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Year : 2010  |  Volume : 47  |  Issue : 3  |  Page : 349--351

Intracystic papillary carcinoma in a male breast following mastectomy for infiltrating ductal carcinoma

S Shukla, S Singh, M Pujani 
 Department of Pathology, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India

Correspondence Address:
M Pujani
Department of Pathology, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi
India




How to cite this article:
Shukla S, Singh S, Pujani M. Intracystic papillary carcinoma in a male breast following mastectomy for infiltrating ductal carcinoma.Indian J Cancer 2010;47:349-351


How to cite this URL:
Shukla S, Singh S, Pujani M. Intracystic papillary carcinoma in a male breast following mastectomy for infiltrating ductal carcinoma. Indian J Cancer [serial online] 2010 [cited 2019 Aug 24 ];47:349-351
Available from: http://www.indianjcancer.com/text.asp?2010/47/3/349/64712


Full Text

Sir,

Male breast carcinoma accounts for less than 1% of all malignancies in men and represents 0.6% of all breast carcinomas. [1] Intracystic papillary carcinoma (IPC) comprises 5% to 7.5% of all male breast cancers. [2] We report a very unusual case of mammary IPC occurring in an elderly man following mastectomy for invasive ductal carcinoma, not otherwise specified (NOS).

A 65-year-old man was admitted to the hospital with a mass in left breast for the last 2 years. There was a history of similar lump in the left breast, which was operated upon and was reported as invasive ductal carcinoma, NOS. On examination, there was a 1.5 Χ 1.0 cm mass in the left breast fixed to the skin. Overlying skin showed a surgical scar mark, and nipple and areola were absent. Multiple left axillary lymph nodes were palpable. Right breast and axilla were normal. Ultrasound imaging revealed the presence of a large anechoic cyst with a hyperechoic nodule. Fine-needle aspiration cytology was inconclusive.

The patient underwent wide local excision and grossly, a specimen of left breast lump with attached skin flap and axillary tail measuring 12 Χ 7 Χ 3 cm were removed. On serial sectioning, the tumor was cystic, measuring 1.5 cm in diameter, with multiple filiform papillae projecting into the lumen. Seven lymph nodes were isolated from attached axillary fat. Microscopic examination showed a large dilated duct with multiple papillary structures in the lumen with fibrovascular cores. The papillae were lined by epithelial cells, and myoepithelial cells were absent. There was nuclear stratification with a moderate degree of anisonucleosis, nuclear hyperchromasia, and high mitotic activity [Figure 1]. There was evidence of invasive ductal carcinoma, grade 2 (modified Bloom-Richardson score) in the multiple sections studied. Three out of 7 lymph nodes dissected showed tumor metastasis. The tumor was reported as IPC with associated infiltrating ductal carcinoma. On immunohistochemistry, the tumor was estrogen receptor-positive and progesterone receptor-positive and Her-2/neu negative. The patient did not report for postsurgery follow-up.

IPC is a rare malignancy of the breast; however, a relatively higher incidence range of 5-7.5% has been reported in men. [3],[4],[5] The California Cancer Registry classifies IPC as either carcinoma in situ (CIS) or invasive. Grabowski et al reviewed 917 cases of IPC (from 1988 to 2005) comprising 47% CIS and 53% cases with invasion and concluded that there is an excellent prognosis for patients diagnosed with IPC regardless of whether the tumor is diagnosed as in situ or invasive. Sentinel lymph node biopsy may be a prudent way to evaluate axillary involvement in patients with IPC. [3]

Collins et al studied the presence and distribution of myoepithelial cell layer (MEC) at the periphery of the nodules in 22 cases of IPC and showed a complete absence of MEC using smooth muscle myosin heavy chain, calponin, p63, CD10, and cytokeratin 5/6. [4]

To diagnose IPC in men, triple assessment (ie, clinical examination and radiological and histologic assessment) is necessary, as it is rare. [6] Grabowski et al confirmed that surgery is the mainstay of treatment, which can be either conservation or mastectomy. Axillary node metastasis can occur in up to 14% of the cases; and therefore, an axillary staging procedure or clearance is recommended by most authors. [3],[5]

In the present case, the patient had invasive ductal carcinoma breast, which was followed by IPC 2 years postsurgery. We did not come across any literature regarding the association of IPC with mastectomy or any other form of treatment-we look forward to reports, if any.

References

1Anderson WF, Devesa SS. In situ male breast carcinoma in the Surveillance, Epidemiology, and End Results database of the National Cancer Institute. Cancer 2005;104:1733-41.
2Gupta D, Torosian MH. Intracystic breast carcinoma in male: Unusual case presentation and literature review. Oncol Rep 2002;9:405-7.
3Grabowski J, Salzstein SL, Sadler GR, Blair S. Intracystic papillary carcinoma: A review of 917 cases. Cancer 2008;113:916-20.
4Collins LC, Carlo VP, Hwang H, Barry TS, Gown AM, Schnitt SJ. Intracystic papillary carcinomas of the breast: A reevaluation using a panel of myoepithelial cell markers. Am J Surg Pathol 2006;30:1002-7.
5Dragoumis DM, Tsiftsoglou AP. Intracystic papillary carcinoma associated with ductal carcinoma in situ in a male breast. J Postgrad Med 2008;54:39-40.
6Romics L Jr, O'Brien ME, Relihan N, O'Connell F, Redmond HP. Intracystic papillary carcinoma in a male as a rare presentation of breast cancer: A case report and literature review. J Med Case Reports 2009;3:13.