ABSTRACT
Intracystic papillary carcinoma (IPC) of the breast is a rare malignant tumour, found mainly but not exclusively in elderly women. IPC may be asymptomatic or presents with a palpable mass or blood-stained nipple discharge. The tumour is encysted within a dilated duct with arborisation of the fibrovascular stroma and contains nodules of papillary carcinoma surrounded by a thick fibrous capsule. Frequently excisional biopsy is required for diagnosis. The mainstay of treatment is breast-conserving surgery or mastectomy. Sentinel node biopsy could be considered in invasive cases. Adjuvant radiotherapy (XRT) and/or endocrine therapy is considered in appropriate cases. Prognosis is excellent. We report three such cases of IPC, in elderly women, which were successfully treated.
Subject(s)
Breast Cyst/diagnosis , Breast Neoplasms/diagnosis , Carcinoma, Papillary/diagnosis , Aged , Biopsy, Fine-Needle , Breast/pathology , Breast Cyst/pathology , Breast Cyst/surgery , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Carcinoma, Lobular/diagnosis , Carcinoma, Lobular/pathology , Carcinoma, Lobular/surgery , Carcinoma, Papillary/pathology , Carcinoma, Papillary/surgery , Female , Humans , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Mammography , Mastectomy/methods , Neoplasm Grading , Neoplasms, Second Primary/diagnosis , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary/surgery , Prognosis , Sentinel Lymph Node Biopsy/methods , Ultrasonography, MammaryABSTRACT
CONTEXT: Pancreaticopleural fistula is seen in acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. Surgery leads to healing in 80-90% of cases but carries a mortality of up to 10%. AIM: Our aim was to assess the management of pancreaticopleural fistula on a specialist pancreatic Unit. METHODS: Patients presenting with pancreaticopleural fistulae were identified from acute and chronic pancreatitis databases. Management and outcome were compared with previous studies identified in MEDLINE and EMBASE. RESULTS: Four patients presented with dyspnoea from large unilateral pleural effusions. Three had a history of alcohol abuse and one of asymptomatic gallstones. All were treated with chest drainage, octreotide and endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent. Two had a pancreatic stent in situ for 5 and 8.5 months respectively. In the third sphincterotomy was performed; in the fourth the pancreatic duct could not be cannulated. The fistula healed in all cases, with no recurrence after 12-30 months, and no deaths. There are 14 reports including 16 cases treated with endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent in the literature, with no recurrence after follow up ranging 4-30 months and no deaths in these 16 cases. CONCLUSIONS: A high index of suspicion is necessary to be aware of its presence. These data suggest that endoscopic management is preferable alternative to surgery for pancreaticopleural fistula.
