Case Report: Pure Encapsulated Papillary Carcinoma of the Breast in a Centenarian: A Case Report of Distant Metastasis After Surgery, and review of literature

Background Breast cancer in elderly patients, particularly in centenarians, presents unique diagnostic and therapeutic challenges. Encapsulated papillary carcinoma (EPC) is a rare subtype that typically exhibits indolent behavior, but its aggressive course remains poorly understood. This report describes an exceptional case of EPC in a 102-year-old woman with a rapid metastatic progression. Case Presentation A 102-year-old female with hypertension presented with a one-year history of a progressively enlarging, left-sided breast mass. Imaging revealed a 28 cm cystic mass with a 14 cm intracystic nodule. Biopsy confirmed ER-positive, PR-negative, HER2-negative encapsulated papillary carcinoma (T3N0M0). Mastectomy with axillary dissection revealed a 13 cm tumor with close surgical margins (<0.5 mm). The final histologic examination concluded to a pure EPC. Three months postoperatively, metastatic lesions in the sternum and liver were identified. Despite initiating letrozole and CDK4/6 inhibitor therapy, the patient succumbed to cardiac arrest. Conclusion The case of a 102-year-old female with EPC of the breast illustrates several unique and clinically significant features, including the rarity of metastasis, exceptional tumor size, and implications of advanced age on the disease course and management. This case study in accordance with the CARE guidelines.