagnosis always requires histologic evidence. Although IPC is associated with an excellent prognosis, surgical resection is important in order to rule out the possibility of any invasive component, which would result in the need for more aggressive treatment. In this paper, we review the radiographic and histologic features of this interesting diagnosis, present a patient case, and explore the possible reason why IPC does not require the same treatment modalities as the more common ductal carcinoma in situ (DCIS).

Invasive Lobular Carcinoma Mimicking Encapsulated Papillary Carcinoma with a Literature Review: A Rare Variant Detected Serendipitously.

Invasive lobular carcinoma with papillary features is a newly proposed variant which presents as a relatively well-circumscribed mass lesion with at least partial peripheral thickened fibrous capsule and central delicate fibrovascular cores, morphologically mimicking encapsulated papillary carcinoma or solid papillary carcinoma. There are only 5 cases described in literature. We here report an interesting example of invasive lobular carcinoma with papillary growth pattern surrounded by a thick fibrous capsule, mimicking encapsulated papillary carcinoma (EPC). The lobular nature of the tumor was confirmed by the absence of membranous expression of E-cadherin and p120 catenin. The lobular cytological features are subtle in this variant and may be overlooked. Differentiation of this variant from papillary carcinomas is crucial for correct tumor categorization, staging and most importantly, proper treatment.

Literature review and case report of bilateral intracystic papillary carcinoma associated with an invasive ductal carcinoma in a male breast.

Intracystic papillary carcinoma (IPC) is a rare tumor with good prognosis that occurs in only 5% to 7.5% of male breast cancer. We report a case of a 46-year-old man who presented a brown nipple discharge a few months ago. He had a bilateral IPC and an invasive ductal carcinoma on the right breast. A double mastectomy was then performed with a bilateral sentinel lymph node biopsy, and he received chemotherapy, radiotherapy, and hormonotherapy. Two years after the diagnosis, the patient recovered and was free of recurrence. Considering the scarcity of this tumor type, we conducted a systematic literature review on the PubMed of all the cases of IPC in men. The clinical presentation, imaging, and treatment of the 43 case reports from the 41 articles selected were described. Furthermore, no clear guidelines for IPC management are available. Conservative surgery should also be preferred, and a sentinel lymph node biopsy should be performed systematically. Moreover, radiotherapy should be proposed in the case of conservative surgery, and hormone therapy could be proposed in the case of invasive IPC or IPC associated with a ductal carcinoma in situ.

Rare Papillary Breast Carcinoma Incidentally Discovered After Trauma-Induced Hematoma.

Papillary carcinoma of the breast is rare, comprising only 0.5% incidence of all breast cancers. Clinically the disease presents in postmenopausal women as a painless breast lump with possible bloody nipple discharge. Prognosis is favorable due to its slow growth. We present a 61-year-old woman incidentally diagnosed with papillary breast carcinoma after presenting with a trauma-induced hematoma of the right breast. The patient presented to our surgery oncology clinic for persistent right breast swelling secondary to a fall, despite initial incision and drainage (I&D) six weeks prior. She had no history of breast cancer. On presentation, her right breast was distended demonstrating an approximately 20cm ill-defined solid mass with skin changes consistent with a tense hematoma. CT scan demonstrated a large complex cystic and solid breast mass measuring 15.2cmx11.8cmx15.2cm with irregular peripheral solid hyperdense polypoid components. She then underwent a right breast incisional biopsy and hematoma evacuation. Frozen sections of the mass outer cavity wall and papillary projections were consistent with encapsulated papillary carcinoma (EPC). The patient was lost to follow-up and did not obtain definitive treatment. Breast cancer rarely presents as a breast hematoma. However, as in this case, if the hematoma fails to resolve, further investigation is warranted. The prognosis of EPC is excellent when identified and treated appropriately.

Encapsulated papillary carcinoma with and without frank invasion: Comparison of clinicopathologic features and role of axillary staging.

To investigate clinical and pathologic features of encapsulated papillary carcinomas (EPCs) that may be associated with invasive disease and characterize the axillary staging practices for EPCs at our institution. A pathology database search for cases containing "papillary carcinoma" was performed. Slides were reviewed by two pathologists. Clinicopathological features and axillary staging practices of EPCs with and without invasion were compared. Twenty-five cases of EPCs were identified. Fifteen cases contained a frank invasive tumor (60%), which were all pT1 (0.7 ± 0.56 cm), and the majority were ER-positive, HER2-negative, low-grade IDC-NST. Seventeen patients underwent sentinel lymph node biopsies (SLNB). No nodal metastases were identified. Follow-up was available for 24 patients (mean = 39 ± 29 months); 23 had no NED. Patients that presented with a self-palpated mass (versus screening) were more likely to have an invasive component; however, no pathologic or radiologic features differentiated EPCs with and without frank invasion. Pathologic and radiologic characteristics did not differentiate EPCs with and without frank invasion. EPCs have an excellent prognosis supported by the notable disease-free survival and negative nodal status in our cohort, which supports the notion that patients with EPCs may forgo axillary staging.

Intracystic Papillary Breast Cancer in a 16-Year-Old Patient.

BACKGROUND: Primary breast cancer in the pediatric population is rare. To our knowledge, no cases of intracystic papillary carcinoma have been reported in patients younger than 21 years. CASE: A 16-year-old patient presented with a retroareolar mass and bloody nipple discharge in her left breast. A biopsy established papillary intracystic carcinoma. The patient was treated surgically and a risk reduction strategy developed in a multidisciplinary session was implemented.

Intracystic papillary carcinoma of the male breast: Dilemmas in diagnosis and management.

Intracystic papillary carcinoma (IPC) is a rare malignancy of the breast which is usually found in postmenopausal women. It is still rarer in males and may present with signs of a benign cystic lump. It is sub-classified into three equally prevalent groups considering treatment strategies: intracystic papillary carcinoma alone, intracystic papillary carcinoma with ductal carcinoma in-situ, and those with evidence of invasion. Even if a preoperative diagnosis is achieved, there are no specific guidelines for the treatment of IPC. Treatment modalities including the extent of surgical excision, lymph node dissection, radiation, and chemotherapy are determined by the grade and size of the lesion and sub-types. However, several reports and studies showed good prognosis with conservative surgery without axillary dissection in IPC not associated with carcinoma in situ or micro-invasion. We present a 40 years old male patient with IPC who was managed by modified radical mastectomy and adjuvant hormone therapy. A brief review of the literature and clinical characteristics, pathology, and treatment of IPC are discussed.

Encapsulated Papillary Carcinoma of the Breast: Imaging Features with Histopathologic Correlation.

Encapsulated papillary carcinoma (EPC) is a rare, clinically indolent breast malignancy most common in postmenopausal women. Absence of myoepithelial cells at the periphery is a characteristic feature. Mammographically, EPC typically presents as a mostly circumscribed, noncalcified, dense mass that can have focally indistinct margins when there is associated frank invasive carcinoma. Ultrasound shows a circumscribed solid or complex cystic and solid mass, and occasional hemorrhage in the cystic component may produce a fluid-debris level; the solid components typically show intense washout enhancement on MRI. Color Doppler may demonstrate a prominent vascular pedicle and blood flow within solid papillary fronds. Encapsulated papillary carcinoma can exist in pure form; however, EPC is often associated with conventional ductal carcinoma in-situ and/or invasive ductal carcinoma, no special type. Adjacent in-situ and invasive disease may be only focally present at the periphery of EPC and potentially unsampled at core-needle biopsy. In order to facilitate diagnosis, the mass wall should be included on core-needle biopsy, which will show absence of myoepithelial markers. Staging and prognosis are determined by any associated frankly invasive component, with usually excellent long-term survival and rare distant metastases.

Intracystic papillary breast carcinoma with DCIS in a man: a case report.

Here we report a case of 50-mm lump within the left breast in a 56-year-old man. The patient underwent left total mastectomy and sentinel node biopsy. The pathology report showed low-grade intracystic papillary breast carcinoma surrounded by ductal carcinoma in situ. Sentinel node biopsy was negative. The patient was prescribed five years tamoxifen.

Lesiones papilares malignas de la mama: nuestra experiencia / Malignant papillary lesions of the breast: our experience

Objetivo Este trabajo tiene como objetivo evaluar las características de las lesiones papilares malignas diagnosticadas en una obra social durante el período que abarca desde marzo de 2007 hasta agosto de 2015. Material y método Se realizó un análisis retrospectivo descriptivo de corte trasversal donde se incluyeron 56 pacientes con diagnóstico de Carcinoma ductal in situ papilar (cdis papilar), Carcinoma papilar encapsulado y Carcinoma papilar invasor. Se evaluaron las características clínicas, imagenológicas y anatomopatológicas. Conclusiones Las lesiones papilares malignas representan un desafío para el diagnóstico y manejo del equipo tratante dada su baja frecuencia y constante revisión de criterios diagnósticos y de manejo posterior

Objective The aim of the current study is to evaluate the characteristics of malignant papillary lesions diagnosed during march 2007 through agost 2015. Materials and method Retrospective and descriptive analysis has been made incluiding 56 patients with pathological diagnostic of papillary dcis, encapsulated carcinoma and invasive papillary carcinoma. We analyzed clinical characteristics, form of presentation in radiological features and pathological findings. Conclusions Papillary lesions of the breast represent a challenge for diagnostic an clinical management for clinicians involved, due to low frequency and a lack of clinical guidelines

Encapsulated Papillary Carcinoma in A Man with Gynecomastia: Ultrasonography, Mammography and Magnetic Resonance Imaging Features with Pathologic Correlation.

Male breast cancer is an uncommon disease that constitutes 1% of all breast cancers and encapsulated papillary carcinoma (EPC) is a rare subtype of malignant male diseases. Gynecomastia is the most common disease of the male breast. We report a 63-year-old male patient with EPC accompanied by gynecomastia that was diagnosed and treated at our breast center. Mammography showed an oval-shaped dense mass with circumscribed margins on the ground of nodular gynecomastia. On ultrasonographic exam, we saw a well-circumscribed complex mass with a solid component which was vascular on Doppler ultrasonography. Magnetic resonance imaging revealed a complex cystic mass containing solid components. Dynamic images showed enhancement of the cystic mass wall and mural components. Tumor stage was evaluated as T2N0. The lesion's histologic examination and immunohistochemical analysis by showing no myoepithelial layer revealed an encapsulated papillary carcinoma. To our knowledge, this is the first case report which describes MR imaging findings of male breast encapsulated papillary cancer.

Intracystic papillary carcinoma of the breast: Experience of a major Chinese cancer center.

BACKGROUND: Intracystic papillary carcinoma (IPC) is a rare breast neoplasm. There are few studies focusing on its clinical features and limited data about its preoperative diagnosis,treatment and outcomes. The purpose of this study is to explore specific characteristics of patients with IPC, investigate its clinicopathological features, prognosis in China and confirm its surgery management. METHODS: We identified 111 patients with IPC from the registry of Tianjin Medical University Cancer Institute and Hospital between 2004 and 2017. Follow-up of cases dating back to January 1, 2004 was obtained from retrospective chart review and patient questionnaires. Differences in clinical features and survival of patients were assessed using the Kaplan-Meier method. RESULTS: The median tumor size was 2.25 cm. Median age was 62 years. In the cases of axillary lymph node dissection(ALND), only 1.1% (1/85) of patients with axillary lymph node metastasis were found. The diagnostic accuracy of preoperative Color Doppler ultrasound and Mammograms for IPC was 62.0% (62/100) and 63.5% (54/85) respectively. The median follow-up period was 52 (range2-149) months. The overall survival rate was 98.9%, 92.2%,and 85.6% at 2,5,and 10 years and the relapse-free rate was 99.1%,97.2%,and 92.0% at 2,5, and 10 years, respectively. The disease-specific survival rate was 100%. CONCLUSION: Overall, we report some unique features of IPC in the Chinese population. The patients of IPC of the breast in China have more excellent prognosis than in Caucasian and other races. The diagnostic accuracy of imaging was low, and was easily misinterpreted as a cyst or benign disease. Preoperative core needle biopsies are very difficult for accurate pathological diagnosis of IPC. IPC is a localized disease with a low frequency of axillary lymph node involvement, rare distant metastases and excellent survival. The low incidence of axillary lymph node metastasis suggests that quadrectomy + sentinel lymph node biopsy (SLNB) and breast-conserving surgery is recommended for IPC.

Intracystic papillary carcinoma of the male breast: a case report.

BACKGROUND: Intracystic papillary carcinoma (IPC) is defined as cancer that develops from the wall of a cyst in the breast. As breast cancer in men accounts for only 1% of all breast cancers, male IPC is an extremely rare form of the disease. The present case report examines IPC in a man, along with an in-depth literature discussion. CASE PRESENTATION: A 64-year-old Japanese man noticed a mass in the right breast and sought medical attention. An elastic and soft neoplastic 3-cm lesion was palpated in the right papilla. As a 1-cm solid tumor with a gradual rise from the cyst wall was confirmed within the cyst, vacuum-assisted biopsy (VAB) was performed on that site. Pathological examination of the biopsy revealed heterotypic cells with an enlarged oval nucleus forming dense papillary structures mainly of vascular connective tissue component. Contrast-enhanced computed tomography (CT) confirmed thickening of the wall that protruded outside the cyst. The preoperative diagnosis was right breast cancer (male IPC) TisN0M0 stage 0 luminal B-like. Total mastectomy and sentinel lymph node biopsy were performed. In the excised specimen, a 4.0-cm unilocular cyst was found, along with a 1-cm solid tumor with a gradual rise from the cyst wall. Pathological diagnosis of the resected specimen shared similar characteristics with the solid tumor in the cyst: notably, an oval nucleus with histologically clear nucleolus and fine granular chromatin, cylindrically shaped heterotypic cells, and the presence of basophilic cells in the papillary growth with a thin stem of fibrovasculature as the axis. Some invasion of tumor cells into the interstitium was confirmed. As such, the final diagnosis was right breast cancer (male IPC) T2N0M0 stage IIA luminal B-like. The expression of hormone receptor (ER and PgR) was high, and endocrine therapy was initiated postoperatively (20 mg/day tamoxifen). At the present time (3 months postoperation), there has not been any evidence of metastasis. CONCLUSIONS: We reported a rare case of an IPC in the male breast, along with a literature review.

Can Sentinel Lymph Node Biopsy Be Spared in Papillary Carcinoma of the Breast?

BACKGROUND: Papillary carcinoma (PC) of the breast represents ∼0.5% of all newly diagnosed cases of breast cancer and usually has an indolent course. The current data suggest lack of a consensus in the surgical management of this disease. Because patients can occasionally develop metastatic disease, sentinel lymph node (SLN) biopsy is often performed during surgery. MATERIALS AND METHODS: In the present study, we retrospectively evaluated the histologic characteristics of 99 cases of PC with or without associated frank invasive carcinoma, including 43 encapsulated or intracystic PCs, 24 solid PCs, and 32 intraductal PCs, and correlated these with the incidence of nodal metastasis. RESULTS: Of the 99 cases, 64 were tumor stage Tis (noninvasive), 5 were T1 microinvasive, 17 T1a, 5 T1b, 5 T1c, and 3 were T2. A total of 37 patients (37%) underwent axillary staging, including 31 SLN biopsies and 6 axillary dissections. Only 1 patient (2.7%) with noninvasive solid PC had evidence of nodal metastasis. Follow-up information was available for 81 patients, with a mean follow-up period of 4.9 years (range, 1-13 years). Two local recurrences, no distant metastases, and no disease-related deaths were recorded. CONCLUSION: PC rarely involves the lymph nodes even in tumors with an associated frank invasive component, and the overall prognosis and long-term survival is excellent. We propose that evaluation of the SLN should not be routinely indicated for patients with PC treated by local control lumpectomy.

Intracystic Papillary Carcinoma of the Breast in a Male Patient.

We report a case of intracystic papillary carcinoma of the right breast in a 59-year old man presenting with bloody nipple discharge for 1 week prior to presentation. Mammography, ultrasonography, and core needle aspiration were consistent with intracystic papillary carcinoma. The patient underwent right simple mastectomy. Pathology was also consistent with low grade intracystic papillary carcinoma. The 21-gene assay revealed a recurrence score of 0, corresponding to a 3% risk of distant recurrence at 10 years. A patient did not receive chemotherapy or post-mastectomy radiotherapy. The patient was placed on tamoxifen and has been free of disease to date.

Intracystic papillary carcinoma of the breast: A SEER database analysis of implications for therapy.

BACKGROUND: Intracystic papillary carcinoma (IPC) of the breast is a rare breast malignancy with an indolent course. However, patients can develop metastatic disease. Indications for surgery and radiotherapeutic management have not been well elucidated. METHODS: We identified 2649 female patients with IPC 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: Median age was 67 years. The majority of patients were white with Stage 0 disease. Most patients had lymph node evaluation and only 34% received radiation therapy. Using a log-rank test, survival was significantly better in Caucasian compared to African-American patients, patients with early stage disease, negative lymph nodes and those who received radiation (all p < 0.0001). In a Cox regression survival model adjusting for age, stage and grade, patients who were African-American (hazard ratio [HR] 2.0, CI 1.4-2.8; p < 0.0001) had a significantly higher risk of death than Caucasians. Patients who received radiation therapy (HR 0.5, CI 0.3-0.7; p = 0.0003) had a lower chance of death than patients that did not undergo radiation. CONCLUSION: Overall, IPC has a good prognosis. Survival is improved in Caucasian patients and in patients who receive radiation therapy. Radiation therapy should be offered to women with IPC who undergo breast conserving surgery.

Carcinoma papilar intraquístico de la mama. Reporte de un caso / Intracystic papillary carcinoma of mamma. Case report

El carcinoma papilar intraquístico es una forma rara de cáncer de mama, con una incidencia del 0,5-1 % de todos los cánceres de mama. Es un tumor que predominantemente afecta a las mujeres de avanzada edad. Aunque esta rara entidad se creyó que era una variante de carcinoma ductal in situ, algunas lesiones pueden ser tumores de bajo riesgo de invasividad. El tumor tiene un excelente pronóstico sin tener en cuenta que sea in situ o invasivo. Por lo tanto, un diagnóstico preciso juega un papel crucial en el manejo de pacientes con esta entidad. Se reportó un caso de carcinoma papilar intraquístico, en una mujer de 75 años de edad. Entre los hallazgos patológicos se encontró que el tumor midió 2 cm y se encontraba situado en el cuadrante inferoexterno de la mama derecha. En el ultrasonido realizado se informó una imagen “ecolúcida”, de bordes bien definidos, y en la mamografía se planteó la presencia de una imagen nodular de contornos irregulares. El diagnóstico histopatológico fue el de un carcinoma papilar no invasivo, dentro de una lesión quística que midió 1 cm, con nódulo sólido en su interior de 0,5 cm con grado nuclear bajo. Se le realizó una tumorectomía amplia. Actualmente se mantiene bajo control. Para la confección del presente trabajo se consultó 17 materiales entre revistas y libros de Cirugía. El mismo se propuso reportar un caso de carcinoma papilar intraquístico, demostrando cuan extraño resulta esta patología para los especialistas del tema.

The intracystic papillary carcinoma is a rare form of mamma cancer, with an incidence of 0.5-1 % of all mamma cancers. It is a tumor predominantly affecting women in advanced age. Although it was believed that this rare entity was a variant of ductal carcinoma in situ, some lesions might be tumors of low risk invasiveness. The tumor has an excellent prognosis despite being in situ or invasive one. Therefore, the precise diagnosis plays an important role in the management of patients with this entity. We report the case of an intracystic papillary carcinoma in a woman aged 75 years. Among other pathological findings, the tumor was 2 cm and was located in the low external quadrant of the right mamma. In the carried out ultrasonography, it was informed an echo lucid image, of well defined edges, and the mammography showed the presence of a nodular image with irregular edges. The histopathologic diagnosis was non-invasive papillary carcinoma, inside a 1 cm cystic lesion, with an 0,5 cm solid nodule inside of low nuclear grade. A wide tumorectomy was carried out. Currently it is controlled. For the elaboration of the current paper we consulted 17 materials of journals and Surgery textbooks. The aim was reporting an intracystic papillary carcinoma case, showing how rare this pathology is for the specialists on the theme.