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Breast malignant, males, children

Carcinoma subtypes

Intracystic (encysted) papillary carcinoma

Reviewer: Monika Roychowdhury, M.D., (see Reviewers page)
Revised: 10 October 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Terminology
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● Also called encapsulated papillary carcinoma, intracystic papillary ductal carcinoma in situ

Epidemiology
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● Rare, usually seen in elderly women
● 0.5-1% of all breast cancers
● May be associated with conventional DCIS or invasive carcinoma

Clinical description
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● Asymptomatic or presents as breast mass or nipple discharge
● Benign appearance on imaging; on ultrasonography, pure cyst, mixed image or solid mass
● Can be divided into pure form and those associated with ductal carcinoma in situ (DCIS) or invasive carcinoma
● Considered noninvasive or minimally invasive, because there is no infiltrating growth pattern and metastases are rare
● Traditionally considered to lack a myoepithelial layer (Am J Clin Pathol 2005;123:36), but one study found expression of type IV collagen (Am J Clin Pathol 2009;131:228)
● More difficult to diagnose preoperatively than other breast tumors (Surg Today 2009;39:5)
● Pseudo-invasion may be due to prior core biopsy causing epithelial displacement (J Clin Pathol 2002;55:780)

Case reports
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● 44 year old man (J Med Case Reports 2009;13:13)
● 58 year old woman with solid variant (Eur J Gynaecol Oncol 2008;29:545)
● 64 year old man with microinvasive tumor (Breast Cancer 2010;17:146)
● Micrometastases in lymph nodes (Int J Surg Pathol 2007;15:143)
● 3 case (Case Rep Obstet Gynecol 2012;2012:979563)

Treatment
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● Favorable prognosis (Am J Surg Pathol 2006;30:1002), even with invasion (Cancer 2008;113:916, Hum Pathol 1998;29:1097)
● Stromal invasion in 92% with high nuclear grade, frequent mitotic activity, cyclin D1+ or p53+ (Breast J 2005;11:2)
● Treatment is similar to that of DCIS (Am J Surg Pathol 2006;30:1002), namely excision, with possible adjuvant radiation or endocrine therapy (Am J Surg 2007;194:497)

Gross description
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● Mural nodule within a large cystic space; may be encapsulated

Gross images
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Intracystic hemorrhagic tumor with invasion


Thick walled cyst in cystic space


Well defined fibrous margin

Micro images
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Papillary tumors

           

           
Classic features


Encapsulated tumor with hemorrhage


Papillary and solid pattern of atypical cells


Focal invasion

   
Core biopsy with luminal calcifications


CK 5/6 negative


Pseudoinvasion due to epithelial displacement post-biopsy

Virtual slides
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Intracystic papillary carcinoma

Positive stains
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● Type IV collagen in one study (Am J Clin Pathol 2009;131:228)

Negative stains
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● CK 5/6, myoepithelial markers except for type IV collagen

End of Breast malignant, males, children > Carcinoma subtypes > Intracystic (encysted) papillary carcinoma

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