Obstetrics and Gynecology Unit, Hospital Hautepierre-University Hospital, Strasbourg, France.
Breast Imaging Unit, Hospital Hautepierre-University Hospital, Strasbourg, France.
Anticancer Res. 2014 Sep;34(9):5017-20.
Intracystic papillary carcinoma (IPC) is a ductal carcinoma of papillary variety that develops in a cystic space surrounded by a fibrous capsule. It is a rare clinicopathological entity, the in situ or invasive character of which is difficult to establish, particularly on biopsy. The treatment is surgical and breast conservation depends on the tumor size. Lymph node exploration is still debated. The diagnosis of IPC is a challenge for the pathologist: the negativity of the basement membrane markers and of myoepithelial cells carries a risk of over-diagnosis on biopsy that can lead to over-treatment.
To illustrate this risk, we report the case of a breast mass of 8 cm; its biopsy evoked invasive papillary carcinoma (no hormone receptors and overexpression of Human Epidermal Receptor-2 (HER-2) and for which neoadjuvant chemotherapy associated with trastuzumab was firstly proposed.
The analysis of all anatomical radio-clinical data in a multidisciplinary context, however, allowed suspecting IPC, thus leading to first-line surgery (mastectomy with negative sentinel lymph nodes). With this diagnosis being confirmed on surgical specimen, no systemic treatment was then necessary. After 48 months, the patient is in complete remission.
囊内乳头状癌（IPC）是一种发生在纤维囊包围的囊性空间内的乳头状导管癌。它是一种罕见的临床病理实体，其原位或浸润性特征难以确定，特别是在活检时。治疗方法是手术，保乳取决于肿瘤大小。淋巴结探查仍有争议。IPC 的诊断对病理学家来说是一个挑战：基底膜标志物和肌上皮细胞的阴性表达存在活检过度诊断的风险，这可能导致过度治疗。
为了说明这种风险，我们报告了一例 8 厘米的乳腺肿块；其活检提示浸润性乳头状癌（无激素受体，人表皮生长因子受体 2（HER-2）过表达），首先提出了新辅助化疗联合曲妥珠单抗的治疗方案。
在多学科背景下对所有解剖放射临床数据的分析，然而，怀疑是 IPC，因此导致一线手术（伴阴性前哨淋巴结的乳房切除术）。在手术标本中确诊后，无需进行系统治疗。48 个月后，患者完全缓解。
