Intracystic papillary breast carcinoma is a rare form of non-invasive carcinoma with an excellent prognosis. It accounts for less than 0.5% of breast cancers. We report the case of a 75-year-old man presenting with a painless cystic lump in the right breast. Ultrasonography showed a cystic lesion and aspiration revealed blood-stained fluid with suspicion of malignancy. Excisional biopsy was necessary to confirm the diagnosis and also indicated that local treatment was adequate.
Keywords: Intracystic, Papillary carcinoma, Male breast cancer
Male breast cancer is a rare disease and the incidence is 1% of all breast cancer. Intracystic papillary breast carcinoma is an extremely rare condition in men and represents only 5–7.5% of all male breast carcinomas. Diagnosis is often delayed because of the benign appearance on physical examination and radiological imaging. Such carcinomas have a better prognosis than other types of breast malignancy. Fine needle aspiration is often inaccurate and excision biopsy may be necessary for the diagnosis. We report a case of 75-year-old man presenting with a cystic lesion of the right breast which recurred after aspiration. An excisional biopsy confirmed the diagnosis and also indicated that local treatment was adequate.
A 75-year-old male presented with a painless mass in the right breast of 1-month duration. On examination, he had a well-defined 2 cm × 2 cm, firm, non-tender, non-adhering lump lateral to the right nipple. The left breast and both axillae were normal. Ultrasound showed a cyst. Aspiration of the lump revealed blood-stained fluid. Microscopic examination revealed foamy macrophages in addition to numerous epithelial cells arranged as three-dimensional papillary clumps with nuclear crowding. There was also variation of nuclear size and prominent nucleoli. The appearance was suspicious of malignancy, with the possibility of a papillary lesion being raised.
The cyst recurred 2 weeks later and the patient subsequently underwent a lumpectomy. Macroscopic examination of the specimen showed a cyst of 30 mm diameter with an intracystic fleshy papillary lesion in its wall. Multiple sections were taken for microscopic examination. The cyst wall was lined by a single layer of epithelial cells without atypia. The papillary lesion was a non-invasive papillary carcinoma. The carcinoma cells were round to polyhedral with mild atypia and rare mitoses. There was no evidence of stromal invasion. The tumour was diagnosed as intracystic papillary carcinoma, low grade. Excision margins were free of tumour. No other treatment was performed. He was doing well at 1-year follow-up.
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