Copyright © 1997-2001 Mammography Specialists Medical Group Inc. All rights reserved

HISTORY:
71 year old woman recently noticed a left breast lump.

DIAGNOSIS:
Intracystic papillary carcinoma

FINDINGS:
Standard MLO and CC views of the left breast show a circumscribed mass with slightly lobulated and irregular margins.


Figure 1) L MLO


Figure 1a) L MLO Magnified


Figure 2) L CC


Figure 2a) L CC Magnified
 
Ultrasound shows a complex cyst with thick wall, mural nodule and echogenic fluid contents.


Figure 3) US Longitudinal


Figure 4) US Transverse

Aspiration yielded thick yellow-orange material (containing atypical cells) and pneumocystogram shows a cyst with thick, irregular wall and a prominent mural nodule.


Figure 5) CC Pneumocystogram


Figure 5a) CC Pneumocystogram Magnified

The photomicrographs show malignant papillary epithelial structures projecting into the cyst cavity. Minimal areas of superficial invasion were also present.


Figure 6) Pathology A


Figure 7) Pathology B

DISCUSSION:
Papillary carcinomas occur in invasive and in situ forms; the latter are represented by intracystic and intraductal types; circumscribed masses dominate the imaging appearance for intracystic lesions, and microcalcifications for intraductal lesions. This pneumocystogram, performed in conjunction with cyst aspiration, replicates the sonographic appearance of a mural nodule projecting into a complex cyst.

REFERENCE:
Soo MS, Williford ME, Walsh R, Bentley RC, Kornguth PJ. Papillary Carcinoma of the Breast: Imaging Findings. AJR 1995; 164:321-326

Submitted by:
G. Thomas Ruebel, M.D. and Donald Bauermeister, M.D.
Virginia Mason Medical Center Seattle, WA

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Copyright © 1997-2001 Mammography Specialists Medical Group Inc. All rights reserved