the overall incidence of invasive papillary carcinomas is rare , accounting for less than 1 - 2% of invasive breast cancers . they are most commonly seen in postmenopausal females and are rare in males . here , a 55-year - old postmenopausal female presented with a painless subareolar mass in the left breast of 4 months ' duration , gradually increasing in size . on examination , there was a single , 3  3 cm , firm , well - circumscribed , palpable lump in the subareolar region of the left breast . the nipple was retracted , without ulceration or discharge , and left axillary lymph nodes were not palpable . fine needle aspiration cytology of the mass was positive for malignant cells and a left - sided modified radical mastectomy was done . on gross examination ( fig . 1 , fig . 2 ) , the lesion was gray white and 3  2  2 cm in size . the cut surface showed a well - circumscribed , solid , cystic , granular mass measuring 3  2  2 cm with areas of hemorrhage , occupying almost the whole breast and surrounded by fibrous tissue . 5 ) were consistent with the diagnosis of invasive papillary carcinoma , with all surgical margins free of tumour . all 8 excised axillary lymph nodes were negative for malignant cells and immunohistochemistry ( ihc ) confirmed the diagnosis . invasive papillary carcinomas of the breast are rare , accounting for less than 1 - 2% of invasive breast cancers . they occur most frequently in postmenopausal women in the 6th to 8th decade of life and in non - white women . more than 75% of the cases include a ductal carcinoma in situ ( dcis ) component . the main difference between papillary cancer and other breast cancers is the appearance of the cells under a microscope . patients having dcis with microinvasion may present with axillary lymph node metastases , whereas dcis patients without microinvasion usually do not present with axillary metastases . the examination of myoepithelial cells and basement membrane is an important step for the diagnosis of invasive cancers . myoepithelial cells are absent in invasive cancers , but some of them may produce basement membrane . there are a number of markers , known as myoepithelial markers , which identify myoepithelial cells . these are s-100 , a - smooth muscle actin , smooth muscle myosin heavy chain , calponin , maspin , cd10 , p63 and high - molecular weight cytokeratin , and all of them have different sensitivities and specificities . of these myoepithelial markers , smooth muscle myosin heavy chain and p63 are specific ; for example , p63 is a special myoepithelial marker which stains the cell nucleus only . in spite of all these available myoepithelial markers , one important microscopic feature detected by he staining which differentiates invasive cancers from dcis is the presence of a concentric stromal reaction around the invasive cancer , which is absent in dcis . another feature is the presence of an irregular circumference of the foci of invasive cancer cells in invasive cancers , which is not seen in dcis . the treatments for invasive ductal carcinoma fall into 2 broad categories : either local or systemic treatment . surgical options include lumpectomy and mastectomy ( partial , total or modified ) , and radiation therapy is most often recommended after surgeries that conserve healthy breast tissue , such as lumpectomy and partial mastectomy . in 75% of papillary carcinoma cases , the cancer spreads to the lymph nodes ; however , overall , patients with papillary carcinomas have a better prognosis than patients with other , more common breast cancers . the detection of dcis has increased due to the availability of newer diagnostic modalities like mammography . however , to differentiate between dciss and invasive cancers , ihc and the presence of certain morphologic features ( detected by he staining ) are needed . most cases of papillary carcinoma are low - grade , slow - growing cancers , with good recovery .
we present the case of a 55-year - old postmenopausal female who presented with complaints of a gradually increasing painless subareolar mass in the left breast of 4 months ' duration . 
 left - sided modified radical mastectomy was performed and the specimen was histopathologically diagnosed as invasive papillary carcinoma . 
 immunohistochemistry confirmed this diagnosis . 
 all 8 excised axillary lymph nodes were negative for malignant cells . 
 postoperative chemotherapy was given and for the past 6 months , the patient has maintained a regular follow - up on an outpatient basis . 
 she does not have any evidence of either local or distant recurrence of tumour metastases .