Encapsulated Papillary Carcinoma of the Breast

HomeRadiologyVol. 308, No. 3 Previous Reviews and CommentaryFree AccessImages in RadiologyEncapsulated Papillary Carcinoma of the BreastJiao Bai, Guilin Wang Jiao Bai, Guilin Wang Author AffiliationsFrom the Department of Radiology (J.B.) and Department of General Surgery (Breast Surgery) (G.W.), the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Rd, Jiangyang District, Luzhou 646000, China.Address correspondence to G.W. (email: [email protected]).Jiao BaiGuilin Wang Published Online:Sep 5 2023https://doi.org/10.1148/radiol.231038MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 60-year-old woman presented with a 2-year history of a painful, gradually enlarging tumor in her left breast. The tumor was first detected 2 years earlier at US as a mixed cystic and solid mass measuring 2.9 × 1.6 × 2.7 cm. However, the patient refused treatment at that time. Physical examination showed a large lobulated, elastic hard, movable mass involving the entire left breast. Mammography was not performed due to the risk of rupturing the mass. MRI revealed a large multilocular cystic mass measuring 12.4 × 11.5 × 9.8 cm with enhancement of the capsule, internal septa, and mural nodules (Figure, A, B). Core-needle biopsy results confirmed a diagnosis of intraductal papillary carcinoma. The patient underwent mastectomy and sentinel lymph node biopsy. Postoperative histologic diagnosis was encapsulated papillary carcinoma (Figure, C).Images in a 60-year-old woman with a large lobulated mass in the left breast. (A) Axial T2-weighted fat-saturated MRI scan demonstrates a large heterogeneous multicystic mass with mural nodules with low T2 signal intensity (arrow). (B) Axial T1-weighted fat-saturated contrast-enhanced MRI scan demonstrates intense enhancement of the mural nodules (arrow), cyst walls, and tumor capsule and no enhancement within the cystic components. (C) Photomicrograph (hematoxylin-eosin stain; original magnification, ×12.5) demonstrates a well-circumscribed encapsulated papillary carcinoma (✩) surrounded by a thick fibrous capsule (arrow).Download as PowerPointOpen in Image Viewer Encapsulated papillary carcinoma is a rare histologic subtype of papillary neoplasm and constitutes approximately 0.5%–1% of all breast carcinomas (1). It is characterized by fine fibrovascular stalks covered by neoplastic epithelial cells of low or intermediate nuclear grade, typically manifesting within cystic spaces surrounded by a fibrous capsule. Its gross specimen commonly manifests as a complex cystic and solid mass, and the tumor tends to enlarge with a cystic growth pattern (2). Upon clinical and radiologic evaluation, encapsulated papillary carcinoma commonly appears as a benign lump and is associated with an excellent prognosis (3). The imaging features of encapsulated papillary carcinoma are usually nonspecific (4). However, due to the long course of the disease in this case, the patient had imaging findings that are typical but rarely seen.Disclosures of conflicts of interest: J.B. No relevant relationships. G.W. No relevant relationships.AcknowledgmentThanks to Tian Xia, MM, from the Department of Pathology at the Affiliated Hospital of Southwest Medical University for kindly providing the pathology image.References1. Rakha EA, Gandhi N, Climent F, et al. Encapsulated papillary carcinoma of the breast: an invasive tumor with excellent prognosis. Am J Surg Pathol 2011;35(8):1093–1103. Crossref, Medline, Google Scholar2. Mac Grogan G, Collins LC, Lerwill M, Rakha EA, Tan BY. Encapsulated papillary carcinoma. In: WHO Classification of Tumours Editorial Board, ed. Breast tumours: WHO classification of tumours. 5th ed. Lyon, France: IARC Press, 2019; 60–62. Google Scholar3. George K, Anna Z, Evanthia K, Vassilios K. Encapsulated papillary carcinoma of the breast: An overview. J Cancer Res Ther 2013;9(4):564–570. Crossref, Medline, Google Scholar4. Eiada R, Chong J, Kulkarni S, Goldberg F, Muradali D. Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances. AJR Am J Roentgenol 2012;198(2):264–271. Crossref, Medline, Google ScholarArticle HistoryReceived: Apr 21 2023Revision requested: Apr 27 2023Revision received: May 3 2023Accepted: May 16 2023Published online: Sept 05 2023 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 308, No. 3 Metrics Altmetric Score PDF download