AJR 2003; 181:186
© American Roentgen Ray Society
Radiologic–Pathologic Conferences of The University of Texas
M. D. Anderson Cancer Center |
Intracystic Papillary Carcinoma of the Breast
Basak Erguvan Dogan1,2,
Gary J. Whitman1,
Lavinia P. Middleton3 and
Michael Phelps1,4
1 Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer
Center, 1515 Holcombe Blvd., Box 57, Houston, TX 77030.
2 Present address: Department of Radiology, Ankara University, Sihhiye, Ankara
06100, Turkey.
3 Division of Pathology, The University of Texas M. D. Anderson Cancer Center,
Houston, TX 77030.
4 The University of Houston, Houston, TX 77204.
Received December 11, 2002;
accepted after revision December 23, 2002.
Address correspondence to G. J. Whitman
(gwhitman{at}di.mdacc.tmc.edu).
A57-year-old woman presented with a palpable abnormality in the upper outer
right breast. Findings on mammography showed a 1.4-cm well-circumscribed round
mass in the right breast at the 10-o'clock position
(Fig. 1A). On sonography, the
mass had internal echoes and gently lobulated borders with some
through-transmission (Fig. 1B).
Sonographically guided core biopsy (Fig.
1C) revealed atypical papillary proliferation suggesting
intracystic papillary carcinoma. The patient underwent right segmental
mastectomy. The histopathologic diagnosis was intracystic papillary carcinoma
(Fig. 1D).
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Fig. 1C. —57-year-old woman with intracystic papillary carcinoma.
Sonographically guided core biopsy of mass (arrows) performed with
18-gauge needle (arrowheads) demonstrated atypical papillary
proliferation.
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Fig. 1D. —57-year-old woman with intracystic papillary carcinoma.
Photomicrograph of histologic specimen shows fibrotic cyst wall and monotonous
papillary projections emanating from fibrovascular cores. (H and E, low
power)
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Intracystic papillary carcinoma of the breast is a rare malignant tumor,
constituting 1—2% of all breast carcinomas
[1]. Intracystic papillary
carcinoma, which may be unifocal or multifocal, has a propensity to occur in
postmenopausal women. Women with intracystic papillary carcinoma may have no
symptoms, a palpable mass, or may present with bloody nipple discharge.
On mammography, intracystic papillary carcinoma is often seen as a round or
oval circumscribed mass, most frequently in the retroareolar region
[2,
3]. Sonography usually reveals
a cystic mass, with or without septations, with solid papillary masses
projecting into the cyst lumen
[2,
3]. Although most papillary
carcinomas are cystic masses, some may be mixed in composition with
predominantly solid components. In some patients, such as this one, a cyst is
not seen on sonography, and the term "solid papillary carcinoma"
may be appropriate. Sonography may be useful for showing wall thickening and
adjacent anechoic and hyperechoic areas that may represent hemorrhage
resulting from ruptured capillaries within the cyst wall or hemorrhagic
infarction of the tumor cells
[4].
Fine-needle aspiration and core needle biopsy may be unable to distinguish
between in situ and invasive papillary lesions because the center of the
lesion is often targeted, and invasion is often identified at the periphery of
the tumor. Therefore, in general, excision is suggested when papillary lesions
are suspected or diagnosed at fine-needle aspiration or core needle biopsy. At
pathologic examination, intracystic papillary carcinoma is usually a
well-circumscribed mass with a cystic component containing a nodular or a
papillary inner surface. The most common histologic feature is arborization of
the fibrovascular stroma. A monotonous cell population, the presence of
mitoses, and the lack of myoepithelial cells confirm the diagnosis of
intracystic papillary carcinoma.
Intracystic papillary carcinoma has a slow growth rate and an excellent
prognosis. The 10-year survival rate has been reported to be 100%
[5]. Segmental mastectomy is
usually performed, and axillary lymph node sampling (axillary lymph node
dissection or sentinel lymph node mapping) is suggested in patients in whom
invasion is likely.
References
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sonographic appearance. Radiology1989; 171:377
—379[Abstract/Free Full Text]
- Soo MS, Williford ME, Walsh R, Bentley RC, Kornguth PJ. Papillary
carcinoma of the breast: imaging findings. AJR1995; 164:321
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