J Breast Cancer.  2012 Mar;15(1):57-64. 10.4048/jbc.2012.15.1.57.

Imaging Findings of Invasive Micropapillary Carcinoma of the Breast

• Yun SU
• Choi BB
• Shu KS
• Kim SM
• Seo YD
• Lee JS
• Chang ES

• KMID: 2286474
• DOI: http://doi.org/10.4048/jbc.2012.15.1.57

Abstract

PURPOSE
The purpose of this study is to evaluate imaging and histopathologic findings including the immunohistochemical characteristics of invasive micropapillary carcinoma (IMPC) of the breast.
METHODS
Twenty-nine patients diagnosed with IMPC were included in the present study. Mammographic, sonographic, and magnetic resonance imaging (MRI) findings were analyzed retrospectively according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings were also evaluated. Microscopic slides of surgical specimens were reviewed in consensus by two pathologists with a specialty in breast pathology.
RESULTS
Most IMPCs presented as a high density irregular mass with a non-circumscribed margin associated with microcalcifications on mammography, as an irregular hypoechoic mass with a spiculated margin on ultrasound, and as irregular spiculated masses with washout patterns on MRI. PET-CT showed a high maximum standardized uptake value (SUVmax) (mean, 11.2). Axillary nodal metastases were identified in 65.5% of the patients. Immunohistochemical studies showed high positivities for estrogen receptor and c-erbB-2 (93.1% and 51.7micro, respectively).
CONCLUSION
Even though the imaging characteristics of IMPCs are not distinguishable from typical invasive ductal carcinomas, this tumor type frequently results in nodal metastases and high positivities for both estrogen receptor and c-erbB-2. The high SUVmax value that is apparent on PET-CT might be helpful in the diagnosis of IMPC.

Keyword

Breast; Carcinoma; Magnetic resonance imaging; Mammography; Ultrasound

MeSH Terms

Breast
Carcinoma, Ductal
Consensus
Electrons
Estrogens
Humans
Information Systems
Magnetic Resonance Imaging
Mammography
Neoplasm Metastasis
Retrospective Studies
Estrogens

Figure

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  Figure 1 An invasive micropapillary carcinoma in a 44-year-old woman with a palpable mass in the left breast. (A) Craniocaudal and mediolateral oblique mammograms show irregular, high-density masses with spiculated margins in the left upper outer quadrant (arrow). An enlarged lymph node with eccentric cortical thickening is seen in the axillary area (arrowhead). (B) B-mode image of the left breast shows an approximately 2.6 cm, irregular, hypoechoic mass with spiculated margins in the 1 o'clock position. (C) B-mode image of the left axilla shows an approximately 2.2 cm, enlarged lymph node with cortical thickening and obliteration of the central fat hilum, which suggests a metastatic lymph node. The lymph node was pathologically confirmed as metastasis. (D, E) Axial, dynamic, contrast-enhanced, T1-weighted MR images of the left breast 2 minutes (D) and 6 minutes (E) after contrast injection show an approximately 3.3 cm, heterogeneous, enhanced mass in the upper outer quadrant. The kinetic pattern was evaluated visually and showed a persistent pattern. (F) 18F-FDG PET maximum intensity projection image shows a subtle increased glucose metabolism (SUVmax=4.6) in the left breast (arrow). Increased glucose metabolism (SUVmax=4.0) is seen in the left axillary lymph node (arrowhead). (G) Photomicrography shows clusters of tumor cells in a micropapillary arrangement that appears to be within clear spaces (H&E stain, ×100; Inlet: positive immunohistochemical stain for estrogen receptor, ×400).

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  Figure 2 An invasive micropapillary carcinoma (IMPC) in a 60-year-old woman who underwent mammographic screening. (A) A magnified craniocaudal mammogram of the right breast shows multiple pleomorphic microcalcifications with a segmental distribution. (B) B-mode image of the right breast shows multiple hypoechoic masses with indistinct margins and segmental distributions in the twelve o'clock position (arrows). Note the calcifications within the mass (arrowheads). (C, D) Axial, dynamic, contrast-enhanced, T1-weighted MR images of the left breast 2 minutes (C) and 6 minutes (D) after contrast injection show non-mass-like, heterogeneous enhancement with a segmental distribution in the right lower outer quadrant. A kinetic curve analysis showed washout pattern (arrows). (E) Photomicrography shows tumor cells in glands or nests that appear in clear spaces associated with microcalcification foci (arrow) (H&E stain, ×200; Inlet: positive immunohistochemical stain for estrogen receptor, ×200).

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