Intraductal Papilloma Of Breast Research Articles

Challenges in the Management of Giant Intraductal Breast Papilloma

Key Clinical MessageThe differential diagnosis of a large breast mass in a post-menopausal woman can include both benign and malignant etiologies. Although rare, diagnosis of giant intraductal papilloma must be considered in the differential. Furthermore, although benign, papillomas presenting as a large breast mass affecting the skin require extensive breast surgical treatment.

Automated breast volume scanning in the diagnosis of breast intraductal papilloma

To investigate the value of automated breast volume scanning (ABVS) in the diagnosis of breast intraductal papilloma (IDP). Totally 239 lesions in 213 women who were scheduled for open biopsy were investigated in this study. The patients underwent both ABVS and conventional ultrasound (US). According to the imaging diagnostic standards of IDP, the diagnostic accuracy for ABVS was calculated, and then compared with US, using histopathological examination as the gold standard. Among the 239 breast lesions studied, 85 were pathologically proved to be malignancies and 154 benign lesions, among which there were 26 cases of IDP. ABVS found 41 cases of IDP (17.2%), with the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy being 88.5%, 91.5%, 56.1%, 98.5%, and 91.2%, respectively. In contrast, US found 32 cases of IDP (13.4%), with the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy being 73.1%, 93.9%, 59.4%, 96.6%, and 91.6%, respectively. ABVS coronal images can better display the structures of dilated lactiferous ducts and the intraluminal echoes, increase the diagnostic accuracy of IDP, and thus provide more information for the diagnosis and differential diagnosis of IDP.

Cytological diagnosis of ductal papilloma with apocrine hyperplasia of breast

Intraductal papillomas of the breast are relatively rare benign lesions with an incidence of approximately 2-3% commonly seen in 20 - 40 years aged women and are rare after 50 years of age. We here in report a case of intraductal papilloma of breast in a 66 year old female with significant family history of breast carcinoma which is a rare presentation. She presented with bloody nipple discharge from right breast since one month. On examination, right nipple is enlarged up to 0.8cm in diameter. Mammogram showed no abnormality. Fine needle aspiration cytology (FNAC) of the enlarged nipple was done and a diagnosis of duct papilloma with apocrine hyperplasia was made. This case report emphasizes the role of FNAC in diagnosing this lesion and relieving the patient from physical and mental trauma at an early stage

マンモグラフィにて特異な石灰化を認めた若年者の乳管内乳頭腫の１例

症例は26歳，女性。1年前から右乳腺CDエリアに腫瘤を自覚していた。右乳頭から白色調の分泌液を自覚したため当院来院。乳頭分泌液細胞診は陰性であった。マンモグラフィでは，右CDの拡張した乳管内に集簇性の淡く不明瞭な石灰化を認め，分枝状の形を呈した。乳腺エコーで，右CDに拡張した乳管とその内部に乳頭状に増殖した腫瘤を認めた。乳腺造影MRIでは，腫瘤は早期より造影され，次第に漸増するパターンを示した。以上より，乳管内乳頭腫(intraductal papilloma, IP)と診断し，乳管腺葉区域切除術を行った。切除標本では，IPの一部に腺の増殖と間質の硬化，多数の微小石灰化を認めた。石灰化は，増殖した腺腔内の分泌物に由来するものと考えられた。本症例では，マンモグラフィの特異な石灰化の原因は，硬化性乳頭腫の一部で上皮が脱落・消失した結果，乳管小葉構造を反映する分枝状の石灰化のみが間質に残り，石灰化が互いに癒合したことと考えられた。IPでは，稀に血行障害による梗塞などの原因で今回のような上皮脱落を伴う間質の硬化を来し，特異な石灰化を呈することも念頭に入れる必要があると考えられた。

乳腺穿刺吸引細胞診で悪性と判定した乳管内乳頭腫 2 例の細胞像と組織像

乳腺穿刺吸引細胞診で悪性と判定した乳管内乳頭腫 2 例の細胞像と組織像

Clinical analysis of 151 patients with carcinomatous change of breast intraductal papilloma

Objective: To explore the clinicopathological features of patients with carcinomatous change of breast intraductal papilloma as well as the treatment protocols and the survival. Methods: The medical records and follow-up data of 151 patients with carcinomatous change of breast intraductal papilloma admmited to Cancer Hospital of Tianjin Medical University from November 1998 to July 2011 were retrospectively analyzed. These patients were categorized into two subgroups by pathology: carcinomatous change which was confined within duct (n = 113, 74.8%) and infiltrative carcinomatous change (n = 38, 25.2%). The clinicopathological features, the treatment protocols and the survival were analyzed. Results: The rate of nipple discharge in patients with infiltrative carcinomatous change was higher than that in patients with carcinomatous change confined within duct (P = 0.036). The expression level of Ki-67 was higher in infiltrative carcinomatous change than in carcinomatous change confined within duct (P = 0.006). The three-year and five-year disease-free survival rates were not significantly different between these two pathological types (P > 0.05). Conclusion: In carcinomatous change of breast intraductal papilloma, the patients with infiltrative carcinomatous change have a lower rate of nipple discharge and a higher expression level of Ki-67. Early detection and early diagnosis are essential to the treatment of carcinomatous change of breast intraductal papilloma and may improve its prognosis. DOI:10.3781/j.issn.1000-7431.2013.12.006

Color doppler ultrasound in the application of breast intraductal papilloma

The aim of this study was to evaluate the application value of high-frequency color Doppler ultrasound in the diagnosis of intraductal papilloma (IDP). A retrospective analysis of 64 IDP cases was done, the pathology proven by surgery with 89 lesions. According to the ultrasonic performance, the lesions were divided into different types and the solid focal were evaluated according to the classification BI-RADS-US standard. There were 47 patients corresponds with the 64 cases of surgical pathology, the accuracy was 73.4%, according to the ultrasonic performance could be divided into two types, named catheter type and solid type, catheter diagnostic accuracy was 22/25 (88%), compared the morphological features of the solid type, grouped according to their size (≥ 2 cm or < 2 cm lesions), discovered there was no statistically significant difference between the benign and malignant lesions by BI-RADS-US grading standard. Two-dimensional ultrasound and Color Doppler flow imaging (CDFI) can make a definite diagnosis and positioning for IDP, but there are still some limitations to differentiate the benign and malignant, it need to pay more attention to the clinical application of substantive IDP and improve the understanding, provide more relevant information for clinic, the focal will be earlier treated to reduce the possibility of malignant happened change.

Mammotome biopsy in diagnosing and treatment of intraductal papilloma of the breast

Intraductal papilloma is a benign breast tumor which needs histopathological verification because of the risk of cancer coincidence. To assess the value of the mammography-guided and ultrasound-guided vacuum-assisted core biopsy in the diagnosis and treatment of intraductal papillomas of breast and to answer the question if mammotome biopsy allows to avoid surgery in these patients. In the period 2000-2011, a total of 2246 vacuum-assisted core biopsies were performed, of which 1495 were ultrasound-guided and 751 were mammography-guided (stereotaxic). In 76/2246 patients (3.4%), aged 19-88 years (mean age was 51,5) histopathological examination confirmed intraductal papilloma. Atypical lesions were accompanying intraductal papilloma in 16/76 cases (21%). Open surgical biopsy performed in these group revealed invasive cancer in 3 women. In all 60 cases (79%) with benign papilloma in biopsy specimens, further clinical observation did not show recurrence or malignant transformation of lesions. Vacuum-assisted core biopsy is a minimally invasive and efficient method used for diagnosing intraductal papilloma of the breast. If histopathological examination confirms a benign character of the lesion, surgery may be avoided but regular follow-up is recommended. However, in all cases histopathological diagnosis of papilloma with atypical hyperplasia, should always be indication for surgical excision.

小児乳管内乳頭腫の1例

症例は7歳，女児．左乳房腫瘤を自覚し来院した．左CE領域に大きさ4.0×3.0cm，弾性硬，辺縁は比較的明瞭で，表面は平滑であった．表在リンパ節は触知しなかった．マンモグラフィ:若年者であり，施行せず．超音波所見:内部エコーは比較的均一で，辺縁が軽度不整な類円形の腫瘤を認めた．線維腺腫を疑い，6カ月の経過観察とした．腫瘤の大きさに変化なく，家族の希望にて全身麻酔下に腫瘤摘出術を行った．腫瘤は被膜に被われ，割面は髄様，灰白色調を呈し，粗大結節状であった．病理組織学的所見:嚢胞状に拡張した管腔内に乳頭状増殖した腫瘍を認める．乳頭状増殖部では円柱状細胞と立方状ないし紡錘形細胞が2層性に配列し，間質は毛細血管を含む線維性結合織からなる．腫瘍細胞に異型性はなく，α-SMA染色においても筋上皮細胞が陽性であった．術後約10年を経過し，現在まで臨床的に再発はない．

Microcalcification Is an Important Factor in the Management of Breast Intraductal Papillomas Diagnosed on Core Biopsy

The follow-up excision (FUE) results were analyzed from 370 cases diagnosed as intraductal papilloma on breast core needle biopsy (CNB) with no history of malignancy or other risk factors. Of these cases, 98.6% were rendered a Breast Imaging Reporting and Data System score of 4 on mammography before the CNB. Fifty-one cases (13.8%) were found to have microcalcifications on microscopic examination of CNB. A total of 7 (1.9%) of 370 cases were upgraded to invasive carcinoma, ductal carcinoma in situ, or pleomorphic lobular carcinoma in situ on FUE. Six of 51 (11.8%) cases with microcalcifications found on imaging and CNB were upgraded to ductal carcinoma in situ or invasive carcinoma, whereas only 1 (0.3%) of 319 cases without microcalcifications was upgraded to pleomorphic lobular carcinoma in situ (P = .003). Results of a multivariate analysis adjusted for age confirmed that microcalcifications was a risk factor for upgrading to cancer, independent of age. Our results indicate that surgical excision is required for intraductal papilloma diagnosed on CNB if microcalcifications are present. However, excision may not be required for those who have no microcalcifications on CNB and no other known risk factors.

Vacuum-Assisted Core Biopsy in Diagnosis and Treatment of Intraductal Papillomas

BackgroundThe aim of this study was to assess the value of mammographically-guided and ultrasonographically-guided vacuum-assisted core biopsy (VACB) in the diagnosis and treatment of intraductal papillomas of breast and to answer the question of whether biopsy with the Mammotome (Mammotome; Cincinnati, OH) allows the avoidance of surgery in these patients. Patients and MethodsIn the period 2000 to 2010, a total of 1896 vacuum-assisted core biopsies were performed, of which 1183 were ultrasonographically guided and 713 were mammographically guided (stereotaxic). ResultsIn 62 patients (3.2%) histopathologic examination confirmed intraductal papilloma, and in 12 patients (19.4%) atypical lesions were also found. Open surgical biopsy specimens revealed invasive cancer in 2 women these 12 women (false-negative rate, 16.7%; negative predictive value, 83.3%). Biopsy specimens from the remaining 50 patients (80.6%) revealed papilloma without atypia, and further clinical observation and imaging examinations did not show recurrence or malignant transformation of lesions. Hematoma developed in 3 (4.8%) patients as a complication of biopsy; surgical intervention was not required in any of the patients. ConclusionVACB is a minimally invasive and efficient method for diagnosing intraductal papilloma of the breast. If histopathologic examination confirms a benign lesion and corresponds to the clinical presentation, surgery may be avoided. However in all cases, histopathologic diagnosis of papilloma with atypical hyperplasia or a suspected malignant lesion in imaging examinations, despite negative biopsy results, should always be an indication for surgical excision.

Combined evaluation of CK5/6, ER, p63, and MUC3 for distinguishing breast intraductal papilloma from ductal carcinoma in situ

The differentiation of intraductal papilloma (IDP) in the breast from ductal carcinoma in situ (DCIS) is sometimes difficult. Fifty papillary lesions (25 DCIS and 25 IDP) were immunohistochemically examined using a panel of antibodies, including CK5/6, ER, p63, Ki-67, chromogranin A, synaptophysin, neuron specific enolase, CD56, MUC1, MUC3, CD44, p21, p27, and p53. The immunohistochemical staining pattern of each antibody was evaluated using the Allred scoring system. Then, the area under curve (AUC) for each antibody was computed by receiver operating characteristic (ROC) analysis. DCIS typically showed high scores for ER and MUC3 reactivity compared with IDP, and the AUC for ER and MUC3 were 0.941 and 0.908, respectively. In contrast, IDP showed high scores for CK5/6 and p63 reactivity compared with DCIS, and the AUC for CK5/6 and p63 were 1.00 and 0.954, respectively. We devised a 'Differential Index' (DI) using the following formula: [S(ER) + S(MUC3)]/[S(CK5/6) + S(p63) + 1]. The distributions of the DI for IDP and DCIS did not overlap when the cutoff value was placed arbitrarily at DI = 1.0. From these results, it is concluded that a panel of four CK5/6, ER, p63, and MUC3 antibodies provide valuable information for differentiating IDP from DCIS.

Surgical excision of intraductal breast papilloma diagnosed on core biopsy

The need for surgical excision of benign papillary lesions diagnosed on core biopsy remains debatable. This lack of consensus arises because although there is a possibility of histological underestimation, there are as yet no reliable predictors of malignancy. We therefore aimed to evaluate the incidence of histological underestimation in our practice, and to identify factors that predict for this, in order to reduce unnecessary surgery without missing out on possible malignancy. Retrospective review of 106 patients diagnosed with a papillary lesion on percutaneous image-guided core biopsy was performed between 1 January 2005 and 31 December 2008. The presence of atypia on core biopsy and the presence of malignancy in the surgical specimen were correlated with standard clinical, radiological and pathological features. Histological underestimation occurred in 15 of 81 patients (19%). Malignancy was more likely when atypia was present in the core biopsy (P= 0.04, OR 5.17). Otherwise, a final diagnosis of malignancy was not correlated with any clinical or radiological features (P > 0.05). The presence of atypia was also not correlated with any clinical or radiological features. In our study, 19% of patients with a benign papillary lesion diagnosed on core biopsy were found to have atypical ductal hyperplasia or malignancy following surgery. In view of this, together with the absence of reliable predictive factors for malignancy, we recommend surgical excision of all papillary lesions diagnosed on core biopsy.

Mammary Tumors With Sebaceous Differentiation in Dogs

Editor: We read with particular interest the 2007 article by Dr Chang et al, which describes the first case of canine mammary carcinoma with sebaceous differentiation. The authors compared the histologic features of the canine tumors with those of human cases. Since then, new and distinctive cases of this mammary carcinoma variant have been reported. Additionally, we sometimes encounter canine mammary gland carcinomas with sebaceous components among our own diagnostic cases. The aim of this letter is to draw the attention of Veterinary Pathology readers to the morphologic variation in reported mammary tumors with sebaceous components to complement the review by Dr Chang et al. Although it has been documented once in the veterinary literature, we believe that these additional data will contribute to the understanding of this peculiar mammary carcinoma subtype. Although the number of well-documented cases is still limited, the World Health Organization classification for human breast tumors now recognizes sebaceous carcinoma as a distinct subtype of invasive breast carcinoma. However, the presence of sebaceous differentiation and other neoplastic components vary markedly among the reported cases, which makes the classification criteria of mammary sebaceous carcinoma ambiguous. A sebaceous component has been described in mammary adenoid cystic carcinomas, invasive ductal carcinoma (some with in situ components of cribriform and comedocarcinoma types), and intraductal breast papilloma with squamous/apocrine metaplasia. Other authors have described tumors with a predominance of sebaceous cells (> 50%), with or without basal cells, and have thus classified them as primary sebaceous carcinomas of the breast. Dr Chang and colleagues were prudent in classifying their canine case as a mammary carcinoma with sebaceous differentiation because, apparently, some cells of the typical ductal carcinoma component had undergone sebaceous differentiation. However, because extensive solid multilobulated neoplastic tissue composed of basal and sebaceous cells was also observed, they probably could have used the term mammary sebaceous carcinoma due to the predominance of sebocytic cells in the neoplasm. The morphologic characteristics (and the degree of cellular atypia) of the nonsebaceous components in these mammary carcinomas may be quite variable. Thus, we believe that the term sebaceous carcinoma is not suitable for all of these lesions and that care must be taken when evaluating mammary tumors with sebaceous differentiation because the nonsebaceous component may be quite aggressive. Histochemistry is helpful in the diagnosis of these neoplasms. The lipid vacuoles in the sebocytic cells are not stained by periodic acid–Schiff, mucicarmine, or alcian blue but are stained by oil red O. Additionally, immunohistochemistry to detect adipophilin may be performed to support the diagnosis. Whereas the oil red O technique is not reliable for detection of lipid in paraffin-embedded tissue, the antibodies to adipophilin will bind sebaceous cells, even in tissues that were routinely processed with the lipid solvents used in paraffin embedding. The origin of the sebaceous component in these mammary carcinomas is unknown. Some authors suggest that basaloid cells of the tumors can differentiate toward cutaneous adnexal structures or that local stem cells might give rise to sebocytes.

Clinical analysis of 52 cases of carcinomatous change of breast intraductal papilloma.

Objective To explore the diagnosis and treatment of cancerization relative to breast intraductal papilloma. Methods Clinical and pathological data of 52 patients with cancerous change of intraductal papilloma were studied retrospectively from January 1998 to December 2008. Results 39 of the 52 cases were diagnosed as malignance or suspected malignance by at least one of the preoperative imaging examinations such as ultrasonography, breast mammography or ductography. Cancer cells were found in 13 of the 46 patients who received fine needle aspiration. Frozen section established the malignance in 18 of the 39 cases. In a postoperative pathological report, 32 cases were cancerization of intraductal papilloma (carcinoma in situ) and 16 were cancerous change with microinvasion, only 4 patients with invasive carcinoma. All the patients received surgical management, 26 of the 52 cases were treated with modified radical mastectomy, 8 of them were performed with breast-conserving surgery (segmental resection plus axillary lymph node resection),7 cases underwent total mastectomy and 11 were just conducted with segmental resection. Only one people was found with axillary node metastasis among the 34 patients who received axillary lymph node dissection.Conclusion The correct preoperative diagnosis of the carcinomatous change of breast intraductal papilloma are always difficult and inconclusive, the frozen section may be helpful and the final diagnosis relied on the fully drawing materials of pathology after the operation. Treatment should be varied based on different pathological findings. Key words: Papilloma, breast intraductal; Cancerization; Breast neoplasms; Diagnosis; Therapy

Intraductal papilloma of ectopic breast tissue in axillary lymph node of a patient with a previous intraductal papilloma of ipsilateral breast: a case report and review of the literature

The presence of ectopic breast tissue in axillary lymph nodes (ALN) is a benign condition that must be differentiated from primary or metastatic carcinoma. Here we report a patient who underwent excision of enlarged ALN 10 years after she had received surgical treatment of ipsilateral breast for an intracystic intraductal papilloma (IDP). Histological examination of the removed ALN revealed that the proliferative lesion consisted of papillary and tubular structures lined by luminal cuboidal cells and a distinct outer layer of myoepithelial cells resembling IDP of the breast. Immunostaining with a set of immunohistochemical markers including AE/AE3, alpha-smooth muscle actin and p63 in combination with estrogen and progesterone receptors confirmed the diagnosis of ectopic IDP.This case shows that even though benign proliferative change in ectopic breast tissue is an extremely rare phenomenon, this possibility should be taken into account for correct diagnosis.

Clinicopathologic Review of the Intraductal Papilloma of Breast

had surrounding pathologic lesions in the operated specimen according to the final pathology, 107 (66.5%) had fibrocystic change, 26 (16.1%) had fibroadenoma, 30 (18.6%) had atypical ductal hyperplasia (ADH), 11 (6.8%) had carcinoma in situ and 4 (2.5%) had invasive ductal carcinoma. During the follow up, 7 patients (4.3%) developed recurrent IDP, 3 patients developed ADH and 5 patients developed carcinoma in situ (4 patients had ductal carcinoma in situ and 1 patient had lobular carcinoma in situ). Conclusion: Intraductal papilloma should be closely followed up due to its malignant potential and the surrounding breast tissue with IDP should be carefully evaluated due to the high rate of developing other precancerous lesions.

Multiple intraductal papillomas of breast clinically masquerading as malignancy

Intraductal papilloma is characterized by proliferation of epithelial and myoepithelial cells overlying fibro-vascular stalks creating an arborescent structure within the lumen of duct. Some times multiple papillomas with florid proliferation of epithelium may be confused with malignancy. A case of multiple intraductal papillomas of breast with ulceration of overlying skin and large lump leading to clinical diagnosis of malignancy is documented here. A 45-year-old female presented with ulcerated mass of six months duration in the left breast. On examination, a firm, immobile lump of 8x 10 cm in size involving nipple with excoriation of surrounding skin and serosanguinous discharge from nipple was present. There was no axillary lymphadenopathy. No family history of carcinoma breast was present. Fine needle aspiration smears showed benign cellular changes with apocrine metaplasia. Biopsy from an area adjacent to nipple showed intraductal papilloma. Simple mastectomy showed lobulated dirty white mass with well circumscribed nodules below the nipple and areola. On histology with immunohistochemistry a diagnosis of multiple intraductal papillomas was made. Patient is on regular follow-up and doing well. The case highlights the problem in differentiating marked papillomatosis from a malignant lesion of breast and importance of biopsy with immunohistochemistry in such cases for proper management.

Surgical Follow-Up and Clinical Presentation of 142 Breast Papillary Lesions Diagnosed by Ultrasound-Guided Core-Needle Biopsy

The clinical management of breast intraductal papilloma (IDP) remains controversial. The objective of this study was to survey a large cohort of benign IDP diagnosed on core needle biopsy (CNB) and to evaluate their clinical presentation and potential risk of associated atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), ductal carcinoma in situ (DCIS) or invasive carcinoma as identified by follow-up surgical excision. We analyzed 345 IDP on CNB; 142 (41.2%) received a subsequent surgical excision while 203 (58.8%) cases did not. Specimens were categorized as IDP, IPD+ADH, IDP+ALH, and DCIS. In patients with surgical follow-up the upgrade to a lesion of greater clinical significance was analyzed according to race, clinical presentation and multiplicity of papillomas. Of the 142 cases, 125 (93.9%) patients had a single IDP, while 17 cases were among 8 patients with multiple IDPs. Patients were predominantly asymptomatic with CNB obtained as follow-up to an abnormal mammogram. Among solitary benign IDP, nearly 25% were upgraded (p < 0.001): 14.0% to ADH and 10.5% to DCIS. For patients with IDP+ADH on initial CNB, 22.2% were upgraded to DCIS. Of the asymptomatic cases 11.4% were upgraded to DCIS, while none of the symptomatic patients showed such upgrade (p < 0.001). In patients with no surgical excision 17 (8.3%) continue to have an abnormal mammogram. We recommend routine mammogram and surgical excision of all IDPs identified on CNB because almost one-fourth (24.5%) of solitary IDP at CNB were upgraded to either ADH or DCIS and the majority of cases were asymptomatic.

Diagnose with galactography in traductal papilloma of breast

目的 评价导管造影检查对导管内乳头状瘤的诊断价值.方法观察51例经手术病理证实的导管内乳头状瘤的临床特征及导管造影钼靶照片表现.结果导管内乳头状瘤在导管造影钼靶照片上表现为典型的充盈缺损、局部导管扩张;导管造影对乳腺导管内乳头状瘤的敏感性为74.5%(38/51),定位准确率为98%(50/51).结论导管造影是目前导管内乳头状瘤较可靠的诊断方法,结合临床特征及触诊检查,仔细操作,可提高诊断率与定位的准确性。