Treat. Intracystic papillary carcinoma of the breast: mammographic, sonographic, and MR appearance with pathologic correlation. Approximately 47% of cases (n = 427) were CIS, whereas 53% of cases had invasion (n = 490). Wynveen CA, Nehhozina T, Akram M et al (2011) Am J Surg Pathol 35(1) 1–14 Intracystic Papillary Carcinoma of the Breast: An In Situ or Invasive Tumor? After mastectomy, radiotherapy or excisional biopsy alone, Intraductal (intracystic) papillary carcinoma of the breast and its variants: a clinicopathological study of 77 cases, Papillary lesions of the breast: a review, Treatment and outcome of intracystic papillary carcinoma of the breast, Metastatic potential of encapsulated (intracystic) papillary carcinoma of the breast: a report of 2 cases with axillary lymph node micrometastases, An update of sentinel lymph node mapping in patients with ductal carcinoma in situ. Intracystic Papillary Carcinoma of Breast. Intracystic papillary carcinoma of the breast with invasion. Papillary hidradenoma. The CCR does not contain complete information regarding treatment modality for all years, and therefore treatment data were not included in this study. Papillary eccrine adenoma. At 5 years, these patients had an observed cumulative survival of 74.5% and a relative cumulative survivalof 83.2%. The majority of the invasive cases were localized at the time of diagnosis (89.6%; n = 439). The tumor affects predominantly older women, but can also be diagnosed in younger women and men. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? When the subtypes were divided, there was a slightly significantly better observed cumulative survival of patients with CIS IPC at 5 years compared with those with invasive IPC (85.0% vs 75.0%; P = .05). Please check your email for instructions on resetting your password. Papillary carcinoma (PC) is a histologic subtype of breast carcinoma characterized by a malignant proliferation of epithelial cells supported by arborescent fibrovascular cores ().Papillary carcinomas can be invasive or noninvasive (papillary ductal carcinoma in-situ [DCIS]) and can exist in localized, mass-forming variants such as encapsulated papillary carcinoma … The invasive tumors are then further classified as localized, regional, or metastatic. The cases were divided into three … It shares features with DCIS and IDC and … Most previous studies show a similarly low rate of lymph node involvement, although axillary dissections were not consistently performed in any study, and there do not appear to be any concrete or universal indications for axillary lymph node dissection.2, 12, 13, 15 However, the CCR data, as well as several other studies, do demonstrate occasional axillary lymph node involvement, and other authors have reported axillary lymph node involvement even in cases without reported adjacent invasive ductal carcinoma.2, 16, Given the controversial and evolving understanding of the invasiveness of the tumor and the occasional axillary lymph node metastasis associated with IPC, we recommend treating IPC similar to DCIS with microinvasion. An intracystic papillary carcinoma of the breast is a type of papillary carcinoma of the breast. CASE 4 Intracystic papillary carcinoma. Unable to process the form. Check for errors and try again. DOI: 10.1007/s10549-020-05680-9. There is no apparently significant difference in the long-term survival of patients in the 2 histologically derived subgroups of IPC. As with papillary carcinomas in general, it tends to occur in postmenopausal women. 2). Breast Cancer Res. There are no data within the CCR as to which cases were isolated IPC and which had an associated lesion, although if there was frank invasive ductal carcinoma, the cases would have been recorded as invasive ductal carcinoma and not as IPC. In-Situ Papillary Carcinoma of Breast. -, 4. This rate is slightly higher than the rate of invasive ductal carcinoma and ductal CIS (DCIS) reported in the male population and higher than previously described in the literature.10, 11 The majority of the larger published case series analyzing IPC do not include any male patients; however, the cases in the CCR demonstrate that IPC is not an entity unique to women and that breast cysts in men may occasionally contain a malignant component.1, 2, 12, 13, The histologic classification of IPC is confusing, and there is controversy within the surgical and pathology literature regarding its categorization and nomenclature.5, 7, 8 In 1980, a classification system was developed that divided papillary carcinomas into the invasive and noninvasive forms.3 The noninvasive form was then further subdivided into the diffuse form, the papillary variant of DCIS (involving multiple small and medium sized ducts), andthe localized form, termed “intracystic” or “encysted” papillary carcinoma.3, 12 This localized form, IPC, describes a solitary tumor in an encysted or dilated duct.3 The presence of a layer of myoepithelial cells (MECs) at the periphery of areas of papillary carcinoma have historically been used to define a lesion as CIS rather than invasive.8 Recent studies have shown that, in contrast to papillary DCIS, IPC does not appear to have an MEC layer surrounding the tumor nodules.5, 7, 8 This observation has lead to the idea that, in some cases, IPC may not actually be an in situ carcinoma, but may actually be an encapsulated nodule of low-grade invasive carcinoma or may be part of a spectrum of progression intermediate between CIS and invasive disease.5, 7, 8 Some pathologists now prefer the term “encapsulated papillary carcinoma” to the more traditional “intracystic papillary carcinoma.”7, 8, 14 Within the CCR, IPC lesions have been reported by the local pathologist as either in situ or invasive. Background: Intracystic papillary carcinoma (IPC) of the breast is a rare form of noninvasive breast cancer. Furthermore, the addition of hormonal treatment does not appear to have impacted outcome.1, 15 Given the overall good prognosis and that no adjuvant treatment has been shown to increase cancer-free survival, there is concern for a potential overtreatment in the disease.5, 15, There is no consensus as to the role of axillary staging procedures for IPC. Matsuo S, Eto T, Soejima H et-al. (4)Department of Pathology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, 589-8511, Japan. Benign appearance on imaging; on ultrasonography, pure cyst, mixed image or solid mass. The survival rates of the 2 histologically derived subgroups of IPC were compared with each other. A 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. After 10 years, the observed cumulative survival was 55.9%, and the relative cumulative survival rate was 74.6%. Dogan BE, Whitman GJ, Middleton LP et-al. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, I have read and accept the Wiley Online Library Terms and Conditions of Use, Therapeutic management of intracystic papillary carcinoma of the breast: the roles of radiation and endocrine therapy, Treatment and outcome of patients with intracystic papillary carcinoma of the breast, Intracystic (encysted) papillary carcinoma of the breast: a clinical, pathological, and immunohistochemical study, Intracystic papillary carcinoma of the breast, Papillary lesions of the breast: selected diagnostic and management issues, Case 35: intracystic papillary carcinoma with invasion, Myoepithelial cell staining patterns of papillary breast lesions: from intraductal papillomas to invasive papillary carcinomas, Intracystic papillary carcinomas of the breast: a reevaluation using a panel of myoepithelial cell markers, Breast cancer in males: a PGIMER experience, Intracystic papillary carcinoma of the breast in male: case report and review of the Japanese literature, Intracystic papillary carcinoma of the breast. Abstract Abstract: Intracystic papillary carcinoma (IPC), a breast tumor mainly occuring in the elderly, has long been considered as a variant of ductal carcinoma in situ (DCIS). The remaining 12 patients did not have any further surgical intervention. The American Journal of Surgical Pathology: May 2011 - Volume 35 - Issue 5 - p 778-779. doi: 10.1097/PAS.0b013e3182142cf3. Dermatopathology. The CCR data demonstrate that, at 5 years, patients who presented with IPC without evidence of invasion had a survival rate that exceeded that of the general population. CLINICAL FEATURES. There were 3 tumor recurrences in this group, but no cancer-related deaths, and all of these recurrences occurred in patients with concurrent DCIS. Although of academic interest, this distinction is likely to be of little clinical relevance.7, 8, 15. Intracystic papillary carcinoma of the female breast with secretory activity: the significance of aspiration cytology as diagnostic procedure. AJR Am J Roentgenol. Relative survival measures the total impact of the disease on survival, regardless of what was considered to be the cause of death. 4 Rosen PP. The database includes information regarding cancer type (histology), patient demographics, disease stage at diagnosis, and survival. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Intracystic papillary carcinoma of the breast. If you do not receive an email within 10 minutes, your email address may not be registered, Intracystic papillary carcinoma (IPC) is regarded as an intraductal neoplasm, but recent evidence suggests that it could be invasive, as it often lacks myoepithelial lining. 1. Features: 1. 145 This may reflect the inclusion of many preinvasive, in situ, and intracystic papillary carcinomas in the various series. Intracystic papillary carcinoma (IPC) is a rare breast malignancy, accounting for <3% of all breast cancers.1, 2 Patients with IPC may present with a palpable mass, bloody nipple discharge, or a radiographic abnormality. Markers. Because of the evolving understanding concerning the invasiveness of IPC, this study specifically focused on whether there is any difference in outcome between tumors classified as invasive or those classified as CIS. The CCR (originally the California Tumor Registry) was established in the late 1940s as a 10% sample of the incident cancer cases within the State. A total of 917 cases of IPC were identified. Some report value in measuring CEA levels in the aspirated cyst fluid 3. Working off-campus? Intracystic papillary carcinoma (IPC) is an uncommon breast neoplasm. 1.1. Several studies, however, have shown that prognosis is excellent and recurrence rates low, regardless of the intervention.1, 2, 15 The mainstay of treatment is surgical excision. 1995;13 (4): 322-4. Gastrointestinal pathology. Also known as intracystic papillary carcinoma when it is within a large space Diagnostic Criteria. J Comput Assist Tomogr 1987; 11:1074-1076. Papillary carcinoma In: Rosen’s breast pathology. The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology, and End Results Program; and the Centers for Disease Control and Prevention's National Program of Cancer Registries. The usual ultrasound appearance is a cystic mass, with or without septations, with solid papillary masses projecting into the cyst lumen. All IPC cases were analyzed with regard to patient sex and age at presentation, as well as tumor stage. Papillary Carcinoma of Breast : Apocrine change. They represent ~0.2-1.3% of all breast cancers. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. To the authors' knowledge there are limited data regarding its epidemiology and only small studies focusing on outcomes. Of these invasive cases, the vast majority were localized at the time of diagnosis (89.6%; n = 439), whereas 7.8% of the cases were classified as regional disease, with either direct extension into adjacent tissue or axillary lymph node involvement (n = 39). Ienzi R, Cirino A, Galia M et-al. Whether the tumor is classified as invasive or CIS, the long-term outcome in patients with IPC is good and the tumor should most likely be managed in a similar manner to DCIS. The overall observed cumulative survival of patients with IPC was 82.0% at 5 years and 61.2% after 10 years. 2. At 5 years, the relative cumulative survival of patients with CIS IPC and invasive IPC were 101.3% and 93.9%, respectively (P = .18). Google Scholar; 5 Knelson MH, El Youssef SJ, Goldberg REA, Balance W. Intracystic papillary carcinoma of the breast: mammographic, sonographic, and MR appearance with pathologic correlation. Large dilated duct or cystic space; Four main patterns Cribriform DCIS Resembles ordinary cribriform DCIS on papillary stalks ; May arise in a papilloma All cancers are reported to the CCR except basal and squamous cell carcinoma of the skin and, since the mid-1990s, cervical CIS and “borderline” tumors of the ovary. An invasive component may also be seen in some cases. Papillary carcinomas are rare malignant breast tumors, constituting 1–2% of breast carcinomas in women [1, 2].Generally characterized by slow growth and a better prognosis than ductal carcinomas not otherwise specified, papillary carcinomas may have in situ (intracystic or intraductal) or invasive components [].Intracystic papillary carcinoma can occur in a pure form, … slide 1 of 18 -, 6. May have a thick fibrous capsule 1.2. Conversely, although the majority of patients with the tumor were women, there were 32 (3.5%) cases diagnosed in men. Intracystic papillary carcinoma (IPC) is an uncommon breast neoplasm. A case of intracystic carcinoma of the breast: the importance of measuring carcinoembryonic antigen in aspirated cystic fluid. There is an excellent prognosis for patients diagnosed with IPC regardless of whether the tumor is diagnosed as in situ or invasive. The cyst contains an abnormal The CCR classifies IPC as either in situ (CIS) or invasive, as determined by the local pathologist. Nominal data were compared using a chi-square test, and survival data were compared using a Z-test. Background: Intracystic/encapsulated papillary carcinoma remains a poorly understood disease of the breast with a little amount of reports that describe it. Within the CCR, <8% of IPC cases were reported to have regional disease, although because it is not reported what percentage of patients underwent axillary lymph node sampling, this rate may not be accurate. -, malignant papillary lesions of the breast, Intracystic papillary carcinoma of breast, Intracystic papillary cancer of the breast. IPC is generally perceived as a malignancy of elderly women.9 Indeed, in the current study, although IPC affected patients of all ages, the majority of patients were older, with the median age being 69.5 years. Histologically, the tumor is encysted within a dilated duct with arborization of the fibrovascular stroma and contains nodules of papillary carcinoma surrounded by a thick fibrous capsule.2-6 Recent information within the pathology literature has demonstrated that, although IPC was once believed to be a variant of ductal carcinoma in situ (CIS), some lesions may actually be low-risk invasive tumors.5, 7, 8. The Berkson-Gage life table method was used to calculate observed cumulative survival and relative cumulative survival rates. On mammography, an intracystic papillary carcinoma is often seen as a round or oval circumscribed mass, most frequently in the retroareolar region. Even those patients who were diagnosed with invasion at the time of diagnosis had a relative survival rate of >90% of that of the general population at both 5 and 10 years. Our review of the literature suggests that this is the largest series of IPC, with an analysis of over 900 cases. Cytopathol. This patient had an associated DCIS.1 The CCR data corroborates these studies while also demonstrating that there is a good outcome from IPC whether the tumor is deemed to be CIS or invasive. It accounts for a significant proportion of intracystic breast cancers. Introduction. Relative survival is a useful way to examine the effect of a particular disease process by comparing patients with the disease to age-matched controls from the general population. However, data available from other series suggest that although associated pathology may help guide treatment, its presence has little effect on overall survival.2, 12 Finally, given the great controversy within the literature regarding the histologic classification of IPC, it is unclear what methods the pathologists are using to determine the histology of the tumors, specifically whether the tumor was CIS or invasive. A total of 917 cases of IPC were identified in the CCR. This is particularly useful for cancers that effect an older patient population, such as IPC. Local pathologists may report the tumor as invasive based on the lack of an MEC layer or the presence of entrapped neoplastic cells within the fibrous capsule, which often have the appearance of invasive carcinoma.8 Without access to the original specimen, it was not possible to determine the criteria used to establish the diagnosis of an invasive lesion. Her tumor was associated with an invasive ductal carcinoma.13 In their analysis of 45 patients with IPC, Fayanju et al observed only 1 patient who had a cancer-related death. Because of its rarity, there is a paucity of literature regarding the tumor, and most studies are in the form of small case series and reviews. 2004;183 (5): 1516. Definitions. In the intracystic variant of in-situ papillary carcinoma, the tumor appears as a mural nodule within a cystic space created by a dilated duct. 102 (5-6): 403-5. Intracystic (encysted) papillary carcinoma has garnered a lot of academic attention because of its peculiar morpho-histological character as well as its frequent association with the morphologically distinct yet intimately related DCIS and invasive ductal carcinoma. Intracystic Papillary Carcinoma of the Breast- Appearance of hypoechoic mass on ultrasound (A) . The median age of IPC patients was 69.5 years (range 27 years-99 years). Intracystic papillary carcinoma (IPC) of the breast is a rare tumor with predilection for elderly women and distinctive pathological features that must be distinguished from ductal carcinoma in situ (DCIS) of papillary type and from invasive papillary carcinoma. Endocrine pathology. Data from the California Cancer Registry (CCR), a total population-based database, were reviewed from the years 1988 through 2005. Two years before, she was diagnosed with right breast intracystic papillary neoplasm, estrogen receptor positive , and treated with lumpectomy only. Cardiovascular pathology. Epidemiology. Because the majority of patients with IPC are older, this overall survival rate may be influenced by their older age and consequent comorbidities. Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. 2. Lesion confined to a cyst. A P-value of <.05 was considered statistically significant. Intracystic carcinoma of the breast refers to a breast cancer located within a cyst. Cases. This excellent long-term prognosis for IPC contrasts with that of other non-IPC breast cancers, the majority of which are invasive ductal carcinoma. The CCR results demonstrate, however, that this distinction is likely not to be of clinical significance because, regardless of the classification, the prognosis is excellent. Papillary Carcinoma of Breast : Solid variant. Bhargava R, Esposito NN, Dabbs … 1. Because it is obtained by adjusting observed survival for the normal life expectancy of the general population of the same age, the relative survival rate is an estimate of the chance of surviving the effects of cancer. 2003;181 (1): 186. Considered noninvasive or minimally invasive, because there is no infiltrating … Intracystic papillary carcinoma has a slow growth rate and an excellent prognosis with 10-year survival rates approaching 100% 1,2. Can be divided into pure form and those associated with ductal carcinoma in situ (DCIS) or invasive carcinoma. Intracystic papillary carcinoma (IPC) is an uncommon breast neoplasm. [Intracystic papillary carcinoma of the breast: mammographic, pneumocystographic, sonographic, power-Doppler and MR appearance: a case report]. Because of the rarity of the tumor, the majority of the published reports to date are small case series from single institutions, with limited conclusions regarding the epidemiology of the tumor or its long-term outcome. An appreciation of associated pathology with IPC may be critical in surgical decision-making. Abstract. Although many authors have suggested that IPC, whether labeled invasive or CIS, be treated similar to DCIS,5, 15 it has been reported that, like IPC, DCIS with microinvasion has an 8% to 14% incidence of axillary lymph node involvement.17-19 Therefore, sentinel lymph node biopsy has been advocated for these patients.17-19 Sentinel lymph node biopsy has not been assessed in IPC, but it appears to be the practical and prudent way to evaluate the axilla in patients with IPC.2, 16. Cancer 2008. Papillary fibroelastoma. In-situ Papillary Carcinoma of Breast. Papillary carcinoma has been associated with a relatively favorable prognosis in many studies; even in women with axillary node metastases. More recent studies show a tendency toward breast conservation, with no significant increase in tumor recurrence or cancer-related deaths.1, 2, 15, In addition to surgical excision, several studies have reported on the use of adjuvant radiation and/or endocrine therapy in the management of IPC.1, 2, 15 In their retrospective review of the treatment and outcome of 40 patients with IPC, Solorzano et al observed that 30% of the patients had received adjuvant radiotherapy. The survival rate of patients with all other types of invasive breast cancer, excluding IPC, was lower. {"url":"/signup-modal-props.json?lang=us\u0026email="}. The involved space is notlined by myoepithelial cells. Pathologically, intracystic papillary carcinomas may show four cellular patterns: The combination of two or more of these patterns may also be seen. At 10 years, however, patients with CIS and those with invasive IPC had a virtually identical cumulative survival (61.7% and 60.6%; P = .08) (Fig. Diagn. In conclusion, IPC is a rare tumor with an excellent prognosis. Intracystic carcinoma of the breast was first reported by Brodie and colleagues [], and it is a relatively rare disease, accounting for only 0.5 to 1.9% of all breast cancers [2, 3].According to the general rules for clinical and pathological recording of breast cancer, a lesion localized in a cyst is defined as noninvasive intracystic carcinoma of the breast, but there is no … The aim of the current study was to evaluate the epidemiology, histologic and staging classification, and overall outcome of patients diagnosed with IPC using a large, population-based database. Relative survival rates compare the mortality of a group of patients with that of a similar group of people from the general population. The data were analyzed with regard to patient sex, age at presentation, tumor stage, and overall survival. Encapsulated papillary carcinoma (EPC) of the breast, synonymous with intracystic or encysted papil inferomedial superolateral oblique projection, breast ultrasound features: benign vs malignant, invasive ductal carcinoma not otherwise specified, intracystic papillary carcinoma of the breast, breast implant-associated anaplastic large cell lymphoma, columnar alteration with prominent apical snouts and secretions (CAPSS), lobular intraepithelial neoplasia (LIN III), pseudoangiomatous stromal hyperplasia (PASH), pleomorphic microcalcifications within breast, punctate microcalcification within breast, egg shell/rim calcification within breast, lobular calcification within breast tissue, intraductal calcification within breast tissue, skin (dermal) calcification in / around breast tissue, suture calcification within breast tissue, stromal calcification within breast tissue, artifactual calcification from outside the breast, granulomatosis with polyangiitis: breast manifestations, differential diagnosis of dilated ducts on breast imaging, hereditary breast and ovarian cancer syndrome, transitional cell form resembling urothelium. 52 Pure invasive papillary carcinoma is extremely rare, with a reported incidence of approximately 0.5% of all invasive breast cancers in some series. Free; Metrics To the Editor: We read with interest the article by Wynveen et al 4 regarding intracystic papillary carcinoma (IPC). The CCR classifies IPC as either CIS or invasive as determined by the local pathologist. By using a large, population‐based database, this study aimed to identify specific characteristics of patients with IPC, investigate its natural history, and determine its … IPC indicates intracystic papillary carcinoma. Key Words: human breast carcinoma, papillary carcinomas, encapsulated, intracystic, solid, prognosis and outcome (Am J Surg Pathol 2011;35:1093–1103) 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 malig- -, 5. NOEL WEIDNER, Farnaz Hasteh, in Modern Surgical Pathology (Second Edition), 2009. Several case series have identified no cancer-related deaths from IPC among patients followed for >50 months.2, 12, 15 Lefkowitz et al reviewed the charts of 29 patients diagnosed with IPC and found only 1 patient was suspected to have died from her cancer. There were no significant differences in the relative survival rates noted between patients with invasive IPC compared with those with CIS IPC at either 5 or 10 years.
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