Breast – Malignant, Males, Children - Intracystic papillary carcinoma

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Breast-malignant, males, children

Morphologic variants of DCIS

Intracystic (encysted) papillary carcinoma

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 19 August 2009

Last major update: August 2009

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

● May be associated with conventional DCIS or invasive carcinoma

Clinical

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● 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 diagnosis 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 Jan 13;3:13)

● 58 year old woman with solid variant (Eur J Gynaecol Oncol 2008;29:545)

● 64 year old man with microinvasive tumor (Breast Cancer 2009 Apr 7 [Epub ahead of print])

● Micrometastases in lymph nodes (Int J Surg Pathol 2007;15:143)

Treatment and prognosis

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● Favorable prognosis (AJSP 2006;30:1002), even with invasion (Cancer 2008;113:916, Hum Path 1998;29:1097)

● Stromal invasion is present in 92% of cases with high nuclear grade, frequent mitotic activity or positive immunostains for 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 papillary Intracystic hemorrhagic Thick walled cyst

tumor tumor with invasion in cystic space

Well defined fibrous margin

Micro images

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Papillary tumors

Classic images

Encapsulated tumor Papillary and solid Fibrotic cyst wall

with hemorrhage pattern of atypical cells

Fibrotic cyst wall and Papillary frond with Focal invasion

papillary fronds fibrovascular core

In-situ papillary carcinoma With mucin 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 > Intracystic (encysted) papillary carcinoma

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