ArticleFrontiers in oncology2026
Apocrine encapsulated papillary carcinoma of the breast with microscopic multifocal capsular invasion: a case report.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Apocrine encapsulated papillary carcinoma (A-EPC) of the breast is exceedingly rare, having been described primarily through sporadic case reports prior to 2022 (typically fewer than 10 cumulative cases per report). The largest series to date - 28 cases from a single centre - was recently published in 2026. Whether breast-conserving surgery (BCS) is appropriate for A-EPC with frank invasion, and how the recent Rakha-Quinn (2025) staging criteria should be applied, remain unresolved. Case presentation: A 57-year-old postmenopausal woman presented with a 5-month history of an enlarging right breast mass. Imaging demonstrated a 27 × 17 × 17 mm well-circumscribed nodule at the 9 o'clock position, approximately 2 cm lateral to the nipple. Intraoperative frozen section identified prominent apocrine cytological features, predicting a hormone-receptor-negative phenotype; same-session sentinel lymph node biopsy (SLNB) was therefore performed during the index operation. Successful BCS with negative margins was achieved. Final histopathology demonstrated A-EPC (2.3 × 1.8 × 1.5 cm) with microscopic multifocal frank invasion (largest focus 4 mm; pT1aN0M0; 0/4 sentinel nodes). Immunohistochemistry confirmed ER-/PR-/HER2 2+ (FISH-negative)/AR+ (~90%)/GCDFP-15+/Ki-67 ~15%. A PIK3CA exon 20 H1047R/L hotspot mutation was detected. After multidisciplinary discussion, no systemic therapy was administered and the patient completed adjuvant whole-breast radiotherapy. Conclusions: Three points were central to this case: intraoperative frozen-section recognition of apocrine differentiation supported same-session SLNB during breast-conserving surgery; systematic application of the Rakha-Quinn (2025) staging criteria - including the 5 mm proximity rule and the assessment of whether microscopic multifocal invasion indicates a diffusely invasive EPC-like pattern - supported staging as pT1a; and the co-occurrence of strong androgen-receptor positivity and a PIK3CA mutation provides a rationale for AR-PI3K dual-pathway targeted therapy should recurrence occur.
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