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Figure 1: High power view of cytology smear showing tumor cells exhibiting Figure 3: Scanner view showing a papillary tumor surrounded by a thick,
pleomorphism, high N:C ratio, hyperchromatic nuclei, and prominent fibrous capsule (HE, ×40)
nucleoli. A cystic macrophage is also seen, suggesting a cystic change in
the neoplasm (Giemsa ×400)

Figure 2: Gross specimen. (a) Modified radical mastectomy specimen
showing tumor; (b) a closer view showing a well-defined, thick capsule
sorrounding a necrotic, friable tumor
was performed to rule out any invasion and to look for Figure 4: Microscopic view showing the tumor architecture and cytological
any micro metastasis in lymph nodes. Gross examination features. (a) Low power view showing papillary structures with fibrovascular
showed a well-circumscribed and encapsulated mass cores. (HE, ×100); (b) high power showing tumor cells exhibiting
pleomorphism, vesicular nuclei with prominent nucleoli (HE, ×400)
measuring 2.8 cm × 2 cm × 2 cm having a friable grey-
white cut surface with areas of necrosis [Figure 2]. The
base of resection and overlying skin were 2 cm and 3 cm
away, respectively, and free of tumor. Sections were
taken from the tumor along with the capsule. Separate
sections from the adjoining breast were also taken to rule
out invasion. Eleven lymph nodes were dissected from
the axillary fat. Microscopic examination showed a thick
fibrous capsule surrounding a neoplasm composed of
blunt or delicate papillary structures with central cores.
Intervening necrotic areas were also seen [Figure 3]. Figure 5: High power view showing tumor cells negative for: (a) smooth
muscle actin immunostains; (b) performed with a positive control in a benign
The cells lining the papillae showed high-grade nuclear papillary tumor (SMA ×400)
atypia with variable N:C ratios, vesicular chromatin, invasive malignancy was seen. All the dissected axillary
and prominent nucleoli [Figure 4]. Mitotic figures were lymph nodes were free of metastasis (0/11). A diagnosis of
seen frequently (> 10/10 hpf). The MEC lining was encapsulated (intracystic) papillary carcinoma, high grade
absent within the papillary processes and at the periphery and triple negative, was rendered. Post-surgery on follow-
of tumor; this finding was confirmed by performing up, the patient is disease free to date (4 months).
immunohistochemistry for smooth muscle actin (SMA)
[Figure 5]. Tumor cells were negative for ER, PR, and DISCUSSION
Her-2/neu immunostains, performed with positive controls
[Figure 6]. Adjacent breast tissue showed only fibrosis. No Papillary lesions of the breast are usually difficult to

Journal of Cancer Metastasis and Treatment ¦ Volume 2 ¦ June 15, 2016 ¦ 225