Intracystic Papillary Carcinoma of the Breast: An In Situ or Invasive Tumor? Results of Immunohistochemical
Analysis and Clinical Follow-up
(Am J Surg Pathol 2011;35:1–14)
Abstract: Intracystic papillary carcinoma (IPC) is regarded as an
intraductal neoplasm, but recent evidence suggests that it could
be invasive, as it often lacks myoepithelial lining. We evaluated
myoepithelial cells and collagen IV, a basement membrane
component, in 40 IPCs from 39 (35 female and 4 male) patients
and assessed their clinical management and follow-up. The
mean patient age at diagnosis was 68 years, and the mean tumor
size was 1.8 cm. Thirteen cases were pure IPC, 8 cases were IPC
with or without microinvasion, and 19 cases were IPC with
invasive carcinoma (IPC+IC), including 1 mucinous and 1
cribriform carcinoma. Ductal carcinoma in situ associated more
often with IPC+IC (84.2%) than with pure IPC (61.5%) or IPC
with or without microinvasion (62.5%). Myoepithelial cells were
completely absent in 33 of 40 (82.5%) IPCs, and only focal in
the remaining 7 of 40 cases (17.5%). Collagen IV lining was
discontinuous in most cases (89%). All tumors were estrogen
receptor positive and HER2 negative; most were progesterone
receptor positive (93%). Eleven patients underwent mastectomy
and 28 lumpectomy; 3 of 27 (11%) patients had lymph node
involvement. Fourteen of all patients treated with breast
conservation received radiation, 10 hormonal treatment, and
none chemotherapy. Four patients treated conservatively (3 with
pure IPC and 1 with IPC+IC) recurred locally, including one
who later developed bone metastasis. We conclude that IPC
constitutes a spectrum of intraductal and IC, with predominance
of the latter. IPC rarely involves lymph nodes and carries very
good prognosis, but can recur locally. This type of tumor is
strongly estrogen receptor positive and hormonal therapy should
be pursued for its management, whereasthebenefitofradiation
after lumpectomy remains unclear.

讨论：
1.乳腺囊内乳头状癌：是原位癌还是浸润性癌？
2.乳腺囊内乳头状癌和导管内癌是否同一个谱系？
3.和浸润性性癌的不同？