Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis

Papillary carcinoma (PC) of the breast, which accounts for 0.5% to 1% of breast cancer, is a distinct histologic subtype that is characterized by malignant epithelial proliferation supported by fibrovascular stalks. However, the classification of PC (whether they are in situ or invasive), its behavior, and management remain a matter of debate. METHODS: In this study, we reviewed 302 PCs including 247 pure PCs without coexisting conventional non-PCs collected from 3 institutions. This included 208 (84%) intracystic PCs (IPC), 30 (12%) solid PCs (SPC), and 9 (4%) papillary ductal carcinoma in situ (DCISs). In addition, previous studies of PC were reviewed. This included 339 pure PCs of a total of 521 PC patients. Clinical and outcome analyses were carried out to assess nature and behavior of these lesions and to determine their optimal outcome-based management. RESULTS AND CONCLUSIONS: SPC is more frequently associated with coexisting conventional invasive carcinoma than IPC (P<0.05). Although the majority of papillary DCIS and some cases of IPC and SPC (both called encapsulated PC) that are surrounded by an intact layer of myoepithelial cells are considered to be true in situ lesions, PC lacking a peripheral layer of myoepithelial cells can be regarded as a special type of invasive carcinoma associated with low incidence of stromal/skeletal muscle invasion, low frequency of lymph node metastasis (3%), and infrequent development of local or distant recurrence. These lesions are therefore characterized by indolent behavior and extremely favorable prognosis. Encapsulated PC can be treated with adequate local therapy. Routine use of adjuvant therapy, particularly chemotherapy, is clearly not appropriate in view of the very low risk of subsequent events. However, hormonal therapy may be indicated in certain cases such as recurrent PC.     

Intracystic papillary carcinoma in the male breast

Intracystic papillary carcinoma is an uncommon noninvasive breast cancer with an excellent prognosis. We report the case of a 74-year-old man. Of the diagnostic tests performed, ultrasonography and pneumocystography were useful for establishing a diagnostic suspicion, however, puncture cytology was inaccurate. Excisional biopsy was necessary to confirm the disease, but also to indicate that local treatment was sufficient.     

Gallbladder metastases from ductal papillary carcinoma of the breast

Breast cancer occurs primarily in women aged 25 years or older. Breast carcinoma has the potential for widespread dissemination, such as metastasis to axillary lymph nodes, bone, lung, pleura, brain, and soft tissues. Liver, gastrointestinal, and biliary tract involvement are infrequent. We report a patient, a 62-year-old woman, with symptomatic cholelithiasis. The patient proceeded to laparoscopic cholecystectomy. She had a previous history of mastectomy with axillary lymphadenectomy, performed for a breast ductal papillary carcinoma, 10 years prior to the cholecystectomy. The gallbladder was hydropic; the wall was thickened, with a focal broad-based lesion on the mesenteric face of the body. Histopathological evaluation of the focal broad-based lesion of the gallbladder revealed poorly differentiated adenocarcinoma infiltration, without mucosal involvement. Subsequent immunohistochemical examination showed the lesion to be cytokeratin 7(CK7)-positive and cytokeratin 20 (CK20)-negative. Estrogen receptor (ER) and progesterone receptor (PgR) were positive. The final pathological diagnosis was breast ductal papillary carcinoma metastases to the gallbladder. Mammography of the other breast was normal. Computed tomography (CT) scan of the brain, chest, abdomen, and pelvis was performed, without any pathological findings. Bone Tc-99 scintigraphy was normal. Six months after the surgery positron emission tomography (PET) showed no evidence of metastatic disease. Two years after the surgery, the patient died, in the absence of recurrence. A literature review revealed only a few more cases of metastasic breast carcinoma to the gallbladder.     

Clinical and pathological features of intracystic papillary carcinoma of the breast

Purpose  To evaluate the clinicopathological features of intracystic papillary carcinoma (ICPC), which have not been established given its rarity and lack of standard diagnostic criteria. Methods  We reviewed the clinicopathological findings and treatment outcomes of 14 patients with ICPC diagnosed between 2002 and 2006. Results  Intracystic papillary carcinoma was diagnosed by fine-needle aspiration biopsy in three patients and by core-needle biopsy in six patients. A preoperative diagnosis was not made in five patients. Three patients underwent magnetic resonance imaging preoperatively, which helped to differentiate benign tumors and maintain free surgical margins. The final pathological diagnosis was invasive carcinoma in 2 (14.2%) of the 14 patients. The patients were followed up for 1–72 months, during which time only one died, of a cancer-unrelated cause. Conclusion  Our results show that ICPC is more difficult to diagnose than common breast cancer preoperatively. Excisional biopsy was necessary when fine-needle aspiration and core-needle biopsy could not provide a diagnosis. Magnetic resonance imaging is helpful to differentiate a benign tumor from invasive disease.     

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.     

乳腺乳头状癌的临床病理特征和分子免疫表型

目的 探讨乳腺乳头状癌的临床病理特征、分子免疫表型及预后.方法 对320例乳腺乳头状癌手术切除标本的病理切片进行观察和免疫组织化学染色,结合临床资料进行统计学分析.结果 导管内乳头状癌5年总生存率(95.38％比83.90％)及无瘤生存率(92.31％比79.66％)均高于浸润性乳头状癌.浸润性乳头状癌分属于5个分子亚型,其中Lumira-A 型5年生存率(91.43％)高于Her-2 (71.43％)和三阴性型(68.42％),差异均有统计学意义(P＜0.05).结论 乳腺浸润性和非浸润性乳头状癌有不同的临床病理学特征,浸润性乳头状癌的分子表型也具有重要意义.     

Treatment and outcome of patients with intracystic papillary carcinoma of the breast

BACKGROUND: Intracystic papillary carcinoma (IPC) of the breast is a rare form of noninvasive breast cancer. An appreciation of associated pathology with IPC may be critical in surgical decision-making. METHODS: The medical records of all patients with IPC treated between 1985 and 2001 were retrospectively reviewed. Three patient groups were identified according to the pathologic features of the primary tumor: IPC alone, IPC with associated ductal carcinoma in situ (DCIS), and IPC with associated invasion with or without DCIS. Types of treatment and outcomes were compared between groups. RESULTS: Forty patients were treated for IPC during the study period. Fourteen had pure IPC, 13 had IPC with DCIS, and 13 had IPC with invasion. The incidence of recurrence and the likelihood of dying of IPC did not differ between the three groups regardless of the type of surgery (mastectomy or segmental mastectomy) performed and whether radiation therapy was administered. The disease-specific survival rate was 100%. CONCLUSIONS: When IPC is identified, it is frequently associated with DCIS and or invasion. Standard therapy should be based on associated pathology. The role of radiation therapy in pure IPC remains to be determined.     

Noninvasive intracystic papillary carcinoma of the male breast. A case report

Ductal carcinoma in situ (DCIS) represents between 0% and 7% of breast cancers diagnosed in men. Noninvasive intracystic papillary carcinoma is a form of DCIS and is therefore an extremely rare presentation of breast cancer. The imaging technique that provides the greatest information on these lesions is ultrasonography. Treatment of DCIS in men continues to be controversial. We present a case of noninvasive intracystic papillary carcinoma treated with partial mastectomy followed by radiotherapy and tamoxifen therapy. After 1 year of follow-up, the patient shows no signs of recurrence.     

Clinicopathologic analysis of solid papillary carcinoma of the breast and associated invasive carcinomas

Solid papillary carcinomas (SPCs) are uncommon tumors composed of circumscribed large cellular nodules separated by bands of dense fibrosis. The aim of this study was to further elucidate the characteristics of SPC, the types and significance of invasive carcinomas associated with these tumors, and the long-term clinical outcome. Fifty-eight SPCs were analyzed (mean follow-up, 9.4 years). Cases were divided into three groups: 1) SPC only (32.7%), 2) SPC with extravasated mucin (8.6%), and 3) SPC with invasive components (58.7%) consisting of neuroendocrine-like (29.5%), colloid (23.5%), ductal not otherwise specified (14.5%), lobular (3%), tubular (3%), or mixed (26.5%). The mean age was 72 years. All were estrogen receptor positive and 86% were histologic grade 1. The total size of the tumor measured 0.3 to 15 cm. In the group with invasive carcinoma, the size of invasion was 0.1 to 4 cm. Axillary nodes were involved in 13% of the cases (6 of 46); all of these had an invasive component in the primary tumor. Local recurrence was seen in 5 patients, all from the group with invasive carcinoma. Overall, 11.7% died of their tumor, 1 to 4 years after diagnosis (mean, 2.3 years); none of them belongs to the group of noninvasive SPC. Five of the 6 patients who died of tumor had invasive components. The sixth patient who died with "metastatic signet-ring cell carcinoma" at 10 years was in the group of patients with SPC with extravasated mucin where the SPC lesion had prominent signet-ring cell features. In conclusion, SPCs are heterogeneous lesions that arise in older women and have an indolent behavior. Lymph node and distant metastases are uncommon and generally limited to cases with (conventional) invasive components.     

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.     

A giant papillary carcinoma of the breast treated with mastectomy and bipedicled TRAM flap

Although the surgical treatment of breast cancer has become more conservative in the last decades, some patients still arrive at the first physical examination with advanced diseases and with large skin infiltration. We report an unusual case of giant invasive papillary carcinoma of the breast underwent mastectomy and reconstruction with a bipedicled transverse rectus abdominis myocutaneous (TRAM) flap.     

经胸乳入路内镜手术治疗甲状腺乳头状癌85例临床分析

目的 探讨经胸乳入路内镜手术治疗甲状腺乳头状癌的可行性、有效性及安全性.方法 回顾性分析2006年3月至2010年3月间浙江大学医学院附属第二医院内镜手术治疗的85例甲状腺乳头状癌患者的临床资料.结果 84例患者手术成功,平均手术时间113.3 min.84例均行中央区清扫,其中12例怀疑颈侧区淋巴结转移者加行患侧颈侧区清扫.平均清扫淋巴结数目在中央区为6.5个,在颈侧区为19.2个.6例(7.14%,6/84)出现术后暂时性声音嘶哑,4例(4.76%,4/84)术后发生一过性低血钙症状.随访9～57个月,B超和ECT提示患侧无残留腺体,局部无复发,颈部外观良好,所有患者对手术效果均满意.结论 内镜甲状腺手术治疗严格选择的甲状腺乳头状癌是安全可行的,但其远期效果还有待长期随访观察.

Abstract：

Objective To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest and breast for the treatment of patients with papillary thyroid carcinoma ( PTC ).Methods Endoscopic thyroidectomy was performed in 85 PTC patients between March 2006 and March 2010. Diagnosis was based on intraoprative frozen section. There were 83 females and 2 males, age averaged at 36. 3 years. Sixty three of 85 cases were diagnosed preoperatively as thyroid carcinoma and US revealed ipsilateral cervical lymph node enlargement suspective of metastasis in 12 cases. Endoscopic thyroidectomy plus selective neck dissection was performed. Results This procedure was carried out successfully in 84patients. There were 51 cases of papillary thyroid microcarcinomas(<1. 0 cm) , 28 cases between 1. 0 cm and<2. 0 cm, and 5 cases with the diameter between 2. 0 cm and 3. 0 cm. Total thyroidectomy, ispilateral lebectomy and ispilateral lebectomy plus contralateral subtotal lobetomy were performed in 4, 6, 74 cases,respectively. Central compartment dissection was performed in all of the 84 cases and ipsilateral neck dissection was also performed in 12 cases that were suspected metastatic lateral neck lymph nodes. The mean operative time was (113. 3 ±46. 5) minutes. No significant blood loss occurred. The mean number of lymph nodes yield in the central compartment and lateral compartment were 6. 5 (range 2 to 14) and 19. 2 (range 9 to 26 ), respectively. Forty-four cases ( 44/84, 52. 4% ) had metastatic lymph nodes in central compartment, while 11 cases (11/12,91.1% ) in lateral compartment. Six patients (6/84,7.14%) had transient vocal cord palsy and recovered after 1-2 months. Postoperative transient hypocalcaemia occurred in 4 cases (4. 8% ) , and there were no other major complications. The average postoperative hospital stay was 3. 7 days (range 3 to 6). No evidence of residual or recurrent disease was found at follow-up. The cosmetic results of this procedure were excellent. Conclusions The anterior chest and breast approach of endoscopic thyroidectomy is feasible and safe and cosmetic worthwhile for selected cases of PTC.     

Risk of invasive breast cancer and ductal carcinoma in situ in women with atypical papillary lesions of the breast

Abstract: Benign papillary lesions of the breast include papilloma and papillomatosis. A retrospective analysis of patients with a papillary breast lesion diagnosed between October 1992 and December 2009 was performed. Patients were excluded if they had a previous or concurrent diagnosis of invasive or in situ cancer or less than 6 months of follow‐up. The Kaplan–Meier method was used to determine the risk of developing subsequent malignancy. The log rank test was used to compare groups of patients. Median follow‐up for the 167 patients included in the study was 4.6 years. Fifty‐one patients had a papillary lesion with atypia and 116 patients had a papillary lesion without atypia. Patients with a papillary lesion with atypia were more likely to develop invasive or in situ breast cancer with a 5 year risk of 13.0% versus 4.6% in patients with no atypia (p = 0.03).     

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

BackgroundIntracystic 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.MethodsWe 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.ResultsMedian 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.ConclusionOverall, 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.     

Therapeutic management of intracystic papillary carcinoma of the breast: the roles of radiation and endocrine therapy

BACKGROUND: The role of radiation and endocrine therapy in the treatment of intracystic papillary carcinoma (IPC) remains unclear. The aim of the current study was to review the management of IPC in order to determine factors associated with use of adjuvant therapies. METHODS: A retrospective review of our surgical and pathology databases from 1995-2006 identified 45 women with IPC. These patients were further divided into those with pure IPC (n = 21), IPC with associated ductal carcinoma in situ (DCIS) (n = 18), and IPC with associated microinvasion with or without DCIS (n = 6). Patient characteristics were compared between groups using the chi-square test. RESULTS: Patients with IPC and microinvasion were more likely to undergo an axillary staging procedure (6/6, 100%) compared to patients with pure IPC (6/21, 29%) or IPC with DCIS (5/18, 28%) (P < .001). Patients with pure IPC were less likely to have radiation therapy than patients with IPC and DCIS or microinvasion (P < .001). However, within the subset of patients with pure IPC, women less than 50 years of age were more likely to have radiation therapy than those older than 50 years (P < .001). Patients with IPC and DCIS or microinvasion had significantly increased use of endocrine therapy versus patients with pure IPC (P < .01). CONCLUSIONS: In our patient population, those patients with IPC and associated DCIS or microinvasion are treated with adjuvant radiation and endocrine therapy on the basis of this associated pathology. The use of adjuvant radiation and/or endocrine therapy should be considered in patients with pure IPC who are of young age (<50 years).