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Figure 6: Low power showing negative immunostaining for: (a) inset showing positive internal control; (b) progesterone; (c) Her-2/neu (HE, ×100)
differentiate. Papillary carcinomas of the breast are divided showed high-grade nuclear features and invasion could
into invasive and noninvasive types. The noninvasive type not be excluded. Axillary interventions include sentinel
is further divided into the diffuse form (papillary variant of lymph node biopsy and/or axillary dissection. The
[11]
ductal carcinoma in situ) and the localized form (intracystic low yield for metastasis and vascular invasion makes
or encysted papillary carcinoma). Encapsulated papillary chemotherapeutic intervention not mandatory. [10] This
[5]
carcinoma is characterised by the presence of papillary treatment modality is considered only in cases associated
carcinoma within an apparent cystically dilated duct. with lymphovascular invasion. Adjuvant radiotherapy and
Myoepithelial cells are present neither in the papillae of endocrine therapy (tamoxifen) has been recommended in
IPC nor at the periphery, in contrast to papillary ductal younger patients (< 50 years) and in patients having IPC
carcinoma in situ (DCIS), in which there are MECs at the associated with invasion and/or DCIS. [12]
periphery of involved spaces. Several IHC stains like
[6]
SMA, CD10, or S-100 can be used to confirm the presence In our case, no DCIS or foci of invasive carcinoma were
of myoepithelial cells. IPCs have been considered to be a seen in the surrounding breast. In addition to that, our
form of low-grade invasive carcinoma with an expansile case showed high-grade morphology (Nottingham’s
growth pattern, or part of a spectrum of progression from histologic score = 8/9, grade III) with triple-negative
in-situ to invasive disease. IPCs may occur alone, but immunostaining, which is a very rare finding. [2]
[6]
more often the surrounding breast tissue contains foci of
low- or intermediate-grade DCIS, usually with a cribriform To conclude, the unusual high-grade adverse
or micropapillary pattern. Areas of invasive carcinoma histomorphological features of IPC, with triple-negative
[7]
may also be seen in association with them. These tumors immunostaining and no invasive foci, as seen in our case,
are usually of low or intermediate nuclear grade with is a rare finding. The management and prognosis in such a
no evidence of necrosis and are strongly ER positive case remains questionable.
and Her-2/neu negative, unlike our case, which shows Financial support and sponsorship
[1]
high-grade nuclear features and is triple negative. Also, Nil.
these tumors are well delineated, remain quiescent, and
are best regarded as intraductal papillary carcinomas. Conflicts of interest
[8]
The patients with IPC are much less likely to die than There are no conflicts of interest.
those diagnosed with other types of breast cancer. At 10
years, the survival rate has been found to be greater than REFERENCES
95%. Lefkowitz et al. have reported a 100% survival
[5]
[9]
rate and 91% disease-free survival rate at 10 years. The 1. Reefy SA, Kameshki R, Sada DA, Elewah AA, Awadhi AA,
treatment options can involve breast-conserving surgery Awadhi KA. Intracystic papillary breast cancer: a clinical update.
in the form of wide local excision with or without adjuvant Ecancermedicalscience 2013;7:286.
radiotherapy or mastectomy. [10] Low-grade tumors are less 2. Terzi A, Uner AH. An unusual case of invasive papillary carcinoma
likely to recur or metastasize and are best treated by local of the breast. Indian J Pathol Microbiol 2012;55:543-5.
excision in the absence of invasion. On the other hand, 3. Ibarra JA. Papillary lesions of breast. Breast J 2006;12:237-51.
patients with higher-grade tumors have an increased risk 4. Kuroda N, Ohara M, Inoue K Mizuno K, Fujishima N, Hamaguchi
of recurrence and metastasis. It is for this reason that N, Lee GH. The majority of triple-negative breast cancer may
[1]
a MRM was performed in our case because cytology correspond to basal-like carcinoma, but triple-negative breast

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