33 Special Types of Invasive Breast Carcinoma: Diagnostic Criteria ...

that 47% of cases (n = 427) were “in situ” lesions (CIS), whereas 53% of had invasion
(n = 490). The majority of the invasive cases were localized at the time of diagnosis
(89.6%; n = 439). At 10 years, patients with “CIS” and invasive disease had a similar
relative cumulative survival (96.8% and 94.4%; P = .18). There was no significant
difference in the long-term survival of patients in the 2 histologically derived
subgroups of IPC. Thus, there is an excellent prognosis for patients diagnosed with
IPC regardless of whether the tumor is diagnosed as in situ or invasive.
The usual absence of axillary involvement and low recurrence rate after local excision
suggests that wide local excision without axillary dissection is currently the treatment
of choice for pure IPC. The role of sentinel lymph node biopsy has not been evaluated
in this disease, but it may be an excellent alternative to full axillary dissection in
patients with IPC associated with invasive carcinoma. The role of radiation therapy in
these patients remains undefined. IPC associated with DCIS or invasive cancer or both
and should be treated on the basis of this associated pathology. Prognosis of pure IPC
is usually excellent because the malignant potential and the proliferative activity of the
cancer is low. Clinicians should keep this in mind when planning surgical and
adjuvant treatments, although these findings suggest that wide, local excision with
sentinel node biopsy is currently the treatment of choice and that the prognosis is very
favorable.
Tsuda et al. (24) reported that loss of heterozygosity (LOH) on chromosome 16q was
a useful marker for the intracystic papillary carcinoma, since intraductal papilloma
showed no LOH. Using the polymerase chain reaction, the malignant potential of
intracystic papillary lesions may be more clearly determined
Intracystic breast carcinoma is uncommon in females and rare in males with only a
handful of case reports in the literature (25-27). It accounts for 5–7.5% of all breast
cancers in males. As in females, it is a localized, non-invasive breast cancer with
papillary, cribriform, or solid proliferations arising within or on the wall of a large
cyst. It commonly presents as a benign-appearing, well-localized lump due to its
underlying cystic nature. In Japanese men, Tochika et al. (27) reported the mean age
of intracystic carcinoma in males as 68.2 years. Most of the patients presented with a
palpable lump. In addition to abnormalities felt on palpation, a few patients presented
with mild pain, bloody nipple discharge and pruritus. Radiological studies are helpful.
Ultrasonography of these lesions typically reveals a hypo-echoic area (representing
the cyst) with soft tissue echoes projecting from wall of the cyst (intracystic tumour).
Intracystic papillary carcinoma tends to be well-defined on mammography; an
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