"Intracystic papillary breast cancer: a clinical update"

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.

Encapsulated Papillary Carcinoma: A Case Report and Review of the Literature

Papillary neoplasms are a distinct assemblage of breast lesions whose main characteristic is the presence of fibrovascular cores which are surrounded by epithelial cells. Papillary lesions are of heterogenous nature, with similar clinical behavior and histomorphologic characteristics. Their biological patterns, however, can be quite different. According to the World Health Organization (WHO) (2019), breast tumors have been recently classified into five subdivisions of papillary neoplasms. They are namely: intraductal papilloma, papillary ductal carcinoma in situ, encapsulated papillary carcinoma (EPC), solid-papillary carcinoma and invasive papillary carcinoma. Despite the papillary architecture being easily recognized, histological variations are diagnostically challenging. The presence or absence of myoepithelial cells in the papillary cores can distinguish the malignant from the benign lesions respectively. EPC is a rare, histologically unique carcinoma type whose main characteristic is a thick fibrous capsule at the periphery and a prolific cell structure with fibrovascular stalk support. A characteristic feature is the absence of myoepithelial cells at the surrounding thick fibrous capsule. Usually, EPC maintains a slowly developing tumor despite the absence of myoepithelial cells. An EPC case presents diagnostic difficulties since it bears close resemblance to malignant and benign papillary breast lesions. Upon a clinical and radiological evaluation, EPC commonly appears as a benign lump. In mammography, the tumor is frequently found in a retroareolar position as a well-defined mass. On the other hand, in an ultrasound, the tumor will appear as a cystic lesion characterized by solid components. The clinical picture of EPC is usually an asymptomatic benign mass which at times can be felt through auto-palpation or screening mammography. A bloody nipple discharge is regarded as a common symptom. We report a case of an EPC of a 81-year-old woman who presented with a mass in the left breast.

Diagnosis, treatment, and outcomes of encapsulated papillary carcinoma: a single institution experience

Background.

Encapsulated papillary carcinoma (EPC) is a rare entity of breast cancer accounting for approximately 1–2% of all breast tumours. There are no evidence-based guidelines for the treatment of EPC.

Materials and methods.

From the database of the National Centre of Pathology (NCP), we obtained pathology reports of 19 patients with histologically confirmed EPC, who were treated at the National Cancer Institute (NCI) in Vilnius, Lithuania, between July 2009 and July 2015. Demographic, diagnostic and treatment data were collected from medical records retrospectively.

Results.

During the indicated period, 19 patients with EPC were treated at the NCI. Three of them had pure EPC, they were 74 to 81 years of age at the time of diagnosis (mean 76.7 years, median 75 years); all of them are still alive and no disease progression has been observed. Seven patients had EPC associated with carcinoma in situ. Nine patients had EPC associated with invasive breast ductal carcinoma. All patients underwent surgery, in most cases – wide local excision. Only one patient died.

Conclusions.

EPC is a rare form of breast cancer and usually presents with an invasive breast carcinoma or carcinoma in situ in postmenopausal women. Tumours have an excellent prognosis in the cases of pure EPC and in both EPC associated with carcinoma in situ (CIS) and invasive carcinoma.

Intracystic Papillary Carcinoma in Male Breast with High Nuclear Grade: A Case Report

Intracystic papillary carcinoma (IPC) in men is an extremely rare disease that accounts for less than 1% of all malignancies with only a few case presentations published so far. This report presents a case of 53-year-old male, who presented a painless swelling of his left breast. The left breast mass was 6 cm maximally and was found to be non-invasive IPC. The tumour is consistently positive for GCDFP-15, ER or PR and negative for HER-2. It consists of predominantly fibrovascular stromal lined by monotonous epithelial cells retaining intermediate to high histological grade with a high nuclear cytoplasmic ratio. In addition, increased numbers of mitotic figures were also seen. Chest X-ray, liver ultrasound and bone centigram showed no evidence of distant metastases. In short, this is the first case report from Saudi Arabia of a male having IPC, with increased number of mitotic figures and high nuclear grades.

Intracystic Carcinoma of the Breast: Report of Two Cases

Intracystic papillary carcinoma of the breast (IPC) is usually seen in postmenopausal elderly women. Its prognosis is much better than other type of breast tumors, and usually do not contain invasive components. Surgical excision with negative margins and axillary sentinel lymph node sampling is the recommended treatment. Two cases of intracystic papillary carcinoma of the breast that was treated at our clinic are herein presented. Both cases were postmenopausal, were both positive for estrogen and progesterone receptors and negative for HER 2. They underwent breast-conserving surgery. One patient had an invasive focus, therefore axillary lymph node sampling was performed, and the sentinel lymph node was not metastatic. This patient received hormonal therapy as well as radiotherapy. In the other case, there was no invasive focus and the surgical margins were negative, therefore, additional surgery was not performed. The patient is receiving hormonal therapy. Intracystic carcinoma of the breast should be kept in mind especially in elderly patients with breast cysts, with clinically or radiologically suspicious features, and biopsy and local excision should be considered. Although there is not any standard approach for patients with IPC, each patient must be evaluated for surgery and should be individually assessed in terms of adjuvant therapy.