LETTER TO EDITOR
|Year : 2010 | Volume
| Issue : 1 | Page : 46-48
Intracystic papillary carcinoma in the male breast: A rare presentation
Pinki Pandey1, Alok Dixit2, Swarn Kaur1
1 Department of Pathology, M M Institute of Medical Sciences and Research, Mullana, Ambala, India
2 Department of Pharmacology, M M Institute of Medical Sciences and Research, Mullana, Ambala, India
|Date of Web Publication||31-Jan-2012|
D-71, MMIMSR Campus, M M University, Mullana, Ambala - 133 203
|How to cite this article:|
Pandey P, Dixit A, Kaur S. Intracystic papillary carcinoma in the male breast: A rare presentation. Indian J Med Sci 2010;64:46-8
Male breast cancer is a rare disease and the incidence is 1% of all the breast cancers. Intracystic papillary carcinoma (IPC) represents a small distinctive subgroup of non-invasive breast cancer, accounts for less than 0.5% of breast malignancies and is extremely rare in men with a handful of case reports in the literature. ,
A 50 year old male presented with a slowly increasing painless lump in the left breast since 6 months, with history of occasional blood stained nipple discharge. On local examination, a soft, non-adhering lump having clear borders and a flat surface, mimicking a breast cyst, was palpable in the left subaerolar area. The overlying skin was normal with retracted nipple. The right breast and both axillae were normal. Ultrasound revealed a cystic lesion. Fine needle aspiration yielded abundant bloody fluid. Smears showed an occasional papillae and isolated cells with mild pleomorphic nuclei and inconspicuous nucleoli, raising the suspicion of a papillary carcinoma, but no definite diagnosis could be made. An excisional biopsy was performed.
Grossly, the specimen showed a cyst of 3.2 × 2.5 cm diameter with an intracystic protruding fleshy papillary lesion in its wall [Figure 1]. Multiple histological sections examined showed a cyst containing papillae and solid proliferation of round to polyhedral mildly atypical cells and infrequent mitoses. Multiple papillae with fibrovascular cores were present covered by a single type of epithelium of varying thickness and absence of myoepithelial cells [Figure 2]. Calcified masses and psammoma bodies were also seen. Excision margins were clear. Multiple histological sectioning did not show stromal or fibrovascular invasion. The tumor was diagnosed as pure IPC. At 15 months follow-up, no tumor recurrence or metastasis was observed.
|Figure 1: Gross photograph of the cut surface of the lesion shows a well defined cyst with fleshy papillary lesions in its wall|
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|Figure 2: Microphotograph shows papillae with fibrovascular cores and overlying epithelial cells. It is difficult to discern the myoepithelial cell layer (H and E, ×400)|
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IPC is a localized, non-invasive breast cancer with papillary proliferations arising within or on the walls of a large cyst.  The IPC can occur in a pure form, or may be associated with ductal carcinoma in situ (DCIS), or invasive carcinoma not otherwise specified. The majority of patients with IPC have associated DCIS or invasive cancer or both. , The presence and distribution of myoepithelial cells is one of the most useful features in distinguishing among the various types of papillary lesions. These cells are present within the papillae and at the periphery of involved spaces in intraductal papillomas but are absent in the papillae of IPC.  Since myoepithelial cells may be difficult to appreciate on routine H and E- stained sections, immunohistochemistry for myoepithelial cell markers such as smooth muscle actin, calponin and smooth muscle myosin heavy chain may be extremely useful.  We could not perform the same in our case due to economic limitations.
The usual clinical manifestation is the palpable mass or nipple discharge. Mammography usually shows well defined margin, while an irregular margin suggests the presence of invasion. Ultrasonography typically reveals a hypoechoic area with soft tissue echoes projecting from the wall of the cyst, as were seen in our case. Sometimes it may be difficult to diagnose on fine needle aspiration cytology and this can be attributed to the cystic and hemorrhagic nature of these lesions. An excisional biopsy is usually required to establish the diagnosis. 
IPC is rare in males, which presents clinically as a benign looking cystic lesion and diagnosis should be suspected when ultrasonography shows an intracystic mural nodule; the mass persists or recurs after fine needle aspiration. Excisional biopsy is necessary to confirm the diagnosis. Multiple sections should be passed and examined microscopically as there might be only a small area of invasion present which could alter the line of treatment and affect the prognosis. The treatment of choice for pure IPC is ample local excision. Prognosis of pure IPC is usually excellent because the malignant potential and the proliferative activity of the cancer are low.
| ¤ References|| |
|1.||Brahmi SA, El M'rabbet FZ, Akesbi Y, Benbrahim Z, Hind E, Znati K, et al. Intracystic papillary carcinoma associated with ductal carcinoma in situ in a male breast: A case report. Cases J 2009;2:7260. |
|2.||Romics L, 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. |
|3.||Andres B, Anguilar J, Torroba A, Martinez-Galvez M, Aguayo JL. Intracystic papillary carcinoma in the male breast. Breast J 2003;9:249-50. |
|4.||Collins 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. |
|5.||Collins LC, Schnitt SJ. Papillary lesions of the breast: Selected diagnostic and management issues. Histopathology 2008;52:20-9. |
[Figure 1], [Figure 2]