Lesiones papilares de mama: estudio clínico-patológico y sobre pronóstico en 144 casos de Medellín, Colombia / Breast papillary lesions: Clinical, pathological, and prognostic study in 144 cases in Medellin, Colombia / Lesões papilares mamárias: estudo clínico-patológico e prognóstico em 144 casos de Medellín, Colômbia

Objetivo: describir los datos sociodemográficos, las manifestaciones clínicas, los paraclínicos, el tratamiento y la recurrencia, en un grupo de pacientes con lesiones papilares. Metodología: estudio analítico de cohorte retrospectiva con fuentes secundarias de información, historias clínicas. Se incluyeron pacientes evaluados entre el 1º enero de 2016 y el 31 de diciembre de 2019. Se recopilaron datos demográficos, clínicos y paraclínicos, que fueron analizados con estadística descriptiva. Resultados: la prevalencia en la muestra fue de 4.7%; todos los casos fueron en mujeres, la media de edad fue 55,5 años; el motivo de consulta más frecuente fue alteración en la imagen de mama (n=79, 54.9%), el tamaño medio de la lesión fue 1,9 cm (rango 0,1-20). Se encontró discordancia entre el diagnóstico por biopsia cortante y el espécimen de patología en 70 (48.6%) casos, en estos se encontró infraestimación de lesiones con mayor riesgo en el 36,1% (n=52). Según la clasificación histológica, el tipo más frecuente de lesión fue el papiloma intraductal 34.7% (n=50), seguido por el carcinoma papilar en 11,8% (n=17). El tipo de cirugía más efectuado fue la cuadrantectomía, con un 68.7% (n=99). La media de seguimiento fue de 28.5 meses y se encontró recaída en siete casos (4.9%). Conclusión: las lesiones papilares comprenden un grupo heterogéneo, que incluye desde las benignas hasta aquellas con potencial maligno. Afectan a las mujeres en la quinta década de la vida, se presentan como una masa, pequeña, unilateral, sin predominio de lateralidad, de crecimiento lento. El tratamiento óptimo para las lesiones de riesgo y con atipias es la cirugía con márgenes negativos, el riesgo de recurrencia es clínicamente relevante.

Objective: to describe the sociodemographic data, the clinical and paraclinical ma-nifestations, the treatment and the recurrence, in a group of patients diagnosed with papillary lesions.Methodology:analytical study of a retrospective cohort with secondary sources of information from users' medical records in the period of January 1, 2016 to December 31, 2019. The demographic, clinical and paraclinical data collected were analyzed using descriptive statistics.Results:the prevalence in the sample was 4.7%; all cases were women, the mean age was 55.5 years; the most frequent reason for consultation was abnormal breast imaging examination (n=79, 54.9 %), the mean size was 1.9 cm (range 0,1-20). Disagreement was found between the diagnosis by sharp biopsy and the pathology specimen in 48.6% of cases (n=70); lesion underestimation with higher risk was found in 36.1% of them (n=52). According to the histological classification, the most frequent was intraductal papilloma in 34.7% (n=50), followed by papillary carcinoma in 11.8% (n=17). The type of surgery most performed was quadrantectomy, 68.7% (n=99). The mean follow-up was 28.5 months and relapse was found in 4.9% (n=7).Conclusion:papillary lesions comprise a heterogeneous group, with a spectrum that includes both benign lesions and those with malignant potential. The lesions affect women in their fifties. They become apparent as a small, unilateral mass, without a pre-dominance of laterality, and of slow growth. The optimal treatment in risk lesions and with atypia is surgery with negative margins. The risk of recurrence is clinically important.

Objetivo: descrever os dados sociodemográficos, manifestações clínicas e paraclínicas, tratamento e recorrência, em um grupo de pacientes com lesões papilares.Metodologia: estudo analítico de coorte retrospectivo com fontes secundárias de informação, prontuários. Foram incluídos os pacientes avaliados entre 1º de janeiro de 2016 e 31 de dezembro de 2019. Foram coletados dados demográficos, clínicos e paraclínicos, os quais foram analisados com estatística descritiva.Resultados: a prevalência na amostra foi de 4,7%; todos os casos eram em mulheres, a média de idade foi de 55,5 anos; o motivo de consulta mais frequente foi a alteração da imagem da mama (n = 79, 54,9%), o tamanho médio da lesão foi de 1,9 cm (variação de 0,1-20). Houve discordância entre o diagnóstico por biópsia cortante e o espécime anatomopatológico em 70 (48,6%) casos, nestes casos subestimação das lesões de maior risco em 36,1% (n = 52). De acordo com a classificação histológica, o tipo de lesão mais frequente foi o papiloma intraductal em 34,7% (n = 50), seguido do carcinoma papilífero em 11,8% (n = 17). O tipo de cirurgia mais realizada foi a quadrantectomia, com 68,7% (n = 99). O seguimento médio foi de 28,5 meses e recidiva foi encontrada em sete casos (4,9%).Conclusão: as lesões papilares constituem um grupo heterogêneo, que inclui desde as benignas até as com potencial maligno. Atingem mulheres na quinta década de vida, aparecem como uma massa, pequena, unilateral, sem predomínio da lateralidade, de crescimento lento. O tratamento ideal para lesões de risco e com atipia é a cirurgia com margens negativas, o risco de recorrência é clinicamente relevante.

Case report: intraductal papilloma of the male breast / Relato de caso: papiloma intraductal em mama masculina

Breast benign tumors, intraductal papilloma and fibroadenomas are common conditions in women; however, they are very rare in males. In this study, we report the case of a male patient, 75 years old, presenting with complaint of bilateral gynecomastia and palpable retroareolar mass in the left breast. The patient was submitted to imaging tests and core biopsy, and the hypothesis of intraductal papilloma was confirmed upon anatomopathological study. The mastology team opted for excision of the lesion and correction of gynecomastia.

Tumores benignos da mama, papiloma intraductal e fibroadenomas são condições comuns em mulheres, mas muito raras em homens. Neste estudo, relatamos o caso de um paciente do sexo masculino, com 75 anos de idade, cuja queixa era de ginecomastia bilateral e massa retroareolar palpável na mama esquerda. O paciente foi submetido a exames de imagem e core-biopsy, e a hipótese de papiloma intraductal foi confirmada após estudo anatomopatológico. A equipe de mastologia optou pela excisão da lesão e correção da ginecomastia.

EVALUATION OF IMMUNOCYTOCHEMISTRY ON THE DIAGNOSIS OF PAPILLARY MAMMARY TUMORS BY FINE-NEEDLE ASPIRATION BIOPSY / Avaliação do uso da imunocitoquímica no diagnóstico dos tumores papilares mamários em punção aspirativa de agulha fina

Purposes: This study has observed the effectiveness of the immunocytochemical method on the diagnosis of papillary lesions of the breast from fine needle aspiration biopsy (FNAB), to validate the method that would avoid unnecessary excision of small intraductal papillomas of the breast when applied to clinical practice. Methods: Medical records and FNAB examinations were analyzed from 2003 to 2012 and subsequently a immunocytochemical examination was performed with p63 myoepithelial cell marker and Ki67 proliferative index, analyzing the specificity and sensitivity of the markers in the diagnosis of papillary lesions of the breast. Results: The immunocytochemistry of the papillary breast lesions material with immunomarkers Ki67 and p63 showed sensitivity of 78.6% and specificity of 73.33% in the identification of benign lesions. Conclusions: The combined use of these markers in FNAB of papillary mammary lesions helps in the therapeutic orientation of the disease, but further studies including a larger number of cases should be performed in order to have a better evaluation of this method.

Objetivo: Este estudo observou a efetividade do método imunocitoquímico no diagnóstico das lesões papilares de mama a partir de amostras por punção aspirativa por agulha fina (PAAF), para validar o método que, aplicado à prática clínica, evitaria a exérese desnecessária dos pequenos papilomas intraductais da mama. Métodos: Foram analisados prontuários e exames de PAAF durante o período de 2003 a 2012 e posteriormente realizado exame imunocitoquímico com marcador de célula mioepitelial p63 e índice proliferativo Ki67, analisando-se especificidade e sensibilidade dos marcadores no diagnóstico de lesões papilares da mama. Resultados: A imunocitoquímica dos materiais das lesões papilares mamárias com os imunomarcadores Ki67 e p63 apresentou sensibilidade de 78,6% e especificidade de 73,33% na identificação das lesões benignas. Conclusões: O uso combinado desses marcadores em PAAF de lesão papilar mamária auxilia na orientação terapêutica da doença, mas novos estudos incluindo um maior número de casos devem ser realizados para melhor avaliar esse método.

The value of MRI in the differential diagnosis of intraductal papilloma and invasive ductal carcinoma / 实用放射学杂志

Objective To investigate the MRI features and characteristics of irregular intraductal papilloma (IDP)and invasive ductal carcinoma (IDC),and to improve the diagnostic accuracy of MRI.Methods This study retrospectively included 3 3 patients with IDP and IDC confirmed by surgery and pathology,and analyzed MRI findings including lesion size,boundary,internal components,plain signal intensity,enhancement mode,ADC value and TIC curve χ.2 test,t test and rank-sum test were performed.Results Compared with the two groups,lesion boundary (P＜0.001),size (P＜0.001 ),ADC value (P＜0.001 ),enhancement mode (P＝0.001 ),TIC curve peak time (P＜0.001),slope (P＜0.001)and peak enhancement rate (P＜0.001)were statistically significant (P＜0.05);lesion (P＝0.159), internal components (P＝0.778),T2 WI signal (P＝0.438)and curve type (P＝0.406)were no statistically difference.Conclusion The irregular mass type IDP and IDC have similar MRI findings,the edge of the lesion,the ADC value,the enhancement mode,and the peak time,slope and peak enhancement rate of the curve are important for the identification of the two diseases.

A Case of Intraductal Papilloma arising in the Parotid Gland / 대한두경부종양학회지

Intraductal papilloma is an extremely rare benign tumor especially when it arises from major salivary gland. Recently, we experienced a case of an intraductal papilloma arising from the parotid gland in a 51-year-old woman. The radiologic finding showed lobulated enhancing and cystic solid mass in the left parotid superficial lobe. Superficial parotidectomy was performed. Pathological findings showed papillary proliferations with fibrovascular cores lined with bland cuboidal or columnar epithelial cells, and immunohistochemical stain results were consistent with intraductal papilloma. We report a case of intraductal papilloma in parotid gland with a review of literature.

Clinicopathological Factors Associated with Remnant or Regrowth of Benign Breast Tumor after Previous Vacuum-Assisted Core Biopsy

PURPOSE: We sometimes encounter remnant or regrowth of benign breast tumors diagnosed as Breast Imaging-Reporting and Data System (BI-RADS) C4 in follow-up breast ultrasound after previous vacuum-assisted core biopsy (VACB). We aimed to evaluate the factors that influence remnant or regrowth tumors at post-VACB site or adjacent tissue. METHODS: From January 2010 to December 2015, we analyzed 647 cases on follow-up. Patients were divided into two groups; group A was defined as patients without recurrent masses on breast ultrasonography during the follow-up period, and group B was defined as those with recurrent masses diagnosed as more than BI-RADS C4 on ultrasonography. RESULTS: Fibrocystic changes, proliferative disease without atypia, intraductal papilloma, apocrine cell change, atypical ductal hyperplasia, sclerosing adenosis, and radial scars were observed in 89.5% (n=579), 15.9% (n=103), 15.3% (n=99), 5.3% (n=34), 5.7% (n=37), 7.6% (n=49), and 6.3% (n=41) of patients, respectively. During the follow-up period, 85 patients were diagnosed as group B. Group B was significantly associated with proliferative diseases without atypia, sclerosing adenosis, and microcalcifications compared to group A (p=0.008, p=0.007, and p=0.001, respectively). After adjustment for confounding variables, group B was more significantly associated with proliferative breast diseases than group A (hazard ratio [HR], 0.558; 95% confidence interval [CI], 0.343–0.907; p=0.018). Furthermore, group B was more significantly associated with intraductal papilloma (HR, 0.571; 95% CI, 0.342–0.953; p=0.032). CONCLUSION: Previously diagnosed proliferative diseases without atypia or microcalcification at first VACB were significantly associated with recurrent breast tumor. Intraductal papilloma was also significantly associated with tumor regrowth.

Early diagnostic value of MRI for intraductal papilloma of the breast / 实用放射学杂志

Objective To analyze MRI features of breast intraductal papilloma,to improve the acquaintance of this disease.Methods The preoperative MRI images (T2 WI-SPAIR,DWI,ADC,TIC and MIP)of eight patients with breast intraductal papilloma confirmed by surgery were reviewed retrospectively,which were compared with the postoperative pathology.The morphology,distribution, enhanced methods and signal characteristics of the lesion were summarized.Results Of 8 cases,the lession was dormant,and MRI revealed three patterns:the first type was occult papilloma,which presented distention of ducts and no solid nodule in 3 cases (37.5%);the second type showed tiny nodules in bar-like dilatation of ducts in 3 cases (37.5%);and the third type presented small round nodules scattering distribued in terminal ductules in 2 cases (25%).The maximum diameter of nodular lesions was 0.4-1.0 cm(average 0.7 cm).The lesions on T2 WI-SPAIR showed equal signal intensity or mixed signals with isointensity/hypointensity,and dilatation catheter.enhancement. The ADC and TIC value were various,therefore,diagnosis of the tumor should be combined with morphology and associated symptoms. Conclusion At early stage,the occult focus of breast intraductal papilloma can be sensitively detected and localized on MRI.It reveals that MRI has advantage in showing morphology of lesion and functional imaging,which is of important value in clinical diagnosis and early treatment.

Analysis of digital mammography and clinical manifestations of rare diseases in male breast / 实用放射学杂志

Objective To probe the X-ray imaging features and clinical manifestations of some rare diseases in male breast.Methods The data of 12 patients with some rare diseases in male breast were collected.The X-ray manifestations and clinical features of the diseases were analyzed.Results The postoperative pathology showed the lipogranuloma in 1 patient,plasma cell mastitis in 2,secondary infection of epidermal cyst in 1,intraductal papilloma in 1,breast cancer in 6 (invasive ductal carcinoma in 4,poor-differentiated adenocarcinoma in 1,and mucinous carcinoma in 1),and breast lymphoma in 1.The digital mammography showed the intramammary solitary masses in 1 1 and multiple ones in 1.10 masses were located at the rear of the areola,and other 2 were opposite.Unclear edge of the lesion was found in 9,spiculation in 1,lobulation in 1,and micro-calcification in 1.Nipple retraction and areola skin thickening in 10 and enlarged axillary lymph node in 1 were also found.The total accurate rate of X-ray diagnosis was 41% (5/12),while that of breast cancer was 83.3%.The total misdiagnosis rate was 59% (7/12),and that of benign lesion was 80% (4/5).Conclusion The diseases in male breast are rare and various,and the X-ray and clinical manifestations are not specific.

The diagnostic value assessment of MRI and ultrasound imaging in breast intraductal papilloma diagnosis / 中国医学装备

Objective:To evaluate the diagnostic value of MRI and ultrasound imagingr in the breast intraductal papilloma.Methods: 29 patients with multiple or isolated breast intraductal papilloma were selected, who were pathologically confirmed. All patients underwent preoperative breast X-ray, ultrasound, dedicated breast MRI plain and dynamic enhanced MRI. According to Breast Imaging Reporting and Data System (BI-RADS), we observed the lesion size, shape, location, margin, polymorphism and its relationship with the catheter by the ultrasound and MRI scan, and analyze enhancement pattern of dynamic contrast-enhanced MRI lesion. Results: In 29 cases of patients with 30 lesions, a total of 28 lesions were detected by MRI, including one patient with bilateral lesions which were positive, and two cases of malignant tumor which were difficult to identify. 25 lesions were detected by ultrasound, in which 4 cases were negative. There were statistical differences in BI-RADS classification of lesions detected by ultrasound and MRI(Z=-2.377,P<0.05). The detection rate of malignant intraductal papilloma lesion by MRI was higher than ultrasound.Conclusion: MRI and ultrasound imaging can be used for diagnosis of intraductal papilloma, but the MRI is superior to ultrasound scanner in lesion detection rate and accuracy, especially in the intraductal papilloma of benign and malignant.

Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy / 한국유방암학회지

PURPOSE: Intraductal papilloma (IDP) is a benign breast disease with malignant potential, for which complete surgical excision is usually recommended. The aim of the present study was to investigate predictive factors for upgrading patients with a benign papillary lesion (BPL). METHODS: This study was an observational study using a prospectively collected cohort. In total, 13,049 patients who underwent a core needle biopsy (CNB) for a breast lesion between January 2009 and May 2015 were enrolled. We reviewed all patients with pathologically confirmed BPL from a CNB. RESULTS: Surgical treatment was performed for 363 out of a total of 592 lesions. According to the pathological differences, the lowest upgrade rate was shown in IDP without atypia (without atypia, 6.0%; with atypia, 26.8%; papillary neoplasm, 31.5%; p54 years and lesion size >1 cm were significantly associated with upgrade to malignancy (odds ratio [OR]=4.351, p=0.005 and OR=4.236, p=0.001, respectively). CONCLUSION: The indications for surgical treatment can be defined as age >54 years and mass size >1 cm, even in IDP without atypia in the CNB results; this also includes cases of IDP with atypia or papillary neoplasm. Therefore, we suggest that close observation without surgery is sufficient for younger women with a small IDP without atypia.

Papiloma intraductal metacrónico en un niño: Caso clínico / Intraductal metachronic papilloma: Clinical case

Introducción. La asociación de telorragia y ginecomastia nos orienta al diagnóstico de papiloma intraductal. Este tumor benigno es muy infrecuente en la edad pediátrica. Caso clínico. Niño de 2 años que presentó ginecomastia y telorragia en la mama izquierda. Se realizó mastectomia. A los 4 años, presentó el mismo cuadro en la mama derecha, que requirió también mastectomia derecha, con buena evolución posquirúrgica en ambas oportunidades. La anatomía patológica informó papiloma intraductal sin signos de malignidad ni atipia. Conclusión. El papiloma intraductal raramente afecta a niños; hay 15 casos reportados. La ecografía es el método de diagnóstico más empleado. En los pacientes masculinos, la mastectomia es recomendada para asegurar un diagnóstico y tratamiento definitivo.

Introduction. The association of gynecomastia and bloody nipple discharge (thelorragia) leads us to the diagnosis of intraductal papilloma. This is a very rare benign tumor in children. Clinical case. A 2 year old male child was referred due to gynecomastia and bloody nipple discharge of the left breast. A mastectomy was performed. At the age of 4 he returned with identical symptoms but in the right breast. A right mastectomy was also required. An excellent clinical outcome was present in the follow up. The pathology reported intraductal papilloma with no evidence of malignancy or atypia. Conclusion. The intraductal papilloma rarely affects children, there are 15 reported cases. Ultrasound is the most useful diagnostic method. In male patients, mastectomy is recommended to ensure definitive diagnosis and treatment.

Clinical analysis of 84 cases of intraductalpapilloma of breast without nipple discharge / 中华内分泌外科杂志

Objective To summarize the clinical characteristics , diagnosis and surgical method of intra-ductal papilloma(IP)of breast without nipple discharge .Methods The clinical data of 84 IP patients(130 le-sions)without nipple discharge admitted from Feb .2011 to Oct.2013 were analyzed retrospectively .Results The age of the 84 patients were mainly ranging from 30 to 50 years old.113(86.92%)lesions were≤10 mm in size, 84(64.42%)lesions had a distance≤20 mm to nipple, 57 accompanied by adenosis , 43 accompanied by fibro-cystic adenosis , 48 accompanied by fibroadenoma , 14 with ductal hyperplasia , and 2 with atypical ductal hyper-plasia.After a follow-up of 3 to 36 months, 5 cases had recurrence , including 4 cases of IP and 1 case of ductal carcinoma in situ.Conclusions IP without nipple discharge has no typical clinical symptoms .Ultrasound exam-ination may have positive findings , but not typical .Preoperative diagnosis is difficult and surgical biopsy is rec-ommended.Multiple and atypical ductal hyperplasia has possibility of recurrence , so follow-up is necessary.

Intraductal papilloma of parotid gland in 1 case / 实用口腔医学杂志

1 case of intraductal papilloma of parotid gland was analyzed by means of clinicopathologic data,hematoxylin-eosin and immuno-histochemical staining.Combined with the relevant literature,clinical pathological features,diagnosis and treatment of the salivary gland intra-ductal papilloma were discussed.

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

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. Copyright © 2013 by TUMOR.

Multiple intraductal papillomas of breast clinically masquerading as malignancy.

Background: 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. Case Report: A 45-year-old female presented with ulcerated mass of six months duration in the left breast. On examination, a firm, immobile lump of 8× 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. Conclusion: 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.

Clinicopathologic Review of the Intraductal Papilloma of Breast / 한국유방암학회지

PURPOSE: Intraductal papilloma of the breast (IDP) is the most common causes of nipple discharge and it is often a solitary, centrally located tumor that most commonly occurs in the fifth and sixth decades of life. There have been many conflicting reports on the malignant potential of IDP. METHODS: From February 2003 to November 2008, we operated 161 patients who were diagnosed with IDP at Konyang University Hospital. A retrospective review of all the pathologic reports and the corresponding radiological reports was undertaken. RESULTS: The mean age of the patients was 43.23 years (SD, +/-10.1). Eighty-three (51.6%) had nipple discharge, 37 (44.6%) had bloody discharge and 46 (55.4%) had yellowish serous discharge. Twenty-four had a mass and 2 had both bloody discharge and a mass. Radiologic significant findings were shown on 20 mammography exams, 71 ductography exams and 157 breast ultrasound exams. Onehundred forty-four (89.4%) patients with IDP or papillomatosis 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.

Clinicopathologic Review of the Intraductal Papilloma of Breast / 한국유방암학회지

PURPOSE: Intraductal papilloma of the breast (IDP) is the most common causes of nipple discharge and it is often a solitary, centrally located tumor that most commonly occurs in the fifth and sixth decades of life. There have been many conflicting reports on the malignant potential of IDP. METHODS: From February 2003 to November 2008, we operated 161 patients who were diagnosed with IDP at Konyang University Hospital. A retrospective review of all the pathologic reports and the corresponding radiological reports was undertaken. RESULTS: The mean age of the patients was 43.23 years (SD, +/-10.1). Eighty-three (51.6%) had nipple discharge, 37 (44.6%) had bloody discharge and 46 (55.4%) had yellowish serous discharge. Twenty-four had a mass and 2 had both bloody discharge and a mass. Radiologic significant findings were shown on 20 mammography exams, 71 ductography exams and 157 breast ultrasound exams. Onehundred forty-four (89.4%) patients with IDP or papillomatosis 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.

Does Ultrasound-Guided Directional Vacuum-Assisted Removal Help Eliminate Abnormal Nipple Discharge in Patients with Benign Intraductal Single Mass?

OBJECTIVE: To evaluate whether the removal of an intraductal mass using an ultrasound (US)-guided directional vacuum-assisted device can eliminate symptoms in patients presenting with abnormal nipple discharge. MATERIALS AND METHODS: Between March 2004 and October 2006, 36 patients who presented with abnormal nipple discharge, underwent US-guided, 11-gauge vacuum-assisted biopsy for a benign intraductal single mass on US. The ability of the procedure to eliminate nipple discharge was evaluated by physical examination during follow-up US. Lesion characteristics, biopsy variables, and histologic features were analyzed to identify factors affecting symptom resolution. RESULTS: Of the 36 lesions, 25 (69%) were intraductal papillomas, 10 (28%) were fibrocystic changes, and one (3%) was a fibroadenoma. The nipple discharge disappeared in 69% (25 of 36) of the women at a mean follow-up time of 25 months (range 12-42 month). There was no difference in the lesion characteristics, biopsy variables, and the histologic features between groups that eliminated the symptom compared those with persistent nipple discharge. CONCLUSION: US-guided directional vacuum-assisted removal of an intraductal mass appears to eliminate nipple discharge in only 69% of patients and thus, it should not be considered as an alternative to surgical excision.

A Case of Intraductal Papilloma in the Parotid Gland / 대한이비인후과학회지

Intraductal papilloma is a rare benign salivary gland tumor that occurs most commonly in the minor salivary gland. We recently experienced a case of intraductal papilloma arising from the parotid gland in a 24-year-old woman. Radiologic imaging shows a well-circumscribed unicystic mass in the right parotid gland. Superficial parotidectomy was performed. Micoscopically, the mass has papillary epithelial proliferation within the dilated lumen of the salivary duct. We report this case with a brief review of literature.

Intraductal Papilloma Arising in the Sublingual Salivary Gland / 대한이비인후과학회지

Intraductal papilloma that arises from the salivary gland is an extremely rare benign tumor and mostly affects the minor salivary gland. We have experienced a case of an intraductal papilloma arising from the sublingual salivary gland in a 51-year-old woman. The radiologic finding shows an unicystic mass having solid portion. The tumor was completely excised transorally. The histologic findings are papillary proliferation of two uniform layers of columnar epithelial and flat basal cells supported by a fibrovascular core. The clinicopathologic features of this tumor is presented with a review of literature.