Intracystic Papillary Carcinoma of the Breast: Clinical and Radiological Findings with Histopathologic Correlation

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1 Intracystic Papillary Carcinoma of the Breast: Clinical and Radiological Findings with Histopathologic Correlation Poster No.: C-2078 Congress: ECR 2015 Type: Scientific Exhibit Authors: S. S. AlSharif 1, J. lian 2, X. tan 3, S. sun 3, R. hsu 2, A. omeroglu 2, B. Keywords: DOI: Mesurolle 3 ; 1 Jeddah/SA, 2 Montreal/CA, 3 Montreal, QC/CA Staging, Diagnostic procedure, Biopsy, Ultrasound, MR, Mammography, Oncology, Breast, Cancer /ecr2015/C-2078 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 11

2 Aims and objectives To describe the imaging features of intracystic papillary carcinoma (ICPC) of the breast and correlate it with histopathological findings Describe imaging features of cases associated with invasive ductal carcinoma (IDC) To emphasize on the importance of early detection as it impact subsequent management Methods and materials Retrospective review of the pathology database in women who underwent surgery for breast cancer with the diagnosis of pure and mixed ICPC from January March 2014 Total of 30 patients identified with 35 lesions (20 pure and 15 mixed) Images were reviewed by two radiologists in consensus following the BI- RADS Lexicon Descriptive statistical analysis (chi squared) was performed to identify statistically significant (p=0.05) imaging features of ICPC, and whether they could help distinguish between pure and mixed lesions, and correlate them to the pathologic and clinical features Results Patients mean age was 68.6 years (+/-12.2 years) 13/35 (37%) lesions that were palpable clinically 7/30 patients (23%) presented with bloody nipple discharge slight left side predominance with R : L ratio of 14:21 Out of 2751 biopsies obtained for breast cancer, 35 lesions (1,3%) with IPC were detected in 30 patients. Of these, 15 lesions (43%) were associated with IDC and 20 lesions (57%) we not associated with IDC. Mean lesion size 1.8 +/-0.9cm (1cm to 3cm) All lesions were showing localized disease Mammographically, (86%,30/35) lesions presented as masses [oval shape (46%,16/35), indistinct margins (32%,11/35) &equal density (49%,17/35)]. Microcalcifications were associated in 3-lesions (9%,3/35) Page 2 of 11

3 On ultrasound, (97%,34/35) of the lesions presented as hypoechoic (47%,16/34) or complex (53%,18/34) masses (mean size; 2.1+/-1cm), [irregular or oval shape (56%,19/34; 38%,13/34 respectively), microlobulated margins (68%,23/34) and posterior acoustic enhancement (69%,24/35)]. Color Doppler demonstrated increased intralesional vascularity (66%,21/32). Elastography was performed on 13 lesions, lesions associated with IDC had mean Fat Lesion Ratio of 4.8 versus 3.4 for lesions without IDC (pvalue=0.086) Pre-operative MRI performed for five lesions (1-invasive & 4-non invasive) showed 4-masses (1-oval, 1-lobulated & 2-irregular) with irregular margins (3/4,75%). Two lesions were T2 hyperintense. Three lesions were associated with non-mass enhancement of clumped &segmental distribution. All lesions showed type-3 enhancement curve No detected statistical significance in the imaging features to differentiate lesions associated with invasive ductal carcinoma Images for this section: Page 3 of 11

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5 Fig. 2: Oval indistinct mass Fig. 3: Irregular spiculated mass Page 5 of 11

6 Fig. 4: clustered coarse heterogeneous microcalcifications associated with a mostly well circumscribed partially obscured mass of similar density to the fibroglandular parenchyma Page 6 of 11

7 Fig. 1: H&E at 100x magnifications, showing the fibrotic capsule on top and papillary carcinoma in the bottom of the picture Page 7 of 11

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9 Fig. 5: Two lesions in two different patients show mixed solid and cystic lesions with posterior acoustic enhancement Fig. 6: Macrolubulated homogenous hypoechoic lesion with intra-lesional vascularity Page 9 of 11

10 Conclusion Imagingconcurs with literature but is not distinguishing for pathology Surgical excision is critical for diagnosis Personal information Authors Contact Info: Shaza AlSharif: Benoit Mesurolle: References Dogan BE, Whitman GJ, Middleton LPet-al. Intracystic papillary carcinoma of the breast.am J Roentgenol. 2003;181 (1): 186. Khoury T, Hu Q, Liu Set al.intracystic papillary carcinoma ofbreast: interrelationshipwithin situandinvasive carcinomaand a proposal ofpathogenesis. ModernPathology2014;27: Lam WW, Chu WC, Tang APet al. Role of radiologic features in the management of papillary lesions of the breast.am JRoentgenol 2006;186(5): Lam WW, Tang AP,Tse G et-al. Radiology-Pathology conference: papillary carcinoma of the breast.clin Imaging2005;29 (6): Liberman L, Feng TL,Susnik B. Case 35:intracystic papillary carcinoma with invasion.radiology 2001;219 (3): Mercado CL,Hamele-Bena D,Oken SM, Singer CI,Cangiarella J. Papillary lesions of the breast at percutaneous core-needle biopsy.radiology 2006; 238(3): Muttarak M,Lerttumnongtum P,Chaiwun Bet al. Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation.am JRoentgenol 2008;191 (3): Pal SK, Lau SK,Kruper Let al. Papillary carcinoma of the breast: an overview.breast Cancer Res Treat2010;122(3): Rodríguez MC,Secades AL, Angulo JM. Best cases from the AFIP:intracystic papillary carcinoma of the breast.radiographics 2010;30 (7): Soo MS,Williford ME, Walsh Ret al. Papillary carcinoma of the breast: imaging findings.am JRoentgenol 1995;164 (2): Page 10 of 11

11 Wagner AE, Middleton LP, Whitman GJ. Intracystic papillary carcinoma of the breast with invasion. Am J Roentgenol 2004;183 (5): Page 11 of 11