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. The majority of studies fail to show a difference in survival depending on which surgical procedure is performed, with a good prognosis with all interventions.1, 2, 12 The surgical management of IPC appears to parallel that of invasive ductal carcinoma, with a lower rate of breast conservation in older studies. The survival rate of patients with all other types of invasive breast cancer, excluding IPC, was lower. This excellent long-term prognosis for IPC contrasts with that of other non-IPC breast cancers, the majority of which are invasive ductal carcinoma. A total of 917 cases of IPC were identified in the CCR. A 51-year-old woman underwent breast imaging evaluation for a clear right nipple discharge. 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. Papillary Carcinoma of Breast : Apocrine change. The addition of radiation to the treatment of patients did not change the incidence of local recurrence or likelihood of death compared with those who did not receive radiation.2 Within this study, no criteria for how patients were chosen to receive radiation were evident. This is now debated since metastatic cases have been reported. The involved space is notlined by myoepithelial cells. On mammography, an intracystic papillary carcinoma is often seen as a round or oval circumscribed mass, most frequently in the retroareolar region. 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. The term invasive papillary carcinoma should be reserved for invasive adenocarcinomas with an exclusively (>90%) papillary histomorphology (Figure 11, A and B). The cyst contains an abnormal The patients are usually older (mean age 63 to 67 years) than with other breast carcinomas. Asymptomatic or presents as breast mass or nipple discharge. 2003;181 (1): 186. A case of intracystic carcinoma of the breast: the importance of measuring carcinoembryonic antigen in aspirated cystic fluid. 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. 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. Learn about our remote access options, Department of Surgery, University of California at San Diego Medical Center, San Diego, California, Department of Pathology, University of California at San Diego Medical Center, San Diego, California, Department of Family and Preventative Medicine, University of California at San Diego Medical Center, San Diego, California, Department of Surgery, Rebecca and John Moores University of California at San Diego Cancer Center, San Diego, California. IPC was defined as a solitary tumor with a pattern recognizable as carcinoma which … J Comput Assist Tomogr. To the authors' knowledge there are limited data regarding its epidemiology and only small studies focusing on outcomes. Clinicians should keep this in mind when planning surgical and adjuvant treatments. In 1988, cancer became a mandatorily reportable disease within California, and continues to be to the present. The CCR classifies IPC as either in situ (CIS) or invasive, as determined by the local pathologist. The CCR does not contain complete information regarding treatment modality for all years, and therefore treatment data were not included in this study. All IPC cases were analyzed with regard to patient sex and age at presentation, as well as tumor stage. Ductal carcinoma-in-situ: long-term results of breast-conserving therapy. 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). J Comput Assist Tomogr 1987; 11:1074-1076. IPC has been perceived to have a good prognosis.2, 12, 15 The CCR illustrates an observed cumulative survival of >60% at 10 years. Approximately 47% of cases of IPC were classified as CIS (n = 427), whereas 53% of cases were classified as invasive (n = 490). Working off-campus? Often they tend to represent papillary breast cancer 2: intracystic papillary breast carcinoma (ICPC) cystic degeneration of ductal carcinoma (not otherwise specified-NOS) 1993;28 (1): 41-4. Cardiovascular pathology. Approximately 47% of cases (n = 427) were CIS, whereas 53% of cases had invasion (n = 490). The median age of IPC patients was 69.5 years (range 27 years-99 years). 1. Papillary carcinoma has been associated with a relatively favorable prognosis in many studies; even in women with axillary node metastases. 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 long-term prognosis. After 10 years, patients with CIS IPC had a relative cumulative survival of 96.8%, whereas those with invasive IPC had a relative cumulative survival of 94.4% (P = .75) (Fig. The majority of the invasive cases were localized at the time of diagnosis (89.6%; n = 439). 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. Can be divided into pure form and those associated with ductal carcinoma in situ (DCIS) or invasive carcinoma. An intracystic papillary carcinoma of the breast is a type of papillary carcinoma of the breast. Intracystic papillary carcinoma of the breast. Conversely, although the majority of patients with the tumor were women, there were 32 (3.5%) cases diagnosed in men. Also known as intracystic papillary carcinoma when it is within a large space Diagnostic Criteria. Relative cumulative survival of intracystic papillary carcinoma is shown for carcinoma in situ (CIS) and invasive tumors. Matsuo S, Eto T, Soejima H et-al. 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. Intracystic papillary carcinomas of the breast are more similar to in situ carcinomas than to invasive carcinoma. Treat. AJR Am J Roentgenol. IPC is a rare disease. 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. This is particularly useful for cancers that effect an older patient population, such as IPC. Cytopathol. 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. Sentinel lymph node biopsy may be a prudent way to evaluate axillary involvement in patients with IPC. Pathology. 1). If you do not receive an email within 10 minutes, your email address may not be registered, Markers. Data from the California Cancer Registry (CCR), a total population-based database, were reviewed from the years 1988 through 2005. Intracystic papillary carcinoma of the breast. Free; Metrics To the Editor: We read with interest the article by Wynveen et al 4 regarding intracystic papillary carcinoma (IPC). 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. Relative survival rates compare the mortality of a group of patients with that of a similar group of people from the general population. 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. An appreciation of associated pathology with IPC may be critical in surgical decision-making. DOI: 10.1007/s10549-020-05680-9. There is an excellent prognosis for patients diagnosed with IPC regardless of whether the tumor is diagnosed as in situ or invasive. 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). 2. 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. 2). The CCR classifies IPC as either CIS or invasive as determined by the local pathologist. Results of Immunohistochemical Analysis and Clinical Follow-up DOI: 10.1097/PAS.0b013e3181fbe20a 3. Relative survival measures the total impact of the disease on survival, regardless of what was considered to be the cause of death. Dermatopathology. (4)Department of Pathology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, 589-8511, Japan. -, 6. Benign appearance on imaging; on ultrasonography, pure cyst, mixed image or solid mass. 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. and you may need to create a new Wiley Online Library account. 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. As with papillary carcinomas in general, it tends to occur in postmenopausal women. We evaluated myoepithelial cells and collagen IV , a basement membrane component, in 40 IPCs from 39 (35 female and 4 male) patients and assessed their clinical management and follow-up. Although of academic interest, this distinction is likely to be of little clinical relevance.7, 8, 15. Intracystic carcinoma of the breast refers to a breast cancer located within a cyst. 1.1. 2004;183 (5): 1516. Philadelphia, Pa: Lippincott-Raven, 1997; 335-354. 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. There is no apparently significant difference in the long-term survival of patients in the 2 histologically derived subgroups of IPC. 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 … Papillary fibroelastoma. Rosen PP (1997) Papillary carcinoma In Rosen’s Breast Pathology pp 335–54 2. At 5 years, these patients had an observed cumulative survival of 74.5% and a relative cumulative survivalof 83.2%. In conclusion, IPC is a rare tumor with an excellent prognosis. 102 (5-6): 403-5. Background: Intracystic papillary carcinoma (IPC) of the breast is a rare form of noninvasive breast cancer. 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. A total of 22 intracystic papillary carcinoma cases were identified in the pathology database at Roswell Park Cancer Institute between 1992 and 2010. Breast Cancer Res. Endocrine pathology. 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). 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? In addition, there has been no clear indication for adjuvant endocrine therapy, even among patients with estrogen receptor–positive tumors. Unable to process the form. Pathologically, intracystic papillary carcinomas may show four cellular patterns: cribriform; compact columnar epithelial; stratified spindle cell; transitional cell form resembling urothelium; The combination of two or more of these patterns may also be seen. Bhargava R, Esposito NN, Dabbs … The tumor affects predominantly older women, but can also be diagnosed in younger women and men. Abstract. 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 … For example, in a study by Carter et al that analyzed 41 cases of IPC treated before 1974, 70% of patients with a diagnosis of IPC from excisional biopsy underwent mastectomy, with greater than one–third of these patients undergoing a radical mastectomy.12 None of these patients developed disease recurrence or had a cancer-related death. The cases were divided into three … The median follow-up was 5 years. 52 Pure invasive papillary carcinoma is extremely rare, with a reported incidence of approximately 0.5% of all invasive breast cancers in some series. 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. Second, it is well documented that IPC may be associated with adjacent areas of DCIS and invasive ductal carcinoma. Introduction. An invasive component may also be seen in some cases. As a comparison, the observed cumulative survival rate and relative cumulative survival rate of all other (non-IPC) invasive breast cancers in the CCR were calculated for the same time period. Encapsulated Papillary Carcinoma Key Facts Terminology Papillary carcinoma present within single well-circumscribed cystic space Synonyms: Encysted papillary carcinoma, intracystic carcinoma Clinical Issues 0.5-2% of breast cancers in women Most common in elderly women (median age: 70) Often presents as palpable mass or circumscribed mammographic … Papillary eccrine adenoma. 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. 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 … These data support previous studies that have shown a low mortality for patients with IPC. Please check your email for instructions on resetting your password. 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. Clearly, patients with IPC are much less likely to die than those diagnosed with the more common types of breast cancer, such as invasive ductal carcinoma. CLINICAL FEATURES. 11 (6): 1074-6. The majority of IPC cases were diagnosed in women (96.5%; n = 866), whereas 3.5% of cases occurred in men (n = 32). Our review of the literature suggests that this is the largest series of IPC, with an analysis of over 900 cases. Cancer 2008. Clinical features. NOEL WEIDNER, Farnaz Hasteh, in Modern Surgical Pathology (Second Edition), 2009. After 10 years, the observed cumulative survival was 55.9%, and the relative cumulative survival rate was 74.6%. Lesion confined to a cyst. Papillary Carcinoma of Breast : Solid variant. 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. 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. 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. 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. Definitions. 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. 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. Papillary Carcinoma of Breast : Apocrine change. It shares features with DCIS and IDC and … {"url":"/signup-modal-props.json?lang=us\u0026email="}. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? The overall observed cumulative survival of patients with IPC was 82.0% at 5 years and 61.2% after 10 years. The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, Department of Health Services, the National Cancer Institute, and the Centers for Disease Control and Prevention is not intended nor should be inferred. The database includes information regarding cancer type (histology), patient demographics, disease stage at diagnosis, and survival. May have a thick fibrous capsule 1.2. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. -, 4. Use the link below to share a full-text version of this article with your friends and colleagues. At 10 years, this survival rate remained >95%. Breast-conserving surgery and mastectomy (simple, modified radical, or radical) have been used in the treatment of IPC. 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. In-Situ Papillary Carcinoma of Breast. Intracystic papillary carcinoma (IPC) is an uncommon breast neoplasm. Intracystic papillary carcinoma (IPC) is an uncommon breast neoplasm. Features: 1. Intracystic Papillary Carcinoma of the Breast- Appearance of hypoechoic mass on ultrasound (A) . In-situ Papillary Carcinoma of Breast. 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.
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