A case of encapsulated papillary carcinoma of the breast treated with emergency surgery due to sudden hemorrhage

Abstract

IntroductionEmergency surgery is rare in management of breast cancer. We report a case of encapsulated papillary carcinoma (EPC) of the breast where emergency surgery was performed because of unsuccessful control of hemorrhage.Presentation of caseA 62-year-old woman visited our hospital complaining of sudden bleeding from the right breast. She had been aware of the tumor for a year, but had left it unattended. It had been increasing in size rapidly for a few days before presentation. Computed tomography showed a hypervascular cystic tumor 9 cm in diameter. Bleeding was observed from a skin breach in the right breast, from which a clot was removed and the wound compressed with gauze. We attempted unsuccessfully to control the hemorrhage over the next 3 days, but the patient became anemic, so emergency surgery was performed to control the bleeding. Histopathology revealed the tumor as estrogen receptor- and progesterone receptor-positive EPC, with a human epidermal growth factor receptor 2 score of 0.DiscussionThere have been only 5 reports of breast cancer treated with emergency surgery. EPC was previously considered an in situ lesion, but the lack of a myoepithelial layer at the lesion's periphery may represent a low grade or indolent form of invasive carcinoma and prognosis is usually good. However, if bleeding into the cyst occurs and hemostasis is difficult, emergency surgery should be considered.ConclusionEmergency surgery is rare in breast cancer but should always be considered as an option when hemorrhage is not readily controlled.

Large encapsulated papillary carcinoma presenting as an arteriovenous malformation

“…EPCs usually presents as a painless mass and are often accompanied with bloody nipple discharge. 3,5,6 They rarely present as an expanding haematoma, as was the case here. Even more unusual, the patient's fatigue immediately following the initial drainage procedure, the findings of large feeding vessels to the mass and an unexpected postoperative haemoglobin drop.…”

Case of Breast Cancer Discovered by Repeated Hematomas after Blunt Trauma to the Breast

“…There are also cases of spontaneous rupture and hemorrhage of encapsulated papillary carcinoma reported in the case report, with the increase of hematoma within a few days, huge tension causing skin necrosis and massive rupture of hemorrhage, and emergency surgical treatment is required. Therefore, the amount of bleeding of breast tumors with cystic components can also be large, which is worthy of surgeons' attention [6]. In two situations, a biopsy is necessary for complete evaluation: when there is absorption and the residual area presents a focal distortion of the parenchyma, or when there is not any absorption, in which the patient has an organized hematoma that will always show mammographically as a mass of high density.…”

Synchronous Luminal A Ductal Carcinoma In Situ in a Recurrent Benign Phyllodes Tumor Diagnosed Preoperatively: An Unusual Presentation of a Rare Neoplasm

“…One more peculiarity of our case is that it was operated on as an emergency, although breast surgery is rarely considered an emergency procedure. Only 10 cases of emergency breast surgery have been reported to date, and those were mostly done to control bleeding from PT or rarely breast carcinoma not responding to compression as in our case [16]. Local recurrence is characteristic of PT and can occur with grade progression even in benign PT.…”