Chinar A Dzayee
Rizgari teaching hospital, Iraq
Title: Encysted papillary carcinoma
Chinar A Dzayee has completed her Bachelor’s degree in Medicine from the Salahaddin University and her Master’s degree in General Surgery in 2008 from Hawler Medical University. She is currently working as a General Surgeon in Rizgari Teaching Hospital and Breast Clinic in Erbil. Her interests are in breast disease and surgery, diagnosis, treatment of benign and malignant breast disease and performing surgery.
A 52 years old lady was presented with right bloody nipple discharge for 4 years. Ultrasound -RT breast-duct dilatation with irregular mass 24×10 mm within the duct, mammography shoes multiple dilated linear branching density from retro areolar area to the lateral margin of RT breast with nipple retraction. Sonographic guide core biopsy was done. Microscopically finding, dilated ductal space one supported by fibrous tissue other showed prominent ductal proliferation with epitheliosismild atypical change in fibrotic stroma, patient underwent surgery by excision of entire duct from nipple to distal part about 9×6×3 cm axilla not touched, sent for histopathology. Microscopical Finding: Intraductal (intracystic) papillary carcinoma, no invasion is seen, all margins were clear, ER positive, PR positive and HER2 negative. She passed smooth post-operative period and received radiotherapy and now on Tamoxifen treatment. Encapsulated Papillary Carcinoma (EPC) of the breast is a rare malignancy accounting for 0.5-1% of all breast cancers, Caucasians are the most common sufferers of EPC (63%), followed by Hispanics (12-30%), Asian/Pacific Islanders (10-13%) and African-Americans (7-10.5%). EPC can be presented either as a palpable mass in an otherwise normal breast or as a swollen breast due to the presence of a huge cystic mass within it. In some cases, nipple retraction may be present with or without nipple bleeding, requiring further examination using imaging and biopsy. EPC may also be simple mammographic findings without any clinical evidence. Almost 50% of the EPCs arise in the retro-areolar region. These lesions are characterized by indolent behavior and extremely favorable prognosis. Encapsulated PC can be treated with adequate local therapy. Routine use of adjuvant therapy, particularly chemotherapy, is clearly not appropriate in view of the very low risk of subsequent events. However, hormonal therapy may be indicated in certain cases such as recurrent PC.