Invasive Papillary Carcinoma of Male Breast, A Rare Entity Diagnosed on Mammotome Biopsy
A 45 year old man presented with gynae comastia of left breast for 5 months. There were no other constitutional symptoms or family history of malignancy. Clinically there was an ill-defined lump in the left breast with skin induration (Figure 1). There were no palpable lymph nodes in the axilla or supraclavicular fossa. Mammography showed dense breast only (Figure 2). Ultra sound revealed a complex solid cystic mass with indistinct margins with no obvious internal vascularity (Figure 3). The previous FNAC and CNB were inconclusive in this patient. So vacuum assisted breast biopsy (VAB) was performed with Mammotome (Ethicon Endo surgery, Cincinnati, Ohio, USA) directional vacuum assisted breast biopsy device. The procedures performed with 11 G handheld vacuum probe. As the patient had complex solid cystic mass probably because of the fact that the tumor contained large necrotic, cystic and hemorrhagic areas. VAB was found useful because it sucked out the fluid initially and prevents obscuring of the mass. After collapse of the cystic component, contiguous samples could be obtained from the solid part of the lesion. So vacuum are used for suction of fluid. and also helps to quantify the solid component thus increase the accuracy of VAB. Histopathology showed papillary cluster of tumour cells and on high magnification was suggestive of papillary adenocarcinoma (Figures 4,5). He then underwent left simple mastectomy and level II axillary clearance. Histopathology confirmed the mass as papillary adenocarcinoma and that surgical margins were free. On immunehistochemical analysis the tumour cells were strongly positive for estrogen and progesterone receptors and was negative for her 2/neu.
Uma Debi
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