Intracystic papillary carcinoma of the breast: Difference between revisions

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#redirect [[intracystic papillary carcinoma of the breast]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Breast PapillaryCarcinomaEncysted PA.JPG
| Width      =
| Caption    = Intracystic Papillary Breast Carcinoma. [[H&E stain]].
| Synonyms  =
| Micro      = Papillary lesion within a cyst
| Subtypes  =
| LMDDx      = [[Intraductal papilloma]], papillary [[DCIS]], [[Invasive papillary breast carcinoma]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[breast]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = +/-bloody discharge from nipple
| Symptoms  =
| Prevalence = Rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = very good
| Other      =
| ClinDDx    = other breast tumours
| Tx        = surgical
}}
'''Intracystic papillary carcinoma of the breast''', also known as '''encapsulated papillary carcinoma of the breast''' (abbreviated '''EPC'''), is an uncommon type of [[breast cancer]] with a very good prognosis.
 
It should not be confused with the ''[[invasive papillary carcinoma of the breast]]'', a more aggressive tumour of the breast.
 
==General==
*Very good prognosis<ref name=pmid21753694>{{Cite journal  | last1 = Rakha | first1 = EA. | last2 = Gandhi | first2 = N. | last3 = Climent | first3 = F. | last4 = van Deurzen | first4 = CH. | last5 = Haider | first5 = SA. | last6 = Dunk | first6 = L. | last7 = Lee | first7 = AH. | last8 = Macmillan | first8 = D. | last9 = Ellis | first9 = IO. | title = Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis. | journal = Am J Surg Pathol | volume = 35 | issue = 8 | pages = 1093-103 | month = Aug | year = 2011 | doi = 10.1097/PAS.0b013e31821b3f65 | PMID = 21753694 }}</ref> - it is similar to [[DCIS]].
*Classically menopausal women.
*~30% present with bloody discharge.<ref name=pmid21057133>{{Cite journal  | last1 = Rodríguez | first1 = MC. | last2 = Secades | first2 = AL. | last3 = Angulo | first3 = JM. | title = Best cases from the AFIP: intracystic papillary carcinoma of the breast. | journal = Radiographics | volume = 30 | issue = 7 | pages = 2021-7 | month = Nov | year = 2010 | doi = 10.1148/rg.307105003 | PMID = 21057133 | URL = http://radiographics.rsnajnls.org/cgi/pmidlookup?view=long&pmid=21057133 }}</ref>
 
==Microscopic==
Features:
*Lesion confined to a cyst.
**May have a thick fibrous capsule
**The involved space is ''not'' lined by myoepithelial cells.
*The cyst contains an abnormal epithelial proliferation with cribriform, solid or papillary architecture.
**Loss of myoepithelial cells within the epithelial proliferation is a '''key feature'''.
**Scattered large cells with pale eosinophilic cytoplasm may be observed<ref>{{Cite journal  | last1 = Collins | first1 = LC. | last2 = Schnitt | first2 = SJ. | title = Papillary lesions of the breast: selected diagnostic and management issues. | journal = Histopathology | volume = 52 | issue = 1 | pages = 20-9 | month = Jan | year = 2008 | doi = 10.1111/j.1365-2559.2007.02898.x | PMID = 18171414 }}
</ref>.
***These cells are so-called globoid cells or clear cells and are immunoreactive for [[GCDFP-15]].
***They should not be mistaken for myoepithelial cells.
**Neoplastic epithelial cells:
***[[Nuclear atypia]] - including: nucleoli, [[nuclear pleomorphism]].
 
Notes:
*Many potential pitfalls with papillary breast lesions on needle core biopsy.
**Complete excision is recommended.<ref name=pmid22244207>{{Cite journal  | last1 = Rizzo | first1 = M. | last2 = Linebarger | first2 = J. | last3 = Lowe | first3 = MC. | last4 = Pan | first4 = L. | last5 = Gabram | first5 = SG. | last6 = Vasquez | first6 = L. | last7 = Cohen | first7 = MA. | last8 = Mosunjac | first8 = M. | title = Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up. | journal = J Am Coll Surg | volume = 214 | issue = 3 | pages = 280-7 | month = Mar | year = 2012 | doi = 10.1016/j.jamcollsurg.2011.12.005 | PMID = 22244207 }}</ref>
*Adequately and carefully sample the specimen to exclude an invasive component.
*Report only the size of the invasive component (if present) to prevent over-estimation of tumor stage.
 
DDx:<ref name=pmid18171414>{{Cite journal  | last1 = Collins | first1 = LC. | last2 = Schnitt | first2 = SJ. | title = Papillary lesions of the breast: selected diagnostic and management issues. | journal = Histopathology | volume = 52 | issue = 1 | pages = 20-9 | month = Jan | year = 2008 | doi = 10.1111/j.1365-2559.2007.02898.x | PMID = 18171414 }}
</ref><ref>{{Cite journal  | last1 = Pathmanathan | first1 = N. | last2 = Albertini | first2 = AF. | last3 = Provan | first3 = PJ. | last4 = Milliken | first4 = JS. | last5 = Salisbury | first5 = EL. | last6 = Bilous | first6 = AM. | last7 = Byth | first7 = K. | last8 = Balleine | first8 = RL. | title = Diagnostic evaluation of papillary lesions of the breast on core biopsy. | journal = Mod Pathol | volume = 23 | issue = 7 | pages = 1021-8 | month = Jul | year = 2010 | doi = 10.1038/modpathol.2010.81 | PMID = 20473278 }}</ref>:
*[[Intraductal papilloma]].
**Absent or scant stroma favors papillary carcinoma over papilloma.
**Is there a single cell or dual cell population in the lesion?
***ER staining will be heterologous in a benign lesion.
***Myoepithelial markers (calponin/p63/SMA +ve)s hould be positive in a benign lesion. 
*[[Papillary ductal carcinoma in situ]].
**Papillary DCIS shows myoepithelial cells (calponin/p63/SMA +ve) at the periphery of the involved spaces
**But papillary DCIS should be negative for myoepithelial cells within the focus of DCIS
**Papillary intracystic carcinoma does not show myoepithelial cells at the periphery of the involved spaces
*[[Invasive papillary carcinoma of the breast]].
**Similar architecture but no cystic space, frankly invasive.
**Very rare.
*Invasive carcinoma arising in association with papillary intracystic carcinoma
**Epithelial entrapment in the encysting fibrous tissue should not be interpreted as invasion. 
**Carcinoma must be seen in the breast tissue outside the encysting fibrous tissue.
**Infiltrating carcinoma is usually of the 'no special type' variety.
*[[Adenoid cystic carcinoma of the breast]]
**The solid variant looks basaloid - solid adenoid cystic carcinoma or a 'basal-like' carcinoma should be considered in these cases.
 
===Images===
<gallery>
Image:Breast PapillaryCarcinomaEncysted 3 PA.JPG|Breast - Intracystic Papillary Carcinoma - Medium power (SKB)
Image:Breast PapillaryCarcinomaEncysted 2 PA.JPG|Breast - Intracystic Papillary Carcinoma - Medium power (SKB)
Image:Breast PapillaryCarcinomaEncysted PA.JPG|Breast - Intracystic Papillary Carcinoma - High power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant LP CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - low power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant MP2 CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant MP CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - medium power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant HP2 CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)
Image:Breast Carcinoma Papillary Intracystic SolidVariant HP CTR.jpg|Breast - Papillary Intracystic Carcinoma, Solid Variant - high power (SKB)
Image:Breast EncystedPapillaryCarcinoma InfiltratingDuctalCarcinoma PA.JPG|Breast - Intracystic papillary adenocarcinoma (top) with associated invasive ductal carcinoma (bottom) (SKB)
</gallery>
 
==IHC==
*Calponin/p63/SMA/CK5-6.
**Loss of myoepithelial cells within the tumour.
**Loss of myoepithelial cells at the cyst wall.
*ER - Homogeneous staining of the epithelial proliferation.
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Breast pathology]]
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