J Korean Soc Radiol.  2014 Sep;71(3):139-145. 10.3348/jksr.2014.71.3.139.

Synchronous Encapsulated Papillary Carcinoma and Invasive Ductal Carcinoma Arising from Intraductal Papilloma in the Same Breast: A Case Report

• Kim JG
• Kim SY
• Lee HJ
• Lee SM
• Kim SY
• Lee DY

• KMID: 1736480
• DOI: http://doi.org/10.3348/jksr.2014.71.3.139

Abstract

Encapsulated papillary carcinoma of the breast is rare, accounting for just 0.5% to 2% of all breast cancers. A histological upgrade from papillary lesion can also possibly occur, however, an upgrade to invasive ductal carcinoma has uncommonly been reported. Furthermore, to the best of our knowledge, there is no reported case of encapsulated papillary carcinoma and invasive ductal carcinoma arising from intraductal papilloma in the same breast. We report an extremely rare case of synchronous encapsulated papillary carcinoma and invasive ductal carcinoma arising from intraductal papilloma on the same breast with radiologic-pathologic correlation.

MeSH Terms

Breast*
Carcinoma, Ductal*
Carcinoma, Papillary*
Papilloma, Intraductal*

Figure

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  Fig. 1 A 56-year-old woman with outside biopsy proven invasive ductal carcinoma. Right craniocaudal (A) and mediolateral oblique mammography (B) show about 1.5 cm sized partly indistinct oval hyperdense mass in right breast upper center, which is biopsy proven malignancy (arrow). There are several circumscribed oval isodense nodules around this lesion.

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  Fig. 2 Ultrasonography shows a 1.2 cm sized partly angular oval hypoechoic mass, which is biopsy proven malignancy (A) and a 1.3 cm sized microlobulated oval hypoechoic mass (B) in right breast upper center. A partly angular round hypoechoic mass (C), circumscribed oval hypoechoic mass (D) in right breast upper outer and a circumscribed oval hypoechoic mass (E) in right breast upper inner are also noted.

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  Fig. 3 The axial dynamic-enhanced T1-weighted image of the first post-contrast acquisition shows rim enhancement for masses in right breast upper center, outer (A, B) and inner (C, arrow).

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  Fig. 4 Enhancement patterns of masses in right breast. A, B. The kinetic curve shows early enhancement and a plateau pattern for biopsy proven malignancy (A) and a enhancing mass (B) in right breast upper inner (same as above in others, not shown).

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  Fig. 5 On the axial positron emission tomography/CT fusion image, the biopsy proven malignancy shows hypermetabolism with a peak standardized uptake value of 10.21 (arrow) and other nodules also show increased fluorodeoxyglucose uptake.

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  Fig. 6 Microscopic findings of pathologic confirmed invasive ductal carcinomas arising in intraductal papilloma. A-C. Invasive ductal carcinoma arising in intraductal papilloma (biopsy proven malignancy, corresponding with Fig. 2A). Multiple papillae in complex arborizing pattern (× 12.5) (A). Nests or cords infiltrate adjacent stroma showing invasion (× 100) (arrow) (B). Well-developed papillary architecture is found (× 100) (arrow) (C). D-F. Invasive ductal carcinoma arising in intraductal papilloma (upper center, Fig. 2B). Microphotograph showing a well-circumscribed mass containing well-developed papillary architecture (× 12.5) (D). Nests or cords infiltrate adjacent stroma showing invasion (× 100) (arrow) (E). Well-developed papillary architecture is found (× 100) (arrow) (F). G-I. Invasive ductal carcinoma arising in intraductal papilloma (upper outer, Fig. 2C). Microphotograph showing a well-circumscribed mass containing well-developed papillary or cribriform architecture. Glandular proliferation within stalks may resemble cribriform architecture (× 12.5) (G). Nests or cords infiltrate adjacent stroma showing invasion (× 100) (arrow) (H). Well-developed cribriform architecture is found (× 100) (arrow) (I). J-L. Invasive ductal carcinoma arising in intraductal papilloma (far upper outer, Fig. 2D). Microphotograph showing a well-circumscribed mass containing well-developed papillary architecture (× 12.5) (J). Nests or cords infiltrate adjacent stroma showing invasion (× 100) (arrow) (K). Well-developed papillary or cribriform architecture are found (× 100) (arrow) (L).

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  Fig. 7 Microscopic findings of pathologic confirmed encapsulated papillary carcinoma. A. Encapsulated papillary carcinoma has thick fibrous capsule (yellow arrow) and adjacent low grade ductal carcinoma in situ (blue arrow). Red arrow indicates artifact, not true invasion (probably rupture during surgery procedure), because there is no stromal reaction (× 12.5). B, C. Well-developed papillae with cytologic atypia are found (× 40). D-F. Immunohistochemical staining is negative for SMM-HC, p63, and CK 5/6, showing absence of myoepithelial cells (× 40).

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