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Wu Z, Li H, Chen Z, Zhou H, Liang X, Huang X, Wang J, Chen T, Xu X, Yang Y. Encapsulated papillary carcinoma of breast: Comparative study of multimodal ultrasound manifestations and pathological features. Clin Hemorheol Microcirc 2025; 89:232-240. [PMID: 39973435 DOI: 10.1177/13860291241295587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
ObjectiveTo investigate the conventional ultrasound (US), contrast-enhanced ultrasound (CEUS) manifestations and the corresponding histopathological characteristics of patients diagnosed with breast encapsulated papillary carcinoma (EPC) and to explore the value of CEUS in diagnosis of EPC.MethodsThe clinical, pathological, US, and CEUS features of 16 patients (17 lesions) with EPC confirmed by postoperative histopathology were retrospectively analyzed.ResultsEPC was prevalent in the postmenopausal women. The majority of conventional US images of EPC showed complex cystic and solid masses with circumscribed margins (70.6%), enhanced posterior echo (94.1%), no sonographic calcification (88.2%), rich blood flow in the solid components within lesions (70.6%) on Color Doppler flow imaging, and high resistance index of blood flow (94.1%). Moreover, CEUS showed mainly centripetal hyperenhancement of the solid components within the lesions with irregular outline, and the enhancement area of the whole masses was essentially the same as the B-mode US area.ConclusionsEPC typically presents as a complex cystic and solid mass. CEUS is helpful to clarify the extent of the solid component and facilitate preoperative core-needle biopsy. A comprehensive evaluation by CEUS is valuable for diagnosing EPC and combining it with clinical features are helpful to further improve the diagnosis of this rare kind of breast cancer.
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Affiliation(s)
- Zehong Wu
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- The First Clinical Medical College of Guangdong Medical University, Zhanjiang, China
| | - Huajuan Li
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zihao Chen
- The First Clinical Medical College of Guangdong Medical University, Zhanjiang, China
| | - Honglian Zhou
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xin Liang
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xing Huang
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiexin Wang
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ting Chen
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaohong Xu
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuping Yang
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Wu Z, Li H, Chen Z, Zhou H, Liang X, Huang X, Wang J, Chen T, Xu X, Yang Y. Encapsulated papillary carcinoma of breast: Comparative study of multimodal ultrasound manifestations and pathological features. Clin Hemorheol Microcirc 2024; 88:537-549. [PMID: 39392601 DOI: 10.3233/ch-242263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
OBJECTIVE To investigate the conventional ultrasound (US), contrast-enhanced ultrasound (CEUS) manifestations and the corresponding histopathological characteristics of patients diagnosed with breast encapsulated papillary carcinoma (EPC) and to explore the value of CEUS in diagnosis of EPC. METHODS The clinical, pathological, US, and CEUS features of 16 patients (17 lesions) with EPC confirmed by postoperative histopathology were retrospectively analyzed. RESULTS EPC was prevalent in the postmenopausal women. The majority of conventional US images of EPC showed complex cystic and solid masses with circumscribed margins (70.6%), enhanced posterior echo (94.1%), no sonographic calcification (88.2%), rich blood flow in the solid components within lesions (70.6%) on Color Doppler flow imaging, and high resistance index of blood flow (94.1%). Moreover, CEUS showed mainly centripetal hyperenhancement of the solid components within the lesions with irregular outline, and the enhancement area of the whole masses was essentially the same as the B-mode US area. CONCLUSIONS EPC typically presents as a complex cystic and solid mass. CEUS is helpful to clarify the extent of the solid component and facilitate preoperative core-needle biopsy. A comprehensive evaluation by CEUS is valuable for diagnosing EPC and combining it with clinical features are helpful to further improve the diagnosis of this rare kind of breast cancer.
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Affiliation(s)
- Zehong Wu
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- The First Clinical Medical College of Guangdong Medical University, Zhanjiang, China
| | - Huajuan Li
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zihao Chen
- The First Clinical Medical College of Guangdong Medical University, Zhanjiang, China
| | - Honglian Zhou
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xin Liang
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xing Huang
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiexin Wang
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ting Chen
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaohong Xu
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuping Yang
- Department of Ultrasonography, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Changrong W, Zhibo Z, Jufeng G, Hongju Y, Feng Y, Jingjing X. Encapsulated Papillary Carcinoma of the Breast: A Review of Clinicopathologic Characteristics, Molecular Mechanisms, and Patient Management. Cancer Control 2024; 31:10732748241299071. [PMID: 39508178 PMCID: PMC11544663 DOI: 10.1177/10732748241299071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 10/09/2024] [Accepted: 10/23/2024] [Indexed: 11/08/2024] Open
Abstract
Encapsulated papillary carcinoma (EPC) represents a distinct entity within the spectrum of breast papillary tumors, typically manifesting as a retroareolar mass. This rare subtype can be effectively visualized using ultrasound and magnetic resonance imaging, which reveal characteristic cystic-solid nodules. Histopathologically, EPC is defined by a papillary tumor structure with a well-defined fibrous capsule, devoid of myoepithelial cells both within and around the capsule. Immunohistochemical staining for myoepithelial markers is essential to confirm the absence of these cells, thereby validating the diagnosis of EPC. At the molecular level, EPC exhibits feature similar to estrogen receptor-positive invasive ductal carcinoma (IDC), with a biological behavior that lies between ductal carcinoma in situ (DCIS) and IDC. Generally, EPC has a favorable prognosis, associated with minimal recurrence and metastatic potential. Therapeutic strategies for EPC may parallel those for DCIS, including surgical excision. Adjuvant radiotherapy is recommended following surgery for patients with concurrent DCIS or those who have undergone breast-conserving therapy. In cases with associated IDC, management prioritizes the treatment of the invasive component. High-grade EPC often requires systemic therapies due to its poorer prognosis and increased risk of lymph node involvement.
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Affiliation(s)
- Wang Changrong
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Zuo Zhibo
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Guo Jufeng
- Department of Breast Surgery, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Yan Hongju
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - You Feng
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Xiang Jingjing
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
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Tan HJ, Tan PH, Leong LCH, Tan VKM, Tan BKT, Lim SZ, Preetha M, Wong CY, Yong WS, Sim Y. Encapsulated papillary carcinoma of the breast: An institutional case series and literature review. Cancer Med 2023; 12:11408-11416. [PMID: 36999966 PMCID: PMC10242344 DOI: 10.1002/cam4.5855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Encapsulated papillary carcinoma of the breast is rare, making difficult diagnosis and resulting in patients undergoing excision biopsy before definitive surgery. Evidence-based guidelines are sparse. We would like to further elucidate the clinicopathological, treatment and survival outcomes. MATERIALS AND METHODS 54 patients identified, with a median follow up duration of 48 months. Patients' demographics, radiological and clinicopathological characteristics, treatment, adjuvant therapies as well as survival data were analysed. RESULTS 18 (33.3%) cases were pure EPC, 12 (22.2%) were EPC associated with ductal carcinoma in situ (DCIS) and 24 (44.4%) cases had concurrent invasive ductal carcinoma. EPCs were more likely to present as a solid-cystic mass on sonography (63.8%), regular-shaped (oval or round) (97.9%), lack spiculations (95.7%) and lack suspicious microcalcifications (95.6%). Median tumour size was largest in the EPC with IDC group (18.5 mm). 2 patients developed loco-regional recurrence. Overall survival is good for EPCs of all subtypes. CONCLUSION EPC is a rare tumour with excellent prognosis.
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Affiliation(s)
- Hiang Jin Tan
- SingHealth Duke‐NUS Breast CentreSingaporeSingapore
- Department of Breast SurgerySingapore General HospitalSingaporeSingapore
| | - Puay Hoon Tan
- Division of PathologySingapore General HospitalSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
| | | | - Veronique Kiak Mien Tan
- SingHealth Duke‐NUS Breast CentreSingaporeSingapore
- Department of Breast SurgerySingapore General HospitalSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Division of Surgery and Surgical OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Benita Kiat Tee Tan
- SingHealth Duke‐NUS Breast CentreSingaporeSingapore
- Department of Breast SurgerySingapore General HospitalSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Division of Surgery and Surgical OncologyNational Cancer Centre SingaporeSingaporeSingapore
- Department of General Surgery (Breast service)Sengkang General HospitalSingaporeSingapore
| | - Sue Zann Lim
- SingHealth Duke‐NUS Breast CentreSingaporeSingapore
- Department of Breast SurgerySingapore General HospitalSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Division of Surgery and Surgical OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Madhukumar Preetha
- SingHealth Duke‐NUS Breast CentreSingaporeSingapore
- Department of Breast SurgerySingapore General HospitalSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Division of Surgery and Surgical OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Chow Yin Wong
- SingHealth Duke‐NUS Breast CentreSingaporeSingapore
- Department of Breast SurgerySingapore General HospitalSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
| | - Wei Sean Yong
- SingHealth Duke‐NUS Breast CentreSingaporeSingapore
- Department of Breast SurgerySingapore General HospitalSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Division of Surgery and Surgical OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Yirong Sim
- SingHealth Duke‐NUS Breast CentreSingaporeSingapore
- Department of Breast SurgerySingapore General HospitalSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Division of Surgery and Surgical OncologyNational Cancer Centre SingaporeSingaporeSingapore
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Tang WJ, Liang YS, Yan J, Hu Y, Sun ML, Liu GS, Pan XH, Wei XH, Jiang XQ, Guo Y. Magnetic Resonance Imaging (MRI) Phenotypes May Provide Additional Information for Risk Stratification for Encapsulated Papillary Carcinoma of the Breast. Cancer Manag Res 2020; 12:11751-11760. [PMID: 33239912 PMCID: PMC7680800 DOI: 10.2147/cmar.s277980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Encapsulated papillary carcinoma (EPC) of the breast is a rare entity. EPC can be underappreciated on percutaneous biopsy, which may require additional procedures if invasion is not recognized preoperatively. We aimed to investigate the magnetic resonance imaging (MRI) phenotypes correlated with preoperative pathological risk stratification for clinical guidance. Materials and Methods The preoperative MRI scans of 30 patients diagnosed with 36 EPCs in multiple centers between August 2015 and February 2020 were reviewed by two breast radiologists. According to the WHO classification published in 2019, EPCs were classified into two pathological subtypes: encapsulated papillary carcinoma and encapsulated papillary carcinoma with invasion. Clinicopathological analysis of the two subtypes and MR feature analysis were performed. Results Evaluation of the MRI phenotypes and pathological subtype information revealed that not circumscribed (P=0.04) was more common in EPCs with invasion than in EPCs. There was a significant difference in the age of patients (P=0.05), and the risk increased with age. The maximum diameter of the tumor increased with tumor risk, but there was no significant difference (P=0.36). Nearly half of the EPC with invasion patients showed hyperintensity on T1WI (P=0.19). A total of 63.6% of the EPC with invasion group showed non-mass enhancement surrounding (P=0.85). In addition, 29 patients (96.7%) had no axillary lymph node metastasis, and only one patient with EPC with invasion had axillary lymph node metastasis. Further pathological information analysis of EPCs showed that higher Ki-67 levels were more common in patients with EPCs with invasion (P=0.04). A total of 29 patients (96.7%) had the luminal phenotype, and one patient with EPC with invasion had the Her-2-positive phenotype. Conclusion The margin, age and Ki-67 level were the key features for EPC risk stratification. In addition, these MRI signs, including a larger tumor, non-mass enhancement surrounding and axillary lymph node metastasis, may be suggestive of a high-risk stratification. Therefore, MRI phenotypes may provide additional information for the risk stratification of EPCs.
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Affiliation(s)
- Wen-Jie Tang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Yun-Shi Liang
- Department of Pathology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Jing Yan
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Yue Hu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Mei-Li Sun
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Guo-Shun Liu
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Xiao-Huan Pan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, People's Republic of China
| | - Xin-Hua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Xin-Qing Jiang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Yuan Guo
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
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Steponavičienė L, Gudavičienė D, Briedienė R, Petroška D, Garnelytė A. Diagnosis, treatment, and outcomes of encapsulated papillary carcinoma: a single institution experience. Acta Med Litu 2018; 25:66-75. [PMID: 30210240 PMCID: PMC6130924 DOI: 10.6001/actamedica.v25i2.3759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
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.
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Affiliation(s)
- Laura Steponavičienė
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania.,Department of Public Health, Institute of Health Sciences Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Daiva Gudavičienė
- Department of Breast Surgery, National Cancer Institute, Vilnius, Lithuania
| | - Rūta Briedienė
- Department of Radiology, National Cancer Institute, Vilnius, Lithuania
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Encapsulated papillary carcinoma of the breast: A clinicopathological study of 49 cases. Curr Probl Cancer 2018; 42:291-301. [PMID: 29731165 DOI: 10.1016/j.currproblcancer.2018.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/26/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Encapsulated papillary carcinoma (EPC) has been considered as a variant of ductal carcinoma in situ. Recent studies suggest that EPC could be invasive, as it often lacks myoepithelial cells (MECs) at their periphery. The current study was performed to investigate the biological features of EPC. METHODS Forty-nine EPC patients admitted to the Tai׳an Central Hospital and Qilu Hospital of Shandong University from January 2004-December 2014 were included in this study. We retrospectively analyzed the clinicopathological findings, the presence and distribution of MECs, as well as the outcomes. RESULTS The mean age at diagnosis was 68.5 years. The mean tumor size was 2.0 cm. MECs were completely absent in all the 49 cases. Most tumors were estrogen receptor and progesterone receptor positive (95.9%). Human epidermal growth factor receptor 2 1+ immunoreactivity was seen in only 8 cases. Twenty-five patients underwent lumpectomy and 24 underwent mastectomy. Thirty-nine received evaluation of lymph node (LN), and 3 (7.7%) patients had LN involvement. Follow-up information was available in 29 patients (8-104 months, mean 47 months), among which 5 developed local recurrences and 2 distant metastases. CONCLUSION EPC is an indolent invasive carcinoma with biological features between in ductal carcinoma in situ and invasive carcinoma, with predominance of the latter. EPC rarely showed LN involvement and was characterized by favorable prognosis. EPC can be treated with adequate local therapy and hormonal therapy, whereas the benefit of radiation after lumpectomy remains uncertain.
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Can Sentinel Lymph Node Biopsy Be Spared in Papillary Carcinoma of the Breast? Clin Breast Cancer 2017; 17:127-133. [DOI: 10.1016/j.clbc.2016.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/11/2016] [Accepted: 08/25/2016] [Indexed: 01/01/2023]
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Ingle SB, Murdeshwar HG, Siddiqui S. Papillary carcinoma of breast: Minireview. World J Clin Cases 2016; 4:20-24. [PMID: 26798627 PMCID: PMC4714291 DOI: 10.12998/wjcc.v4.i1.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/20/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
The term “intracystic papillary ductal carcinoma in situ” constitutes only 0.5% to 1% of all breast cancers. It is usually seen in postmenopausal age group. Herein, we are presenting a minireview about this unusual breast malignancy usually difficult to diagnose on clinical grounds and highlighting modalities of diagnosis and management.
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Reefy SA, Kameshki R, Sada DA, Elewah AA, Awadhi AA, Awadhi KA. "Intracystic papillary breast cancer: a clinical update". Ecancermedicalscience 2013; 7:286. [PMID: 23304242 PMCID: PMC3539854 DOI: 10.3332/ecancer.2013.286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Intracystic (encysted) papillary cancer (IPC) is a rare entity of breast cancer accounting for approximately (1-2%) of all breast tumours [1], usually presenting in postmenopausal women and having an elusive natural history. The prediction of the biological behaviour of this rare form of breast cancer and the clinical outcome showed its overall favourable prognosis; however, its consideration as a form of ductal carcinoma in situ with non-invasive nature is to be reconsidered as it has been shown to present histologically with invasion of basement membrane and even metastasis [2]. The objective of this review is to shed some light on this rare, diagnostically challenging form of breast cancer, including its radiological, histological, and molecular characteristics and its pathological classification. The final goal is to optimize the clinical management including the role of sentinel lymph node biopsy (SLNB), general management with adjuvant radiotherapy (RT), mammary ductoscopy, and hormonal treatment. METHODS A literature review, facilitated by Medline, PubMed, and the Cochrane database, was carried out using the terms 'Intracystic (encysted) papillary breast cancer'. RESULTS Intracystic papillary breast cancer (IPC) is best managed in the context of a multidisciplinary team. Surgical excision of the lump with margins in excess of 2 mm is considered satisfactory. Sentinel lymph node biopsy (SLNB) is recommended as data have shown the possibility of the presence of invasive cancer in the final histology. RT following IPC alone is of uncertain significance as this form of cancer is usually low grade and rarely recurs. However, if it is associated with DCIS or invasive cancer and found in young women, radiotherapy may be prudent to reduce local recurrence. Large tumours, centrally located or in cases where breast conserving surgery is unable to achieve a favourable aesthetic result, a skin sparing mastectomy with the opportunity for immediate reconstruction can be offered. Adjuvant endocrine therapy may be suggested as almost certainly these tumours are hormonal positive. CONCLUSION Further research is required to determine the role of adjuvant radiotherapy and endocrine therapy in IPC. Understanding the low-grade nature of this form of breast cancer allows treatment options to be less radical and safely omitted.
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Affiliation(s)
- Sara Al Reefy
- King Hamad University Hospital, Muharraq, Kingdom of Bahrain
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