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

Affiliations
  • 1Department of Radiology, Chungnam National University Hospital, Daejeon, Korea. med20@hanmail.net
  • 2Department of Pathology, Chungnam National University Hospital, Daejeon, Korea.
  • 3Department of Nuclear Medicine, Chungnam National University Hospital, Daejeon, Korea.
  • 4Department of Surgery, Chungnam National University Hospital, Daejeon, Korea.

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

  • 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).

  • 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).


Cited by  1 articles

Invasive Micropapillary Carcinoma in Axillary Ectopic Breast and Synchronous Ductal Carcinoma In Situ in the Contralateral Breast
Seung Won Oh, Hyo Soon Lim, Ji Shin Lee, Sung Min Moon, Min Ho Park
J Breast Cancer. 2017;20(3):314-318.    doi: 10.4048/jbc.2017.20.3.314.


Reference

1. Petersen JL. Breast carcinomas with an unexpected inside-out growth pattern: rotation of polarization associated with angioinvasion. Pathol Res Pract. 1993. 189:A780.
2. Adrada B, Arribas E, Gilcrease M, Yang WT. Invasive micropapillary carcinoma of the breast: mammographic, sonographic, and MRI features. AJR Am J Roentgenol. 2009. 193:W58–W63.
Article
3. Siriaunkgul S, Tavassoli FA. Invasive micropapillary carcinoma of the breast. Mod Pathol. 1993. 6:660–662.
4. Zekioglu O, Erhan Y, Ciris M, Bayramoglu H, Ozdemir N. Invasive micropapillary carcinoma of the breast: high incidence of lymph node metastasis with extranodal extension and its immunohistochemical profile compared with invasive ductal carcinoma. Histopathology. 2004. 44:18–23.
Article
5. Gunhan-Bilgen I, Zekioglu O, Ustün EE, Memis A, Erhan Y. Invasive micropapillary carcinoma of the breast: clinical, mammographic, and sonographic findings with histopathologic correlation. AJR Am J Roentgenol. 2002. 179:927–931.
6. Kim DS, Cho N, Ko ES, Kim DY, Yang SK, Kim SJ, et al. Imaging and the clinical-pathologic features of invasive micropapillary carcinoma of the breast. J Korean Radiol Soc. 2007. 56:497–503.
Article
7. Yang WT, Chang J, Metreweli C. Patients with breast cancer: differences in color Doppler flow and gray-scale US features of benign and malignant axillary lymph nodes. Radiology. 2000. 215:568–573.
Article
8. Tavassoli FA, Devilee P. International Agency for Research on Cancer, World Health Organization. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. 2003. Lyon: IAPS Press;35–36.
9. Guo X, Chen L, Lang R, Fan Y, Zhang X, Fu L. Invasive micropapillary carcinoma of the breast: association of pathologic features with lymph node metastasis. Am J Clin Pathol. 2006. 126:740–746.
10. Wong SI, Cheung H, Tse GM. Fine needle aspiration cytology of invasive micropapillary carcinoma of the breast. A case report. Acta Cytol. 2000. 44:1085–1089.
Article
11. Gil-Rendo A, Martínez-Regueira F, Zornoza G, García-Velloso MJ, Beorlegui C, Rodriguez-Spiteri N. Association between [18F]fluorodeoxyglucose uptake and prognostic parameters in breast cancer. Br J Surg. 2009. 96:166–170.
Article
12. Ueda S, Tsuda H, Asakawa H, Shigekawa T, Fukatsu K, Kondo N, et al. Clinicopathological and prognostic relevance of uptake level using 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer. Jpn J Clin Oncol. 2008. 38:250–258.
Article
13. Cermik TF, Mavi A, Basu S, Alavi A. Impact of FDG PET on the preoperative staging of newly diagnosed breast cancer. Eur J Nucl Med Mol Imaging. 2008. 35:475–483.
Article
14. Choi WH, Kim SH, Yoo LR, Park YH, Lee SY, Sohn HS, et al. Pre-operative FDG PET/CT findings related to early tumor recurrence in breast cancer patients. 2007. In : The Society of Nuclear Medicine 54th Annual Meeting; Abstract #47.
15. Kim MJ, Gong G, Joo HJ, Ahn SH, Ro JY. Immunohistochemical and clinicopathologic characteristics of invasive ductal carcinoma of breast with micropapillary carcinoma component. Arch Pathol Lab Med. 2005. 129:1277–1282.
Article
16. Luna-Moré S, delosSantos F, Bretón JJ, Cañadas MA. Estrogen and progesterone receptors, c-erbB-2, p53, and Bcl-2 in thirty-three invasive micropapillary breast carcinomas. Pathol Res Pract. 1996. 192:27–32.
Article
17. Nassar H, Wallis T, Andea A, Dey J, Adsay V, Visscher D. Clinicopathologic analysis of invasive micropapillary differentiation in breast carcinoma. Mod Pathol. 2001. 14:836–841.
Article
18. Paterakos M, Watkin WG, Edgerton SM, Moore DH 2nd, Thor AD. Invasive micropapillary carcinoma of the breast: a prognostic study. Hum Pathol. 1999. 30:1459–1463.
19. Walsh MM, Bleiweiss IJ. Invasive micropapillary carcinoma of the breast: eighty cases of an underrecognized entity. Hum Pathol. 2001. 32:583–589.
Article
20. Yu JH, Kim SW, Han WS, Kim SW, Park IA, Youn YK, et al. Micropapillary carcinoma of breast. J Korean Breast Cancer Soc. 2004. 7:132–135.
Article
21. Tresserra F, Grases PJ, Fábregas R, Férnandez-Cid A, Dexeus S. Invasive micropapillary carcinoma. Distinct features of a poorly recognized variant of breast carcinoma. Eur J Gynaecol Oncol. 1999. 20:205–208.
22. Kim JK, Song YJ, Cho SI, Ryu DH, Yun HY, Sung RH. Clinicopathologic significance of p53 and c-erbB-2 protein expression in breast carcinoma. J Korean Breast Cancer Soc. 2002. 5:59–64.
Article
23. Barbati A, Cosmi EV, Sidoni A, Collini P, Porpora MG, Ferri I, et al. Value of c-erbB-2 and p53 oncoprotein co-overexpression in human breast cancer. Anticancer Res. 1997. 17:401–405.
24. Bebenek M, Bar JK, Harlozinska A, Sedlaczek P. Prospective studies of p53 and c-erbB-2 expression in relation to clinicopathological parameters of human ductal breast cancer in the second stage of clinical advancement. Anticancer Res. 1998. 18(1B):619–623.
25. Bertheau P, Steinberg SM, Merino MJ. C-erbB-2, p53, and nm23 gene product expression in breast cancer in young women: immunohistochemical analysis and clinicopathologic correlation. Hum Pathol. 1998. 29:323–329.
Article
26. Ross JS, Fletcher JA. The HER-2/neu oncogene: prognostic factor, predictive factor and target for therapy. Semin Cancer Biol. 1999. 9:125–138.
Article
Full Text Links
  • JBC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr