Intraductal Papilloma Research Articles

Tuberculosis of the Breast: A Challenging Component of Benign Breast Diseases

Introduction: Tuberculosis (TB) of the breast is a rare manifestation of extra-pulmonary localization of thedisease. The incidences vary from a minimum in developed countries to a high in developing countries likeIndia and Africa.Materials and Method: This study was a hospital-based observational study carried out in 75 cases ofbenign breast disease which were studied with special reference to Tuberculosis of the breast. All patientswho were clinically diagnosed as a benign breast lump, above the age of 14-years and among them who werewilling to undergo investigations and treatment were included. Ziehl-Neelsen staining was performed in allfine needle aspirates and finally, treatment modality used.Results: The present study involved 67 cases of benign breast lumps and 8 cases of recurrent breast abscesses.Further, it depicts predominant benign breast lumps which were fibroadenoma in 65.7% fibroadenosis in23.80%, TB breast in 4.50%, ductal papilloma in 2.90% and phyllodes tumour of the breast in 1.5% of cases.Conclusion: For the TB of the breast in India, various treatment modalities are available. With timelydiagnosis, the morbidity can be minimised with less amount of suffering.

Evaluating the usefulness of breast strain elastography for intraductal lesions

PurposeStrain elastography for imaging lesion stiffness is being used as a diagnostic aid in the malignant/benign discrimination of breast diseases. While acquiring elastography in addition to B-mode images has been reported to help avoid performing unnecessary biopsies, intraductal lesions are difficult to discriminate whether they are malignant or benign using elastography. An objective evaluation of strain in lesions was performed in this study by measuring the elasticity index (E-index) and elasticity ratio (E-ratio) of lesions as semi-quantitative numerical indicators of the color distribution of strain. We examined whether ductal carcinoma in situ (DCIS) and intraductal papilloma could be distinguished using these semi-quantitative numerical indicators.MethodsIn this study, 170 ultrasonographically detected mass lesions in 162 cases (106 malignant lesions and 64 benign lesions)—in which tissue biopsy by core needle biopsy and vacuum-assisted biopsy, or surgically performed histopathological diagnosis, was performed—were selected as subjects from among 1978 consecutive cases (from January 2014 to December 2016) in which strain elastography images were acquired, in addition to standard B-mode breast ultrasonography, by measuring the E-index and E-ratio.ResultsThe cut-off values for E-index and E-ratio in the malignant/benign discrimination of breast lesions were determined to be optimal values at 3.5 and 4.2, respectively, based on receiver operating characteristic (ROC) curve analysis. E-index sensitivity, specificity, accuracy, and AUC value (area under the curve) were 85%, 86%, 85%, and 0.860, respectively, while those for E-ratio were 78%, 74%, 74%, and 0.780, respectively. E-index yielded superior results in all aspects of sensitivity, specificity, accuracy, and AUC values, compared to those of E-ratio. The mean E-index values for malignant tumors and benign tumors were 4.46 and 2.63, respectively, indicating a significant difference (P < 0.001). E-index values of 24 DCIS lesions and 25 intraductal papillomas were 3.88 and 3.35, respectively, which showed a considerably close value, while the false-negative rate for DCIS was 29.2%, and the false-positive rate for intraductal papilloma was as high as 32.0%.ConclusionE-index in strain elastography yielded better results than E-ratio in the malignant/benign discrimination of breast diseases. On the other hand, E-index has a high false-negative rate and false-positive rate for intraductal lesions, a factor which should be taken into account when making ultrasound diagnoses.

Massive Breast Intraductal Papilloma Undiagnosed After Several Core Needle Biopsies: A Case Report

Background: Patients with breast Intraductal Papilloma (IDP) and atypical ductal hyperplasia have an increased risk for breast cancer. Core Needle Biopsy (CNB) plays a significant role in inchoate diagnosis of atypical IDP. However, the standard procedure of CNB may be unable to provide definite diagnosis of a complicated large mass. This is the first report of the largest case of peripheral atypical IDP with ductal epithelial atypical hyperplasia and hemorrhage necrosis. The mass grew larger, without a clear diagnosis. Herein, we documented our recommendations for the treatment of a large breast mass. 1.2. Case Summary: A 74-year-old Chinese female had a palpable left breast mass for two years, which was enlarging in the past one month. The patient had periodic breast check-ups in a reputed hospital. However, the ultrasound examination and four CNBs of the breast mass did not provide a clear diagnosis, besides non-lactating mastitis. However the mass was finally diagnosed as an atypical IDP after intraoperative pathology. The patient recovered well after the lumpectomy. Conclusion: When obtaining the sample from cystic tissue during CNB, the needle should take the core of the mass as well as the surrounding wall of the cyst. Clear diagnosis is important for further treatment. Large breast IDP in elderly may develop into breast cancer, so we recommend that lumpectomy is necessary rather than periodic check-ups for these patient.

Saudi women perception, attitude and awareness about abnormal nipple discharge

Background: Nipple discharge (ND) is known as any fluid that leaks from one or both nipples of a non-pregnant and non-breastfeeding breast. Intraductal papilloma, duct ectasia, papillomatosis, mastitis, or fibrocystic changes are the most frequent causes of abnormal benign conditions. Up to authors' knowledge; there are not enough published papers regarding perception and attitude of Saudi women about abnormal ND and its causes. The main objective of this study was to examine perception and attitude of Saudi women about abnormal ND among Saudi women in Kingdom of Saudi Arabia. Methods: A community-based cross-sectional study was conducted from September to November 2020. A pre-designed online questionnaire was distributed on social media targeting Saudi women in different age groups to be self administered. Data were compiled and analyzed using a statistical package for the social sciences. The relation between abnormal ND and sociodemographic characters was determined using the chisquare test. A p-value of less than 0.05 was considered to be statistically significant. Results: According to our results, 8.2% (n = 176) of participants reported abnormal breast secretions other than during pregnancy or breastfeeding. Among 30.7% (n = 54) of cases, the secretions were accompanied by redness, 41.5% reported breast pain, 48.8% had small pits or wrinkles in the skin, 36.4% suffered from nipple retraction, 35.2% reported itchy sores or a rash on the nipple, in 32.4% of cases the secretions accompanied with a change in the size or shape of the breasts, and 25.6% observed that secretions were accompanied with a change in the internal composition of the breast or the appearance of an unknown mass. Conclusion: Abnormal ND was relatively prevalent among Saudi women. There was a significant relationship between social status, smoking, menstrual cycle regularity, having children, and late for childbearing.

Intraoral ductal papilloma of the lower lip in a 6-year-old patient

Ductal papilloma is a type of rare salivary gland tumor of minor salivary glands and commonly seen in the lower lip and buccal vestibule. Ductal papilloma usually presents in the form of three histopathological variants, namely sialedenoma papilliferum, intraductal papilloma, and inverted ductal papilloma. The etiopathogenesis of a ductal papilloma remains unclear, but some authors suggest the association with human papilloma virus. Diagnosis of intraoral ductal papilloma predominantly depends on the histopathological features; however, clinical differential may include benign lesions such as mucocele, lipoma, and fibroma. Considering the benign and nonaggressive nature of such tumors, histopathology alone is suitable for the diagnosis. However, immunohistochemistry may be used in cases of aggressive growth or in malignant counterpart. In this case report, we report the rare case of intraoral ductal papilloma of the lower lip mimicking a mucocele in a 6-year-old female patient.

Cytological Evaluation of Pathological Male Breast Lesions

Objective This study aimed to determine the cytodiagnostic spectrum of various male breast lesions, which were corroborated on histopathology as appropriate, to describe the process of the cytomorphology of some uncommon pathological lesions, and to discuss the reasons of their misdiagnoses. Materials and methods In this 8-year study, a total of 114 patients underwent fine needle aspiration cytology (FNAC). In a representative case, nipple discharge from an 8-month-old child was examined. Confirmatory histopathology was obtained in 38 cases only. Results Gynecomastia was the most common (63.5%) male breast pathology. Invasive breast carcinoma of no special type was the most common variant of male breast malignancy. Half of the "gray zone" of cytological lesions was confirmed as cancer, but the rest were diagnosed as fibrocystic disease and intraductal papilloma. All cases with malignant cytology matched their corresponding histopathology. However, a tumor from an intraductal papillary carcinoma was miscued as ductal carcinoma on previous FNAC. Conclusion Cytological evaluation of male breast lesions provides highly sensitive and specific results with excellent histologic reproducibility. Thus, it should be the ideal pretherapeutic diagnostic procedure for male breasts. However, some benign pathological conditions, which are particularly associated with epithelial hyperplasia, perplex the cytomorphologic scenario into the "gray zone."

A clinicopathological profile of benign breast diseases in women in a tertiary care hospital

Background: Benign breast conditions are associated with morbidity and great concern for the patient and are 4-5 times more common than breast cancer. Benign breast diseases are the most common cause of breast problems in females and it is more frequent than malignant ones up to 30% of women will suffer from a benign breast disease requiring one or other sort of treatment at some part of their lives. Objectives were to find out the proportions of various benign breast lesions among women aged 18 yrs and above. Methods: A prospective study was conducted in the Department of Surgery, Shree Gokulam Medical College, Thiruvananthapuram for a period of 18 Months from January 2016 to June 2017. A total of 180 study subjects were included in the study. All the women aged more than 18 yrs. old attending the surgery OPD with palpable or immunologically detected breast lesions will be consecutively selected for the study. Results: The commonest case among the study population was fibroadenoma 56 (31.1%). There were 9 cases of duct ectasia, 8 duct papilloma’s. Fibroadenoma could be diagnosed clinically with an accuracy of about 88% (56 cases) out of total 69 cases.Conclusions: In short, a comprehensive clinical history and a triple assessment would suffice the tool for effective diagnosis of Benign breast diseases within 72 hrs. With correct radiological and cytological assement unnecessary morbidity associated with surgeries can be avoided in some patients.

A case of inverted ductal papilloma of the buccal mucosa

A case of inverted ductal papilloma of the buccal mucosa

Use of fiberoductoscopy for the management of pathological nipple discharge: ten years follow up of a single center in China.

Pathological nipple discharge (PND) is usually associated with benign intraductal papilloma, which has a higher malignant rate than other benign tumors in most cases. Fiberoductoscopy (FDS) is an alternative possibility in diagnostic and finding lesions in PND patients. Previously, the bloody discharge was presumed to show papilloma or breast cancer. However, as we started using FDS, papilloma or cancer also can be found in the cases with a transparent or yellow discharge. This study investigated the value of FDS for the diagnosis and locating of intraductal lesions in cases with nipple discharge. A retrospective analysis of 3,696 cases that initially presented with pathologic nipple discharge was performed. There were 4,456 FDSs performed, and the correlations between the FDS findings for distinct types of lesions and the pathological diagnosis were determined. Among the 2,816 cases of elevated lesions, FDS confirmed 1,933 cases of intraductal papilloma, 584 cases of intraductal papillomatosis, and 299 cases of intraductal carcinoma. Among the 880 cases of non-elevated lesions, FDS confirmed 380 cases of duct dilation, 350 cases of duct inflammation, 136 cases of duct dilation and inflammation, and 14 cases of ductal carcinoma in situ (DCIS). All patients followed up 3 months to 12 years. There were 241 DCIS in total, and 8 cases had local recurrence, 2 cases had metastasis. Invasive ductal carcinoma, 41 cases, 3 had recurrence and 3 had metastases, and 1 for death. Invasive lobular carcinoma 23 cases, recurrence 2 cases, metastasis 1 case. FDS has a high positive predictive rate and correlates well with the results of the pathological examination. The advantage of FDS is that it can observe the lesions, increasing the detection rate of early stage breast cancer, simple to operate, low cost, and no need for the appointment, appropriate for Chinese conditions.

Upgrade rate of intraductal papilloma diagnosed on core needle biopsy in a single institution

The management of intraductal papilloma (IDP) diagnosed on core needle biopsy (CNB) is controversial due to the variable upgrade rates to breast carcinoma (BC) on subsequent surgical excision reported in the literature. The purpose of our study was to investigate the upgrade rate of IDP diagnosed on CNB to BC in subsequent surgical excision and the impact of clinical, pathologic, and radiologic variables. This is a retrospective cohort of all women who had a diagnosis of IDP on a CNB between 2005 and 2018 in a tertiary academic center with subsequent surgical excision. Upgrade was defined as ductal carcinoma in situ (DCIS) and invasive carcinoma on surgical excision. Statistical analyses included Pearson's chi-square, Wilcoxon rank-sum, and logistic regression. A total of 216 women with IDP in a CNB were included. Nineteen patients (8.8%) upgraded to BC in the overall cohort, including 14 DCIS and 5 invasive carcinomas. An upgrade rate of 27% was found in atypical IDP (14 of 51 cases), while only 3% of pure IDP upgraded to BC (5 of 165 cases). Older age (>53 years) at the time of biopsy (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.01–1.09, p = 0.027) and concomitant atypical ductal hyperplasia (ADH) (OR = 9.69, 95% CI = 3.37–27.81, p < 0.0001) were significantly associated with upgrade. Our results support surgical excision of IDP on CNB when associated with ADH or diagnosed in women aged older than 53 years. The low surgical upgrade rate of 3% for pure IDP on CNB in younger women should be part of the management discussion.

Принципи лікування жінок з доброякісними захворюваннями молочної залози

ResumeIntroduction. Breast diseases occupy a leading place in the structure of pathologyof the female reproductive system. According to statistics, fibrocystic mastopathy isdiagnosed in 50-60% of women. Pain and other manifestations of mastopathy impair thequality of life of patients and, last but not least, increase the risk of breast cancer.The purpose of the work is a retrospective analysis of the results of treatment ofpatients with benign breast diseases in the Thoracic surgery clinic of the NationalMilitary Medical Clinical Center «Main Military Clinical Hospital».Materials and methods. The treatment of 768 patients with benign breast diseaseswas analysed. The scope of the required examination has been determined. The maingroups by the method of treatment are considered: surgical (234 women), medical(379 women), dynamic observation (125 women). A group of patients (30 women), whoalso had similar complaints but need examination and treatment for other chest diseaseshas also been identified.Results and discussion. It was determined that the group with breast neoplasmsrecovered in all cases. The indications for surgical treatment of benign tumors andcysts, as well as, separately, intraductal papilloma, have been clarified and consideredonce again. In the second group, most women showed improvement after therapy.Unfortunately, there is no single algorithm for treating patients with dyshormonalmanifestations. Therefore, treatment should be comprehensive (including changes inwork, rest, sleep, nutrition, underwear), gradual (from simple to complex), objective andshould be based on survey data, very balanced, especially when using hormone therapy,which has a large number of side effects and complications.Conclusions. Breast cancer occupies a leading position among the malignantpathology of the female population, so doctors should be vigilant, and women should besubject of dispensary and preventive examination. Benign diseases of the mammaryglands are a complex, multifactorial problem and its solution should be started fromestablishing the cause and only then – prescribing treatment.

Histologic Correlation of Breast Biopsies Presenting as Non-Mass Enhancing Lesions on Magnetic Resonance Imaging: A Contemporary Single Institutional Series

Abstract Introduction/Objective Non-mass enhancement (NME) in breast tissue is an area of enhancement on MRI that appears distinct from background breast parenchyma, but lacks definitive features of a mass. NME is characterized by its internal enhancement pattern and distribution, and can represent benign, high risk, or malignant pathology. Given this considerable overlap, a core biopsy is often necessary for diagnosis and management. We aimed to elucidate the most frequent histologic findings found on breast biopsies for MRI NME. Methods Using our institutional database we identified 70 female patients with high risk status for breast cancer with MRI screen detected NME (BIRADS-4-suspicious for malignancy) that underwent subsequent biopsy procedure during the period of 01/2016-12/2017. Primary pathologic diagnoses were subcategorized as follows: malignant, atypical, benign mass-like lesions, fibrocystic changes (proliferative, nonproliferative), or “other” primary diagnoses. Results The median age of patients was 48 years (range: 22-76 years). Of the 70 patients, 66 underwent MRI-guided core biopsy, 3 underwent ultrasound-guided core biopsy and 1 underwent excisional biopsy. The primary diagnosis was analyzed. Of these 70 cases, 8 (11.4%) were malignant (7 with ductal carcinoma in situ and 1 with invasive ductal carcinoma), 1 (1.4%) had atypical lobular hyperplasia, and the remaining 61 (87.1%) showed benign findings (36 with fibrocystic changes (FCC), 22 benign mass-like lesions, 3 with other non-specific findings). The FCC were subcategorized as proliferative (usual ductal hyperplasia, columnar cell change, incidental radial scar, incidental intraductal papilloma, sclerosing adenosis, focal pseudoangiomatous stromal hyperplasia (PASH)) or nonprolifeative (stromal fibrosis, duct ectasia, apocrine metaplasia). Majority (61.1%) of FCC were both proliferative and nonproliferative, 22.2% proliferative only and 16.7% nonproliferative only. Benign mass-like lesions included PASH (45.4%), fibroadenomatoid nodule (22.7%), fat necrosis (18.2 %) and remaining had the diagnosis of clustered apocrine cysts, papillomatosis, and radial sclerosing lesion. Conclusion Less than a third of cases showed malignant findings and more than two-third of cases showed benign findings with a high rate of detection of proliferative lesions and PASH.

Spectrum of Papillary Breast Lesions According to World Health Organization Classification of Papillary Neoplasms of Breast.

IntroductionPapillary breast lesions are segregated into benign and malignant based on the presence or absence of myoepithelial cells in the papillary cores. Papillary breast lesions are further classified into: intraductal papilloma, papilloma with atypical ductal hyperplasia (ADH)/ductal carcinoma in situ (DCIS), papillary DCIS, solid papillary carcinoma in situ, solid papillary carcinoma with invasion, invasive solid papillary carcinoma, encapsulated papillary carcinoma and encapsulated papillary carcinoma with invasion. In this study, we evaluated the spectrum of papillary breast lesions in resection specimens of the breast according to the latest World Health Organization (WHO) classification of breast tumors.MethodsThis was a retrospective cross-sectional study, and was conducted at Liaquat National Hospital for a period of six years, from January 2012 till December 2017. Data of patients that underwent surgeries for breast tumors were included in the study. All specimens were grossed, according to defined protocols, and representative sections were taken after inking resection margins. Hematoxylin and eosin-stained sections were examined by experienced histopathologists, and myoepithelial stains (p63 and myosin) were done in selected sections of all tumors. Histopathological classification of papillary tumors was performed according to WHO classification of breast tumors.ResultsThe study involved 190 excision specimens of papillary breast lesions. Mean age of the patients was 45.6±17.1 years. Most of the lesions were between two and five centimetres (69.1%). For invasive carcinomas (n = 76), the most frequent grade was II (52.6%). For in situ and invasive carcinomas (n = 129), lymphovascular invasion and axillary metastasis were noted in 5.4% and 9.3% cases, respectively. Among papillary breast lesions, 36.8% were benign (intraductal papilloma, solitary or multiple) while 63.2% harbored ADH, DCIS, or invasive carcinoma. Invasive papillary carcinoma was the most frequent malignant papillary lesion (20%), followed by solid papillary carcinoma with invasion (12.6%). We found significant associations between patient’s age and tumor size with histological type of papillary lesion as benign papillary lesions had smaller size and younger age compared to malignant papillary lesions.ConclusionWe noted a high frequency of malignancy in papillary breast lesions. Moreover, malignant papillary lesions were significantly associated with higher age and larger tumor size.

The Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In Situ in Patients with Intraductal Papilloma without Atypia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 034).

Available retrospective data suggest the upgrade rate for intraductal papilloma (IP) without atypia on core biopsy (CB) ranges from 0 to 12%, leading to variation in recommendations. We conducted a prospective multi-institutional trial (TBCRC 034) to determine the upgrade rate to invasive cancer (IC) or ductal carcinoma in situ (DCIS) at excision for asymptomatic IP without atypia on CB. Prospectively identified patients with a CB diagnosis of IP who had consented to excision were included. Discordant cases, including BI-RADS > 4, and those with additional lesions requiring excision were excluded. The primary endpoint was upgrade to IC or DCIS by local pathology review with a predefined rule that an upgrade rate of ≤ 3% would not warrant routine excision. Sample size and confidence intervals were based on exact binomial calculations. Secondary endpoints included diagnostic concordance for IP between local and central pathology review and upgrade rates by central pathology review. The trial included116 patients (median age 56years, range 24-82) and the most common imaging abnormality was a mass (n = 91, 78%). Per local review, 2 (1.7%) cases were upgraded to DCIS. In both of these cases central pathology review did not confirm DCIS on excision. Additionally, central pathology review confirmed IP without atypia in core biopsies of 85/116 cases (73%), and both locally upgraded cases were among them. In this prospective study of 116 IPs without atypia on CB, the upgrade rate was 1.7% by local review, suggesting that routine excision is not indicated for IP without atypia on CB with concordant imaging findings.

Concurrent breast adenoid cystic carcinoma and primary squamous cell carcinoma: report of a rare case with single institutional case reviews

BackgroundAdenoid cystic carcinoma and primary squamous cell carcinoma are both rare breast neoplasms, which possess drastically different morphological and molecular features as well as distinguishing clinical behaviors and prognosis.Case presentationIn this report, we described a rare case in which concurrent adenoid cystic carcinoma and keratinizing squamous cell carcinoma were diagnosed in contralateral breasts in an 85 year-old female patient. The patient had a history of adenoid cystic carcinoma diagnosed 11 years ago, which was treated by partial mastectomy followed by whole breast radiation. The recurrent carcinoma on the same side of the breast was small in size but appeared to involve an intraductal papilloma. Also, a newly occurred large cystic mass was identified on the contralateral breast, which histologically presented as a keratinizing squamous cell carcinoma with no glandular differentiation. No in situ or invasive carcinoma was identified in the overlying skin of the lesion, and no malignancy in a second site was found by PET-CT. Therefore, this lesion was mostly likely a primary squamous cell carcinoma of the breast.ConclusionThe concurrence of two such rare neoplasms was likely an incidental finding or was therapy-related. However, more mechanistic studies are needed in order to understand whether predisposing genetic alterations exist in this rare case. Besides, cases of both breast adenoid cystic carcinoma and carcinoma with predominant squamous differentiation diagnosed in our institution were reviewed, which help to better characterize their clinicopathological features.

The role of histogram analysis in diffusion-weighted imaging in the differential diagnosis of benign and malignant breast lesions

BackgroundThe present study aims to investigate the role of histogram analysis of intravoxel incoherent motion (IVIM) in the differential diagnosis of benign and malignant breast lesions.MethodsThe magnetic resonance imaging and clinical data of 55 patients (63 lesions) were retrospectively analyzed. The multi-b-valued diffusion-weighted imaging image was processed using the MADC software to obtain the gray-scaled maps of apparent diffusion coefficient (ADC)-slow, ADC-fast and f. The MaZda software was used to extract the histogram metrics of these maps. Combined with the conventional sequence images, the region of interest (ROI) was manually drawn along the edge of the lesion at the maximum level of the gray-scale image, and the difference of the data was analyzed between the benign and malignant breast lesions.ResultsThere were 29 patients with 37 benign lesions, which included 23 fibroadenomas, 6 adenosis, 1 breast cysts, 4 intraductal papillomas, and 3 inflammations of breast. Furthermore, 26 malignant lesions in 26 patients, which included 20 non-specific invasive ductal carcinomas, 5 intraductal carcinomas and 1 patient with squamous cell carcinoma. The ADC-slow (mean and the 50th percentile) and f (minimum, mean, kurtosis, the 10th percentile and 50th percentile) of these malignant breast lesions were significantly lower than those of benign lesions (P < 0.05), while ADC-fast (kurtosis) and f (variance, skewness) of these malignant breast lesions were significantly higher than those of benign lesions (P < 0.05).ConclusionThe histogram analysis of ADC-slow (mean and the 50th percentile), ADC-fast (kurtosis) and f (minimum, mean, kurtosis, the 10th percentile and 50th percentile. Variance, skewness) can provide a more objective and accurate basis for the differential diagnosis of benign and malignant breast lesions.

ASO Author Reflections: Management of Benign Breast Intraductal Papillomas Without Atypia Diagnosed at Imaging-Guided Biopsies.

ASO Author Reflections: Management of Benign Breast Intraductal Papillomas Without Atypia Diagnosed at Imaging-Guided Biopsies.

Pathology of breast papillary neoplasms: Community hospital experience

In this study, 550 breast papillary neoplasms collected in a community hospital over more than ten years were reviewed and analyzed. This included 457 intraductal papillomas, 53 papillary carcinomas, 35 papillary DCIS and five invasive papillary carcinomas. The diagnostic rate of papillary neoplasms increased over time, likely due to better recognition by pathologists. Intraductal papillomas occurred most frequently in the upper outer quadrants and contained ADH/DCIS in 19% of cases. A total of 28% of non-incidental papillomas were associated with ADH/DCIS, and 29% of patients with papillomas had ADH/DCIS in adjacent tissue; nearly half of papillomas that were > 1 cm in size contained ADH/DCIS in the papilloma or adjacent to it. No single feature could predict an upgrade on excision for non-atypical intraductal papillomas diagnosed on core biopsy. There was no significant difference in the association of ADH/DCIS with central or peripheral papillomas. The overall upgrade rate of non-atypical intraductal papillomas to DCIS on excision was 2%, which justifies the conservative management of non-atypical sub-centimeter lesions.Papillary carcinomas occurred in older than intraductal papilloma patients and were most frequent in the upper quadrants. Although classically devoid of a myoepithelial cell layer, papillary carcinomas may contain some residual or even an ample myoepithelial cell layer in the papillae. An association between papillary carcinoma and conventional invasive carcinoma was found in 40% of EPCs and 89% of SPCs.Papillary DCIS was usually low- or intermediate-grade. The presence of a myoepithelial cell layer in the papillae was not inconsistent with this diagnosis.Invasive papillary carcinoma may have two histologic patterns: papillary and cribriform.

Recurrent intraductal papilloma mimicking secretory breast cancer in a 10-year-old girl—a case report

Recurrent intraductal papilloma mimicking secretory breast cancer in a 10-year-old girl—a case report

Papillary Lesion of the Breast in a Young Girl Suspicious to Juvenile Papillomatosis, Clinical Decision Making in a Multi-disciplinary Team and Review of the Literature

Background: Papillary lesions of the breast are a heterogeneous group of neoplasms, the diagnosis and treatment of which is challenging. Typically surgical excision is recommended for papillary lesions after core needle biopsy (CNB) to rule out concurrent malignancy when a diagnosis of papilloma with atypia is yielded on CNB. For papilloma without atypia, however, making a decision about excision versus observation is challenging.Case Presentation: A 14-year-old female with nipple discharge, and a 2 cm mass in the right breast, with the pathology of intra-ductal papilloma without atypia on CNB presented. The question to be answered by multi-disciplinary team was the best management of this papillary lesion and whether the follow up was adequate or excision was mandatory.Question: What is the best plan for management of the young patient according to the primary pathology report of Juvenile Papillomatosis?Conclusion: Histoathology review of CNB specimen in rare and high risk lesions may have some advantages. On the other hand, in high risk circumstances, the excision of the lesion is recommended. Thus, in this case, the multi-disciplinary team recommended excision of the lesion.