Intraductal Papilloma Of Breast Research Articles

Management of Breast Intraductal Papilloma Diagnosed on Core Needle Biopsy: Excision or Follow-up?

Introduction Management of intraductal papillomas (IDPs) diagnosed on core needle biopsy (CNB) remains controversial.We report our experience of IDPs identified on CNB, our institutional rates of upgradation to atypia/malignancy as well as radiologic/pathologic features that may allow selection for surgery as well as those for safe observation. Methods The study is a retrospective review of patient records from 2012 to 2019, at a tertiary care hospital in Pakistan. Data was analyzed using Statistical Package for Social Sciences (SPSS), version 21.0 (IBM Corp., Armonk, NY). Associations between various patient factors were assessed using Pearson's chi-square test. Results This study included a total of 55 female patients with IDPs, with a mean age of 54.67 ± 15.57 years. On CNB, 69.1% (n = 38) of patients had IDP without atypia while 30.9% (n = 17) had IDP with atypia, with single IDPs being the most common lesions on excisional biopsy. Overall, of all CNB-diagnosed IDPs, only 4/55 (7.3%) demonstrated upgradation (3/4 to DCIS, 1/4 showed atypia) on excisional biopsy, and all these upgraded cases had failed to demonstrate atypia on initial CNB. Conclusion CNB-identified cases of IDPsare rarely upgraded on excision and thus routine excision in all cases may be unnecessary. Appropriate patient selection based on radiology-pathology findings should be done. Those with suspicious findings on imaging as well as those that demonstrate atypia on CNB must be excised.

Upgrade rates of intraductal papilloma with and without atypia diagnosed on core needle biopsy and clinicopathologic predictors

Surgical excision of breast intraductal papilloma (IDP) without atypia diagnosed on core needle biopsy (CNB) is controversial as the risk of upgrade to malignant lesions is not well established. This study investigates upgrade rates of benign and atypical IDP to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) and clinicopathologic predictors. We identified 556 cases of IDP diagnosed on CNB at a single institution from 2010 to 2020 after excluding patients with a history of breast carcinoma, ipsilateral high-risk lesion, radiologic/pathologic discordance, or less than 2 years of follow-up if no excision within 1 year. Of these, 97 biopsies were consistent with atypical IDP and 459 were benign IDP. Surgical excision was performed for 318 (57.2%), and the remaining 238 (42.8%) underwent active monitoring. The upgrade rate for IDP without atypia was 2/225 (0.9%; 1 DCIS and 1 IC). Of 93 surgically excised atypical IDPs, 19(20.4%) upgraded (14 DCIS and 5 IC). Of 238 nonexcised IDPs followed clinically (range, 24-140 months, mean 60 months), there was no subsequent breast cancer diagnosed at the IDP site on follow-up. Mean age of patients was 56yr±12.6 SD without upgrade, 63yr±10.6 SD (P=.027) with DCIS, and 61yr±10.8 SD (P=.35) with IC. Atypical IDP was more likely to upgrade if biopsied by stereotactic guidance (8/19, 42.1% P=.035). At our institution, we had an exceedingly low upgrade rate for benign IDP. Overall, patients with upgrade to DCIS were older. For atypical IDP, upgrade was seen in higher proportions of stereotactic biopsies.

Overexpression of lncRNA MAPT-AS1 exacerbates cell proliferation and metastasis in breast cancer.

BackgroundTo investigate the function of MAPT antisense RNA 1 (MAPT-AS1) in breast cancer (BC), evaluating its potential diagnostic value for BC patients.MethodsThis study involved 498 patients with BC, 222 patients with benign breast diseases, including 74 cases each of of breast fibroadenoma, breast intraductal papilloma, and ductal hyperplasia and 429 healthy controls. We collected 20 cases of BC tissues and adjacent normal tissues and blood was taken from each participant. The expression levels of MAPT-AS1 were detected using reverse transcription polymerase chain reaction (RT-PCR). According to the median serum level of MAPT-AS1, patients were divided into a high expression group and a low expression group. We established MAPT-AS1 overexpression and knockdown in human BC cell line ZR-75-1 and MDA-MB-231 to study the function on cell proliferation [using cell counting kit-8 (CCK-8) assay], migration, and invasion (using Transwell assay).ResultsThe expression of MAPT-AS1 was significantly up-regulated in tissues and serum of BC patients compared with controls (P<0.0001 for both). Receiver operating characteristic (ROC) curve analysis showed that MAPT-AS1 had a large area under the curve (AUC) of 0.893. The expression of MAPT-AS1 in serum was closely related to the large tumor size, grade, tumor-node-metastasis (TNM) stages, and human epidermal growth factor receptor 2 (HER-2) expression status of BC patients. Overexpression of MAPT-AS1 activated the Wnt/β-catenin signaling pathway, promoting proliferation, migration, and invasion.ConclusionsOverexpression of MAPT-AS1 in tissues and serum is a reliable diagnostic marker for BC, and MAPT-AS1 regulates the proliferation and metastasis of BC cells by activating the Wnt/β-catenin signaling pathway.

Evaluation of intraductal breast papilloma based on immunohistochemical analysis of p16, p53 and ki-67

Evaluation of intraductal breast papilloma based on immunohistochemical analysis of p16, p53 and ki-67

Detailed Morphologic Evaluation of Breast Papillary Lesions on Core Biopsy Is Critical for Accurate Classification and Clinical Management: The Experience of an Academic Institute

BackgroundDistinguishing between a breast intraductal papilloma and a papillary lesion with atypia or malignancy can be very challenging on core biopsy. There has been a long ongoing debate over whether or not it is necessary for breast papillary lesions diagnosed on core biopsies to be surgically excised, and the upgrading rate after excision varies. Method and/or ResultThis study was carried out in a subspecialized academic pathology department, with well-formed criteria established among the faculty for the categorization of breast papillary lesions, with emphasis on the morphology evaluation of cellular features. A total of 320 breast core biopsies with follow-up excisions were identified. Of these, 286 cases had concordant results between the biopsy and excision, giving a concordance rate of 89.4%, with 98% concordance (143/146) in benign papilloma, 100% (111/111) in papillary carcinoma, and 51% (32/63) in papilloma with atypia. Of the upgraded cases, two were upgraded from benign to atypical, 11 from atypia to malignancy, and only one from benign to malignant. The overall average upgrading rate was 4.4% (14/320), with the critical upgrading (from benign to atypia or malignancy) rate of 0.94% (3/320). Downgrading was only identified in the group of papilloma with atypia, with 20 of 63 cases downgraded to benign papilloma on excision. ConclusionOur study indicates that surgical excision may not be necessary for all papillary lesions after detailed evaluation of the morphology on core biopsies. Assessing the morphological features of the epithelial cells is critical for the accurate classification and clinical management of papillary lesions.

Human Papillomavirus (HPV) Detection by Chromogenic In Situ Hybridization (CISH) and p16 Immunohistochemistry (IHC) in Breast Intraductal Papilloma and Breast Carcinoma

PurposeThis study explored human papillomavirus (HPV) amplification in breast benign and malignant lesions by chromogenic in situ hybridization (CISH) and the concordance of p16 expression by immunohistochemistry. Patients and MethodsThe presence of HPV6/11 and HPV16/18 in 33 cases of intraductal papilloma, 34 cases of ductal carcinoma in situ (DCIS), and 56 cases of invasive breast carcinoma (IBC) was evaluated using matched-background breast parenchyma and breast reduction as control groups. Association with clinicopathologic factors including prognosis was assessed. ResultsHPV 6/11 was observed in 0 cases (0%) of breast reduction, one case (3%) of intraductal papilloma, 11 cases (32.4%) of DCIS, and eight cases (14.3%) of IBC. HPV 16/18 was detected in three cases of (9.1%) breast reduction, six cases (18.8%) of intraductal papillomas, 14 cases (41.2%) of DCIS, and 25 cases (44.6%) of IBC. There was no difference in the HPV status between intraductal papilloma and breast reduction. HPV amplification in intraductal papilloma did not associate with developing atypia or carcinoma after long-term follow-up. However, HPV 6/11 and HPV 16/18 amplification was significantly higher in both DCIS and IBC when compared with breast reduction (P < .05). Compared with background breast parenchyma, HPV 16/18 amplification was significantly higher in both DCIS and IBC (P = .003 and P = .013, respectively). No correlation between p16 immunohistochemical staining and either of the HPV CISH testing was found (P > .05). ConclusionHPV infection was detected in both breast lesions and background parenchyma. HPV infection may play a role in the pathogenesis of breast cancer but is not associated with intraductal papilloma. Immunohistochemical stain for p16 is not a good surrogate marker for HPV infection in breast lesions.

Genome-wide DNA methylome and whole-transcriptome landscapes of spontaneous intraductal papilloma in tree shrews.

BackgroundBreast intraductal papilloma (IP) is mainly caused by the abnormal proliferation of ductal epithelial cells. Tree shrews have potential as an animal model for the study of breast tumours; however, little is known regarding the transcriptome and DNA methylome landscapes of breast IP in tree shrews. In this research, we conducted whole-genome DNA methylation and transcriptome analyses of breast IP and normal mammary glands in tree shrews.MethodsDNA methylation profiles were generated from the whole-genome bisulfite sequencing and whole-transcriptome landscapes of IP and control groups of tree shrews through strand-specific library construction and RNA sequencing. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes functional enrichment analyses and gene set enrichment analysis were performed. Spearman’s correlation analysis was used to identify statistical relationships between gene expression and DNA methylation.ResultsA genome-wide perspective of the epigenetic regulation of protein-coding genes in breast IP in tree shrews was obtained. The methylation levels at CG sites were considerably higher than those at CHG or CHH sites, and were highest in gene body regions. In total, 3,486, 82 and 361 differentially methylated regions (DMRs) were identified in the context of CG, CHG, and CHH, respectively, and 701 differentially methylated genes (DMGs) were found. Further, through transcriptomic analysis, 62 differentially expressed genes, 50 long noncoding RNAs, and 32 circular RNAs were identified in breast IP compared to normal mammary glands. Correlation analysis between the DNA methylation and transcriptome data revealed that 25 DMGs were also differentially expressed genes, among which the expression levels of 9 genes were negatively correlated with methylation levels in gene body regions. Importantly, integrated analysis identified 3 genes (PDZ domain-containing 1, ATPase plasma membrane Ca2+ transporting 4 and Lymphocyte cytosolic protein 1) that could serve as candidates for further study of breast IP in tree shrews.ConclusionsThis research has unearthed the comprehensive landscape of the transcriptome and DNA methylome of spontaneous IP in tree shrews, as well as candidate tumorigenesis related genes in IP. These results will contribute to the use of tree shrews in animal models of breast tumours.

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.

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.

Benign Breast Intraductal Papillomas Without Atypia at Core Needle Biopsies: Is Surgical Excision Necessary?

The aim of this study was to determine the upgrade rate of image-guided core needle biopsy (CNB)-proven benign breast intraductal papillomas (IDPs) without atypia to high-risk benign lesions or malignancy after surgical excision. A retrospective database search at a single institution identified 102 adult female patients with benign breast IDPs without atypia diagnosed on imaging-guided CNBs who subsequently had surgical excisions between 2011 and 2016. Patient characteristics, imaging features, biopsy techniques, and the pathology reports from imaging-guided CNBs and subsequent surgical excisions were reviewed. The upgrade rate to malignancies or high-risk benign lesions was determined at the patient level. The upgrade rate to malignancy was 2.9% (3/102), including two cases of ductal carcinoma in situ (DCIS) and one case of microinvasive (< 1mm) ductal carcinoma arising from DCIS. The upgrade rate to high-risk benign lesions was 7.8% (8/102), with seven cases of atypical ductal hyperplasia and one case of atypical lobular hyperplasia. A personal history of breast cancer and a larger mean lesion size were significantly associated with an upgrade to malignancy (p < 0.05). The management of benign breast IDPs without atypia detected on imaging-guided CNBs is controversial. Our results suggest risk stratification is important in approaching these patients. Although surgical excision should be considered for all benign breast IDPs without atypia, observation with serial imaging may be appropriate in selected low-risk patients. This approach will save many women from surgeries and decrease the cost of medical care.

A retrospective observational study of intraductal breast papilloma and its coexisting lesions: A real-world experience.

BackgroundBreast intraductal papilloma is a heterogeneous group. The aim of the study is to investigate the intraductal breast papilloma and its coexisting lesions retrospectively in real‐world practice.MethodsWe retrospectively identified 4450 intraductal breast papilloma and its coexisting lesions.ResultsAbout 18.36% of intraductal papilloma coexisted with malignant lesions of the breast, 37.33% coexisted with atypia hyperplasia (AH), 25.24% coexisted with benign lesions, and only 19.10% coexisted without concomitant lesions. In addition, 36.80% of intraductal breast papilloma had nipple discharge, 51.46% had a palpable breast mass, and 16.45% had both nipple discharge and a palpable breast mass. About 28.18% experienced discomfort or were asymptomatic. Furthermore, 98.99% had ultrasound abnormalities, and 53.06% had intraductal hypoechogenicity upon ultrasound. 31.89% had mammographic distortion, and 14.45% had microcalcification upon mammography. Intraductal breast papilloma with malignancy had significant correlations with clinical manifestations.ConclusionCoexisting malignancy was also related to ultrasound abnormality (BIRADS 4C and 5), mammographic distortion, and microcalcification upon mammography but was not related to the intraductal hypoechoic upon ultrasound. Coexisting atypical hyperplasia correlated with nipple discharge but not palpable mass, mammographic distortion, or intraductal hypoechoic upon ultrasound. The coexisting AH was also related to abnormality upon ultrasound or microcalcification compared with the benign lesions. The intraductal papilloma coexists with malignancy or AH accounted for more than 50%, and the clinical information on papilloma and its coexisting lesions is nonspecific. We recommended surgical treatment for benign intraductal papillary lesions.

The value of CESM in the evaluation of intraductal breast papilloma: a comparative study with DCE-MRI

BackgroundThe purpose of this study was to assess the accuracy of contrast-enhanced spectral mammography (CESM) as compared to dynamic contrast-enhanced MRI (DCE-MRI) in the evaluation of intraductal breast papilloma with histopathological correlation. This study is a retrospective study done on 45 consecutive patients. Their ages ranged between 36 and 70 years with a mean age of 51.1 ± 8.7. All of them were suspected to have intraductal papilloma on full-field digital mammography (FFDM), 3D automated breast ultrasound (3D-ABUS), and 2D handheld ultrasound (2DHHUS). CESM and DCE-MRI were done for all patients. The data were collected, tabulated, statistically analyzed using an IBM personal computer with Statistical Package of Social Science (SPSS).ResultsThere were 37 histopathology proven papillomas either by US-guided core needle biopsy, surgical biopsy following wire localization or fine-needle aspiration cytology (FNAC). Lesions are divided into three subgroups according to size. When the size of lesion > 10 mm MRI sensitivity and specificity is 100% and 66.7%, that of CESM is 90.1% and 0% respectively. In lesions sized 5–10 mm Sensitivity and specificity of MRI is 100% and 58% respectively and those of CESM are 63.6% and 50% respectively. Lesions less than 5mm MRI sensitivity and specificity is 100% and 0%, that of CESM was 0% and 100% respectively.ConclusionDCE-MRI has a significantly higher sensitivity than CESM for the diagnosis of intraductal papilloma whatever the size of the lesion, especially when the size is less than 5 mm.

The role of magnetic resonance imaging in detection and surgical treatment of breast intraductal papillomas

Background: Intraductal papillomas are discrete benign tumors of the breast duct epithelium. Due to the risk of subsequent carcinoma, a surgical excision is generally recommended as a precaution. However, it is difficult to initially diagnose and accurately locate the lesions both in pre-surgery and surgery periods. Methods: Retrospectively analyzed 245 patients, with a pathologically proven breast intraductal papillomas. All the patients underwent magnetic resonance imaging (MRI) scans and ultrasound examination(s) pre-surgery and/or in surgery. All the patients who underwent surgery were divided into four groups according to the following operation method type(s): ultrasound & clinical examination excision, methylene blue notation excision, methylene blue notation & MRI guide excision, and MRI guide excision. Then, the differences between the last two MRI guide excisions and the first two conventional methods were analyzed. Afterwards, 238 patients were followed up for recurrence checks. SPSS 19.0 statistical software was used and the results of P Results: A total of 161 (65.7%) and 48 (19.6%) patients were pathological diagnosed of solitary and multiple papilloma separately, and 36 (14.7%) patients had papillomatosis; 168 and 243 cases with positive signs, which were detected in all 245 patients who had underwent ultrasound and MRI examination(s), with the detection rate being 68.6% and 99.0% respectively. MRI imaging could clearly present mass-like lesions (solitary and multiple mass) and non-mass like lesions (ductal and regional). Whereas, ultrasound imaging could barely show mass-like (solitary and multiple mass) lesions. In surgery, when compared with traditional methods, MRI imaging could also more accurately locate the lesions and guide the excision. MRI guidance is both applicable to patients with and without nipple discharge, in addition to those who show no abnormal signs in ultrasound imaging. The recurrence-free survival time with traditional surgery methods was significantly lower than those in the MRI guide groups. Conclusions: MRI is accurate at the detection, localization and resection range of intraductal papilloma lesions; all capabilities which are critical to successful breast surgery.

The role of magnetic resonance imaging in detection and surgical treatment of breast intraductal papillomas.

BackgroundIntraductal papillomas are discrete benign tumors of the breast duct epithelium. Due to the risk of subsequent carcinoma, a surgical excision is generally recommended as a precaution. However, it is difficult to initially diagnose and accurately locate the lesions both in pre-surgery and surgery periods.MethodsRetrospectively analyzed 245 patients, with a pathologically proven breast intraductal papillomas. All the patients underwent magnetic resonance imaging (MRI) scans and ultrasound examination(s) pre-surgery and/or in surgery. All the patients who underwent surgery were divided into four groups according to the following operation method type(s): ultrasound & clinical examination excision, methylene blue notation excision, methylene blue notation & MRI guide excision, and MRI guide excision. Then, the differences between the last two MRI guide excisions and the first two conventional methods were analyzed. Afterwards, 238 patients were followed up for recurrence checks. SPSS 19.0 statistical software was used and the results of P<0.05 being considered statistically significant.ResultsA total of 161 (65.7%) and 48 (19.6%) patients were pathological diagnosed of solitary and multiple papilloma separately, and 36 (14.7%) patients had papillomatosis; 168 and 243 cases with positive signs, which were detected in all 245 patients who had underwent ultrasound and MRI examination(s), with the detection rate being 68.6% and 99.0% respectively. MRI imaging could clearly present mass-like lesions (solitary and multiple mass) and non-mass like lesions (ductal and regional). Whereas, ultrasound imaging could barely show mass-like (solitary and multiple mass) lesions. In surgery, when compared with traditional methods, MRI imaging could also more accurately locate the lesions and guide the excision. MRI guidance is both applicable to patients with and without nipple discharge, in addition to those who show no abnormal signs in ultrasound imaging. The recurrence-free survival time with traditional surgery methods was significantly lower than those in the MRI guide groups.ConclusionsMRI is accurate at the detection, localization and resection range of intraductal papilloma lesions; all capabilities which are critical to successful breast surgery.

Value of Magnetic Resonance Imaging Texture Analysis in the Differential Diagnosis of Benign and Malignant Breast Tumors.

Objective To investigate the difference in texture features on diffusion weighted imaging (DWI) images between breast benign and malignant tumors.Methods Patients including 56 with mass-like breast cancer, 16 with breast fibroadenoma, and 4 with intraductal papilloma of breast treated in the Hainan Hospital of Chinese PLA General Hospital were retrospectively enrolled in this study, and allocated to the benign group (20 patients) and the malignant group (56 patients) according to the post-surgically pathological results. Texture analysis was performed on axial DWI images, and five characteristic parameters including Angular Second Moment (ASM), Contrast, Correlation, Inverse Difference Moment (IDM), and Entropy were calculated. Independent sample t-test and Mann-Whitney U test were performed for intergroup comparison. Regression model was established by using Binary Logistic regression analysis, and receiver operating characteristic curve (ROC) analysis was carried out to evaluate the diagnostic efficiency.Results The texture features ASM, Contrast, Correlation and Entropy showed significant differences between the benign and malignant breast tumor groups (PASM=0.014, Pcontrast=0.019, Pcorrelation=0.010, Pentropy=0.007). The area under the ROC curve was 0.685, 0.681, 0.754, and 0.683 respectively for the positive texture variables mentioned above, and that for the combined variables (ASM, Contrast, and Entropy) was 0.802 in the model of Logistic regression. Binary Logistic regression analysis demonstrated that ASM, Contrast and Entropy were considered as the specific imaging variables for the differential diagnosis of breast benign and malignant tumors.Conclusions The texture analysis of DWI may be a simple and effective tool in the differential diagnosis between breast benign and malignant tumors.

A retrospective observational study of intraductal breast papilloma and its coexisting lesions: A real-world experience.

e13558Background: Breast intraductal papilloma comprises a wide spectrum of lesions, ranging from benign intraductal papilloma to papilloma with foci of atypia or papillary carcinoma, it can harbor...

PIK3CA and AKT1 mutations in hidradenoma papilliferum

AimsHidradenoma papilliferum (HP) is a benign vulvar neoplasm that arises from anogenital mammary-like glands, and its morphology is similar to mammary intraductal papilloma. The aim of this study was to...

Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: Rate of upgrade to carcinoma at excision.

The surgical management of mammary intraductal papilloma without atypia (IDP) identified at core-needle biopsy (CNB) is controversial. This study assessed the rate of upgrade to carcinoma at surgical excision (EXC). This study identified women with a CNB diagnosis of intraductal papilloma without atypia or carcinoma at a cancer center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. The radiologic and clinicopathologic features of patients with a CNB diagnosis of IDP were correlated with an upgrade to carcinoma at EXC. The study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent EXC. The upgrade rate was 2.3% (4 of 171). The upgraded lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥ 8 mm away. Twenty-four women (25 IDPs) did not undergo EXC and had stable imaging on follow-up (median, 23.5 months). The upgrade rate at EXC for IDPs diagnosed at CNB with radiologic-pathologic concordance was 2.3%. These findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2819-2827. © 2016 American Cancer Society.

MR features of intraductal papilloma of the breast

Objective To characterize the MR features of intraductal papilloma of the breast.Methods The MRI data of 24 patients with intraductal papillomas of the breast verified by histopathology were analyzed.The MRI features analyzed included morphology,signal intensity on pre-enhanced T1 WI and FE T2 WI,the patterns of dynamic enhancement,and the mean ADC on DWI.The ADC values for intraductal papilloma and normal breast tissue were compared using paired t test.Results The maximum diameter of the tumors ranged from 0.3 cm to 2.0 cm.Of the 24 tumors,17 were round or oval and 7 were irregular in shape:the margins were well-defined in 18 cases,and ill-defined in 6 cases.AII tumors were isointensity or hypointensity on T1 WI,and slight hyperintensity on T2 WI.On dynamic enhanced images,all the 24 tumors showed rapid initial enhancement.and the mean early phase enhancement rate was(156.50±19.67)%.In the early phase.homogenous enhancement was shown in 15 cases and heterogeneous enhancement in 9 cases.In the delayed phases,the most tumors(18/24)had ring-like enhancement pattern in which signal intensity in peripheral is higher than that in center.The patterns of time-signal intensitycurves were type Ⅲ(washout)in 19 cases and type Ⅱ(plateau)in 5 cases.With b=1000 s/mm2,the mean ADC value for intraductal papilloma[(1.14±0.29)×10-3mm2/s]was significantly lower than that of the normal breast tissue [(1.83±0.32)x 10-3mm2/s (t=5.53,P=0.000).Conclusions MRI features of intraductal papilloma are similar to breast cancer in washout pattern on DCE-MRI and lower ADC value on DWL However,relative lower early enhancement rate and dynamic signal intensity course on DCE-MRI are characteristic clues to differentiating intraductal papilloma from breast eancer. Key words: Breast neoplasms; Magnetic resonance imaging

树鼩乳腺导管内乳头状瘤一例

报告一例树鼩乳腺导管内乳头状瘤。患病树鼩为雌性，3岁。肿块位于腹部皮下乳腺部位，直径约为1.0 cm，椭圆形不规则，表面光滑。组织病理学观察发现肿块含有乳腺特有的乳腺终末导管结构和少量乳腺小叶结构，由导管乳头和小叶状增生细胞组成，乳头分支少，较为粗大，细胞体积较大，细胞界限清晰，核分裂少见，伴有大汗腺样化生。核仁明显，细胞核位于细胞中央一侧，胞浆丰富并且呈红色，伴有坏死。诊断为乳腺导管内乳头状瘤。 A case of breast intraductal papilloma of tree shrews is described. Masses in the breast area were found in a 3-year-old female tree shrew. The lump diameter is about 1 cm, irregular oval and smooth surface. Histopathological examination with H.E staining showed that mass contained breast specific terminal ductal structures and a small amount of breast lobules, which was composed of ductal papillary and lobular hyperplasia. The nipple was less branching and more bulky; the cell volume was bigger; the cell boundary was clear; the nuclear division was rare, and accompanied by sweat gland metaplasia. The nucleus is located in the side of the cell, and the cytoplasm is rich and red with necrosis. The pathological feature of case supported the diagnosis of breast intraductal papilloma.