Solitary and multiple intraductal papillomas solitary intraductal papillomas are usually located centrally or in the retroareolar region and, when symptomatic, present with bloody or clear nipple discharge. We report a unique case of a recurrent, benign breast papilloma presenting as an aggressive malignant tumor. The pathologic feature of intraductal papillomas is defined as a papillary structure composed of a fibrovascular stromal core lined by luminal epithelial cells and myoepithelial cells. Intraductal papilloma is a benign, circumscribed, intra. Aug 20, 2019 usguided directional vacuumassisted removal or us followup without intervention could be an alternative to surgical excision for benign breast papilloma without atypia. Intraductal papillomas of salivary glands are extremely rare benign tumors that are most commonly derived from minor salivary glands. It rarely produces symptoms or a breast lump one can feel, and is usually detected through screening mammography. Also called usual ductal hyperplasia, intraductal hyperplasia, hyperplasia of usual type, papillomatosis but this term may be confused with papilloma or florid papillomatosis of nipple, epitheliosis epidemiology. Clinicopathologic features of intraductal papillary neoplasm of. Most often, a solitary papilloma is a benign process that occurs in the subareolar ducts and is often.
A, intraductal papilloma with ductal carcinoma in situ dcis with solid growth circles, moderate cytologic atypia, and prominent cell. Intraductal papillomas were unilocular cystic lesions with intraluminal papillary growth of bland columnar cells. Intraductal papilloma is a benign tumor found within breast ducts. The spectrum of intraductal papillary lesions comprises intraductal papilloma, papilloma with atypical ductal hyperplasia adh, papilloma with ductal carcinoma. Subclassification of these lesions may be diagnostically challenging, especially with limited sampling via core biopsy. The management of benign intraductal papillomas ip.
Yes, atypical papilloma usually refers to an intraductal papilloma that contains atypical ductal hyperplasia adh. Oct, 2018 what is the prognosis of intraductal papilloma of breast. Intraductal papillary carcinomas affect women in their fifth and sixth decade of life. Intraductal papilloma symptoms and diagnosis see online here ductal papillomas are commonly identi. Papillomas are intraductal epithelial proliferations with a central. As this array of papillary lesions cannot be differentiated by clinical and imaging means, the diagnosis relies on pathologic examination. Histopathology of the excised specimen revealed ductal papilloma with adenosis and ductal hyperplasia. Intraductal papilloma with ductal carcinoma in situ. The purpose of this study was to characterize mri features of solitary intraductal papillomas and identify features that differentiate intraductal papillomas from small idcs. Whereas sp typically consisted of a combination of exophytic squamous epithelium and endophytic intraductal.
Intraductal papilloma is a benign neoplasm rarely found in the male breast. Intraductal papillomas are benign, and often complicated by superimposed epithelial metaplasia or hyperplasia. Intraductal papillomas of the breast are benign lesions with an incidence of approximately 23% in humans. The exact incidence of intraoral intraductal papilloma is not easy to evaluate in the literature due to the inconsistent terminology as the term papillary cystadenoma is often applied instead of.
The abnormal proliferation of ductal epithelial cells causes the growth. Intraductal papilloma and its association with nipple discharge are well known. Intraductal papilloma with benign pathology on breast core. Most commonly appear as modestlyt2bright, circumscribed. Dec 25, 2019 pathology of small, peripheral intraductal papillomas. Intraductal papilloma of the submandibular gland the. Intraductal papilloma diagnosed on core biopsy can have surgical excisional upgrade to atypical ductal. Diagnostic pitfalls in papillary lesions of the breast. Intraductal papilloma is a common disease in the breast with clinical manifestation of nipple.
Management of benign intraductal solitary papilloma diagnosed. Pathological criteria and practical issues in papillary. Intraductal papilloma is a benign breast condition. A solitary intraductal papilloma is usually found centrally posterior to the nipple affecting the central duct. In general, papillomas of breast are associated with an increased risk for breast cancer into the future.
Rarely, intraductal papillomas are found in the salivary gland. Mutational analysis of akt1 and pik3ca in intraductal. Same small, peripheral intraductal papilloma idp smallperipheral subtype sp st 200. Multiple intraductal papillomas are located peripherally, found in any breast quadrant affecting the peripheral ducts.
The radiologist assessed us features of the mass, its distance from the nipple, the pattern of duct filling by the mass, whether the mass involved the branch ducts and the presence of abnormal axillary lymph nodes. Intraductal papillomas are usually surgically removed to treat the symptom of nipple discharge and to exclude associated abnormalities, including small early cancers which may be found in the adjacent breast tissue. This study aimed to assess the association of human papilloma virus and laryngeal tumors. However, multiple papillomatosis has quite distinct characteristics and decision making can be somewhat challenging. Assign 85033 for invasive adenocarcinoma arising in a papilloma with highgrade dysplasia, perihilar bile duct primary. It is a benign breast tumor and develop along with degenerative breast change. The discharge is usually spontaneous and from a single duct, and is commonly unilateral. In the absence of a mass, the most common cause of bloody nipple discharge is an intraductal papilloma. Hence many core needle biopsy cnb is done in suspected intraductal papilloma. This link between papillomas and ductal hyperplasia conditions can be in part explained by the common chromosomal and genetic alterations found in both conditions. Followup of breast papillary lesion on core needle biopsy. Although architecture is cribriform, extent and cytologic atypia are insuf. Multiple papillomatosis of breast and patients choice of.
We report a case of an intraductal papilloma arising in the unusual site of the submandibular gland. A dilated duct can be frequently visible sonographically. Usguided directional vacuumassisted removal or us followup without intervention could be an alternative to surgical excision for benign breast papilloma without atypia. Patients with ductal papillomas can have either a solitary lesion or multiple papillomas. Nevertheless, a real impact between human papilloma. That fibroadenoma and intraduct papilloma may have a common pathogenesis is discussed. Two types of intraductal papillomas are generally distinguished. An intraductal papilloma is a noncancerous breast tumor that forms in a milk duct. Histopathology breastintraductal papilloma youtube. In particular, no reports in literature have addressed this question in africanamerican population. An intraductal papilloma is a benign, wartlike tumor that can develop in a duct of the breast. Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy. Atypical papilloma with complex architecture demonstrated by rigid secondary lumens.
Ipt n 2, ipmn n 9, intraductal papilloma, cystadenoma, and cystadenocarcinoma two, three and two respectively. Cystadenocarcinomas invaded the surrounding tissue and were composed of markedly atypical tumour cells. The situation becomes confusing in some special subtypes, namely solid papillary carcinoma and. When many ducts are involved the process is termed papillomatosis. Pathology of papilloma with atypia or ductal carcinoma in. Intraductal papillary carcinomas are rare and accounts for 2% of all breast cancers. This field shows the idp sp st black arrow and the abundant usual ductal hyperplasia udhlike proliferation blue arrow that involves it. In contrast, both cystadenomas and cystadenocarcinomas showed a multicystic appearance with a papillary configuration. May degeneration and hyalinize to form a sclerosing papilloma. Papillary dcis papilloma papillary dcis cell types in papillae epithelial and myoepithelial epithelial only. A search of our database for breast papillary lesions. Pdf histopathological evaluation of minor salivary gland. According to the tumor location, intraductal papilloma can be divided into central large duct papilloma, which is usually located in the. Sep 19, 2014 the final histopathology showed intraductal papilloma 36%, duct ectasia 1850%, dcis 1 2.
Papillary lesions of breast represent a range of lesions. Outcomesresolutions the prognosis of intraductal papilloma of breast is generally excellent on a surgical excision and removal of the tumor. Thus, the presence of microcalcifications may help stratify patients with intraductal papilloma seen on cnb into 2 groups, providing additional management followup options. Intraductal papilloma with florid epithelial hyperplasia. Intraductal papillomas of the breast american cancer society. Histopathology images of intraductal papillary carcinoma. Pathology of small, peripheral intraductal papillomas. Salivary tissue intraductal papillomas are rare, benign tumours that predominantly affect minor salivary glands.
Papillary lesions include benign and malignant lesions. Outline of talk practical approach to papillary breast lesions. Mixed squamous cell and glandular papilloma of the lung a very rare lesion of the lung. Intraductal papilloma arising from the accessory parotid gla. Intraductal papilloma online pathology video lecturio. The same is true for intraductal papillary carcinoma, which logically should be classi. The spectrum of intraductal papillary lesions comprises intraductal papilloma, papilloma with atypical ductal hyperplasia adh, papilloma with. These can grow inside the ducts of the breast, often near to the nipple. Histopathological evaluation of minor salivary gland papillary.
Microcalcification is an important factor in the management. Intraductal papilloma an overview sciencedirect topics. They are made up of gland tissue along with fibrous tissue and blood vessels called fibrovascular tissue. Intraductal papilloma other conditions cancer research uk. Ductal carcinoma in situ dcis, also known as intraductal carcinoma, is a precancerous or noninvasive cancerous lesion of the breast. How is the histology coded for an invasive adenocarcinoma arising in a papilloma with highgrade dysplasia. Benign breast disease represents a spectrum of disorders that come to clinical attention as imaging abnormalities or as palpable lesions found on physical examination. Papillary lesions of the breast are exclusively intraductal neoplasms, although rarely an invasive carcinoma of the breast may have a predominantly papillary architecture. Papilloma with atypia atypical intraductal papilloma. When adh involving a papilloma is present on a core biopsy, studies have shown that there is a risk of finding a more significant lesion on surgical excision, such as ductal carcinoma in situ or even invasive carcinoma.
However, pathological nipple discharge can also be identi. Breast papillomas simply share the same name because they have similar features. Histopathological evaluation of minor salivary gland. Intraductal papilloma is a benign tumor that grows in the ductal system of the breast. Papillary lesions of the breast diagnostic histopathology. Practical approach to papillary breast lesions yunnyi chen, md, phd professor director of immunohistochemistry laboratory director of breast pathology services ucsf overview of papillary lesions benign intraductal papilloma vs papillary carcinoma intraductal papilloma with atypia adh vs dcis encapsulated intracystic papillary carcinoma.
She underwent multiple resections over the course of 79 years. Our patient was a 56yearold postmenopausal african american woman who was followed in the breast clinic with a long history of multiple breast papillomas. Specific terminology for this differs among authorities. May 08, 2007 histopathology breast intraductal papilloma. Veterinary pathology classification and grading of canine.
Thirteen out of 36 had intraductal papilloma on final histopathology. Virus and other head and neck sites such as the larynx is not well studied. Media in category histopathology of intraductal papilloma the following 10 files are in this category, out of 10 total. The management of intraductal papillomas on core biopsy continues to be controversial. What are benign breast changes how are benign breast changes diagnosed found what is an intraductal papilloma what are my treatment options where do i get more information for women who have breast changes. Practical considerations in breast papillary lesions.
Intraductal papilloma of breast radiology reference article. Histopathology of intraductal papilloma of the breast by excisional biopsy. Incidence of reexcision for positive margins was 8. Intraductal papilloma of the breast libre pathology. However, it is unclear whether surgical excision is warranted for benign lesions.
Papillary hyperplasia is seen most often as part of the spectrum of fibrocystic changes but occasionally occurs as pure papillary hyperplasia. Fortyfour intraductal papillomas and 49 small diameter. A diagnosis of papilloma with atypia on core biopsy cb requires excision, as the risk of associated malignancy is high average 36. Although intraductal papillomas idps are benign, they are occasionally involved by a monomorphic, atypical cellular proliferation, morphologically identical to ductal carcinoma in situ dcis or atypical ductal hyperplasia adh. When they are involved by atypical duct hyperplasia, the prevailing practice is to upgrade. Apr 24, 2014 the optimal course of clinical followup after a diagnosis of breast papillary lesion on a core needle biopsy cnb remains elusive.
Jan 18, 2018 papillary lesions of the breast include a wide range of lesions with variable biologic behavior, ranging from benign, atypical to malignant. Intraductal papilloma with benign pathology on breast core biopsy. Learn about intraductal papilloma symptoms, treatment, and prevention. From the department of pathology, university of michigan, ann. Intraductal papilloma usually refers to intraductal papilloma of the breast. Diagnostic dilemmas in intraductal papillomas of the breast. Intraductal papilloma symptoms, treatment, what, types, causes.
We report a case of multiple papillomatosis in association with ductal carcinoma in situ dcis. The correlation between blood stained discharge and final histopathology of intraductal papilloma was insignificant p0. Intraductal papillomas are benign noncancerous, wartlike tumors that grow within the milk ducts of the breast. Intraductal papilloma symptoms and diagnosis medical. A small incision is made along the edge of your areola, then the papilloma.
The tumour was completely excised and recurrence is not expected. A moynihan 1, em quinn, c smith2, m stokes 1, m kell, jm barry1 and sm walsh1 1 department of breast surgery, breast health unit, mater misericordiae university hospital, dublin. There is a marked papillary proliferation within the unilocular cyst lumen fig. Genital warts are small, fleshy growths that occur after exposure to the human papilloma virus hpv. In this report, we present the case of a 55yearold caucasian man who presented with spontaneous bloody nipple discharge of the right breast. To the best of our knowledge, it is the first observation that microcalcification is an important factor in the management of breast intraductal papillomas diagnosed on cnb. It is defined as a proliferation of epithelial and myoepithelial cells overlying fibrovascular stalks, creating an arborescent structure within the lumen of a duct. Here, we first report a patient with an intraductal papilloma that presented as an accessory parotid mass. Intraductal breast papillomas are n ot at all related to the human papillomavirus virus hpv in addition, papillomas are not related to genital warts. Papillary lesions of the breast span the spectrum of benign, atypical, and malignant. Intraductal papilloma is more common in patients with other benign breast diseases such as columnar cell hyperplasia, sclerosing adenosis, and ductal hyperplasia. We used droplet digital pcr for the mutational analysis of akt1 e17k and pik3ca h1047r, e542k, and e545k in 60 papillomas. Solitary papillomas solitary intraductal papillomas are single tumors that often grow in the large milk ducts near the. Management of benign intraductal solitary papilloma.
Papilloma may be seen as a welldefined solid nodule or intraductal mass which may either fill a duct or be partially outlined by fluid either within a duct or by forming a cyst. Fibroadenoma and intraduct papilloma a common pathogenesis. Unusual recurrent metastasizing benign breast papilloma. However, in the cnb specimen, sometimes it is difficult to determine whether the tumor is benign or. The human papilloma virus hpv can play a role in the development of head and neck. Histopathology 2015, 66, 761770 this maximum dimension fulfills the criteria for low nuclear grade dcis within an intraductal. We compared us and mammographic findings with the histopathology in 198 patients with 251 intraductal breast masses. They are usually solitary and often arise in the period.
Usually ductal papillomas are between 1 and 2cm in size. In the malignant category, most of the lesions are of low nuclear grade, and most are also considered to behave in an in situ manner. The management of both intraductal papilloma with atypical hyperplasia and papilloma with dcis is by complete excision and a stringent followup. Following establishment of a benign diagnosis, treatment in general is aimed at symptomatic relief and patient education.