Keywords: Breast; cystic; papillary
Ductal carcinoma is treated as a variation of insitunun. However, intracystic papillary carcinomas differ clinically and radiologically from ductal carcinoma insitu.
Intraclavicular papillary carcinoma is usually surrounded by a fibrous capsule and is limited within the capsule. Histologically, dilate ductus arises and grows there. Malignant papillary lesions are associated with the largest change in breast pathology.
The first intracavitary papillary carcinoma case
was shown in 1962 by Kraus and Neumbecker.[
Intracystic papillary carcinoma is diagnosed immunohistochemically
in the papillary cell layer by the
absence of myoepithelial cell layer. Characteristically, it
is diagnosed with anti-p63, smooth muscle actin and
CD10 antibody.[
Histopathological diagnosis is recommended. On mammogram, a mass image with a contour of 15 mm in diameter with a contour was observed in the internal mammogram. On the upper external mammogram of the right breast, a uniformly limited image of the dens with a diameter of 5 mm was observed (intramammarial LAP?). Bx was taken at the hospital where the patient referred, but no pathological diagnosis was made. Then the breast of the patient was excised in the outer center.
Afterwards, exterior center pathology of exclusion
a tumor with papillomatous areas on the inner surface
of the esophageal pathology (İzmir Katip Çelebi
University, Atatürk Training and Research Hospital
Pathology No: 2014 / P-27016) with dimensions of
2.7x2.5x2.1 cm was serous hemorrhagic fluid within
the cystic sections (Figure
Tumor diameter 2.7 cm tumor is nuclear grade 2. Surgical limits are released. Lateral surgery revealed low nuclear grade ductal carcinoma insitu focus at 2 mm distance. In the area of intracystic papillary carcinoma, ER (-), PR% (-), CERB-2 (-), cytokeratin14 (+), cytokeratin AE1 / AE3 (+), P53 5% and KI-67 proliferation index were reported as 3%.
In addition, smooth muscle actin and calponin
applied in this focus were found in the tumor and in
the periphery (-) (Figures
In addition, a block of smooth muscle actin, calponin,
P63, cytokeratin 5/6 was administered; No diagnostic
staining pattern was observed with cytokeratin
5/6 and p63 (Figures
Then, reactive lymph node hyperplasia was detected
in 21 lymph nodes after the axillary dissection
of the patient. As a result of council, it was deemed
appropriate to take KT + RT + HT in the next treatment
of the patient. The patient was admitted to our
clinic to receive 4 cycles of Adriamycin + Cyclophosphamide.
The patient received curative doses of radiotherapy
and hormonal therapy after chemotherapy. No local recurrence
or metastasis were detected at the 40-month
follow-up.
Immunohistochemical examination Absence
of myoepithelial cells in papillary and periphery of
smooth muscle actin stain. Neighboring normal ducts
and lobules are surrounded by smooth muscle actinpositive
myoepithelial cells (Figure 3: smooth muscle
actin x40, Figure 4: smooth muscle actinx100)
The majority of intracystic carcinomas are intracystic
papillary carcinomas and the remaining pathologies
are invasive ductal carcinoma with cystic degeneration,
medullary carcinoma, mucinous carcinoma, adenoid
cystic carcinoma and squamous carcinoma.[
They consist of a single cyst or a few cysts in the retroaerolar
region of 70?90% and are placed in a single
quadrant. 5?25% may have nipple discharge and 18% of
cases are asymptomatic. Intracystic papillary carcinoma
is seen as a round or oval mass on mammogram. Indefinite
limited and spicially contoured appearance is rare.
Mammograms can be seen in areas of microcalcification
as well as in the immune system. Fine needle aspiration
biopsy or true-cut biopsy is the most difficult to identify.
Solorzano and his colleagues therefore said that an
excisional biopsy was needed. The advanced carcinoma
focus on a cystic wall may not manifest itself with this
fine needle biopsy or cyst asphyxiation. An excisional biopsy
is required to assess the entirety of the material.[
In the recent studies, it was observed that there was
no difference between the patients who underwent
the segmental mastectomy and those who underwent
the mastectomy and the recurrence and cancer-related
deaths. Very rarely, axillary microinvasion, lymph
node metastases, is encountered.
Wasserberg and colleagues found a 7% incidence of
ductal carcinoma insitu intrapapillary carcinoma in the
patient, with distant metastases in 2% of these patients
with lymph node involvement.[
Some studies suggest adjuvant radiotherapy and
endocrine therapy. Evaluation of case-based treatment
options is beneficial.[
Result
Disclosure Statement
Cystic lesions seen in the mammals are benign formations.
Intracystic papillary carcinoma of the memine
is a very rare tumor and it is better than intraductal
carcinoma. It is important that the cystic lesions seen
in postmenopausal women are followed. Particular attention
should be paid to the solid construction in the
cyst. Cells that dysplase during localization or multiple
foci on a wall of the cyst are rare. There is a risk of these
lesions turning into intracystic papillary carcinoma
over time. These structures in the cyst can develop
papillary non invasive carcinoma. However, intracystic papillary carcinomas are slowly growing well-limited
masses. Follow-up and case-based treatment protocols
should be followed.
The authors declare no conflicts of interest.
