Intracystic papillary breast carcinoma

Case contributed by Alexandra Stanislavsky

Presentation

Asymptomatic woman. Round 5 screening mammogram.

Patient Data

Age: 60
Gender: Female
mammography

There is a rounded mass in the upper outer quadrant of the left breast with circumscribed margins, which are partially obscured by the adjacent breast parenchyma.

Prior mammograms, two years ago.

mammography

Comparison to the prior study shows that this was present previously, but has considerably increased in size and density.

Mammographic workup

mammography

Given the interval change from the previous imaging and incomplete visualization of the margins, the patient was recalled for further assessment. Standard workup views, including a true lateral projection of the left breast, CC and MLO spot compression views were performed. These confirm persistence of a circumscribed rounded mass without any lobulations, and a surrounding low-density halo.

ultrasound

Complex cystic lesion in the left breast at 2 o'clock 6cm from the nipple, corresponding to the mammographic abnormality. The intracystic solid nodule demonstrates loss of the cyst wall along the points of attachment, angular margins with the cyst wall, probable duct extension (see the first image) and internal vascularity - all of which are suspicious features for malignancy.

Post Biopsy

mammography

Biopsy clip location corresponds to the mammographic lesion. Note however the reduction in size due to rupture of the cystic component in the process of biopsy. The role of the breast clip, in this case, is to aid future localization, rather than for mammographic-ultrasound correlation.

Case Discussion

Biopsy and subsequent wide local excision confirm an encysted papillary carcinoma.

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