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.

Inverted ductal papilloma of the salivary gland

@#This is a case consult of slides stated to be from an excision of a buccal mucosa mass in a 58-year-old-man. The specimen was described as a 3 cm diameter roughly oval tan-gray tissue with a 2 x 1.5 cm mucosal ellipse on the surface that has a central ulcerated punctum. Cut section showed an underlying 1.7 cm diameter roughly oval well-circumscribed mass with a granular tan surface. Histological sections show a papillary lesion with an orifice on the mucosal surface and with epithelial nests invaginating into the underlying lamina propria in a non-infiltrative pattern. (Figure 1) The lesion is composed of papillary epithelial fronds with cleft-like spaces between the fronds. (Figure 2) The papillary fronds are lined by non-keratinizing basaloid stratified squamous cells with a superficial layer of columnar glandular cells along with mucous goblet cells interspersed among the squamous cells. (Figure 3) All the cellular components are devoid of cytologic atypia and mitoses. Based on these microscopic features we signed the case out as inverted ductal papilloma (IDP).

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.

Benign Intraductal Papilloma without Atypia on Core Needle Biopsy Has a Low Rate of Upgrading to Malignancy after Excision / 한국유방암학회지

PURPOSE: The management of benign intraductal papilloma (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial. This study was performed to evaluate the rate of upgrading to malignancy or high-risk lesions after excision and to identify factors associated with upgrading using a large series of benign IDP cases without atypia. METHODS: We included patients who were diagnosed as having benign IDP without atypia on CNB and underwent surgical or vacuum-assisted excision between 2010 and 2015. We analyzed the clinical, radiologic, and histopathologic features of IDPs that were upgraded to malignancy or high-risk lesions after excision. RESULTS: A total of 511 benign IDPs without atypia diagnosed via CNB were identified, of which 398 cases were treated with excision. After reviewing these cases, four cases of high-risk lesions in adjacent tissue on CNB, two cases which were revealed as papilloma with atypia, and nine cases of malignancy in the same breast were excluded. In the remaining 383 cases, the rate of upgrading to malignancy and high-risk lesions after excision was 0.8% and 4.4%, respectively. The presence of concurrent contralateral breast cancer, the presence of symptoms, and multifocality were factors significantly associated with upgrading to malignancy on subsequent excision. Surgical excision rather than vacuum-assisted excision was significantly associated with upgrading to high-risk lesions or malignancy. CONCLUSION: The rate of upgrading to malignancy for benign IDP without atypia was very low, suggesting that close clinical and radiologic observation may be sufficient for patients with benign IDP without atypia on CNB under proper settings.

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.

Detection of Human Papillomavirus in Korean Breast Cancer Patients by Real-Time Polymerase Chain Reaction and Meta-Analysis of Human Papillomavirus and Breast Cancer

BACKGROUND: Human papillomavirus (HPV) is a well-established oncogenic virus of cervical, anogenital, and oropharyngeal cancer. Various subtypes of HPV have been detected in 0% to 60% of breast cancers. The roles of HPV in the carcinogenesis of breast cancer remain controversial. This study was performed to determine the prevalence of HPV-positive breast cancer in Korean patients and to evaluate the possibility of carcinogenic effect of HPV on breast. METHODS: Meta-analysis was performed in 22 case-control studies for HPV infection in breast cancer. A total of 123 breast cancers, nine intraductal papillomas and 13 nipple tissues of patients with proven cervical HPV infection were tested by real-time polymerase chain reaction to detect 28 subtypes of HPV. Breast cancers were composed of 106 formalin-fixed and paraffin embedded (FFPE) breast cancer samples and 17 touch imprint cytology samples of breast cancers. RESULTS: The overall odds ratio between breast cancer and HPV infection was 5.43 (95% confidence interval, 3.24 to 9.12) with I2 = 34.5% in meta-analysis of published studies with case-control setting and it was statistically significant. HPV was detected in 22 cases of breast cancers (17.9%) and two cases of intaductal papillomas (22.2%). However, these cases had weak positivity. CONCLUSIONS: These results failed to serve as significant evidence to support the relationship between HPV and breast cancer. Further study with larger epidemiologic population is merited to determine the relationship between HPV and breast cancer.

Breast Imaging Reporting and Data System Category 3 Lesions Detected on Whole-Breast Screening Ultrasound / 한국유방암학회지

PURPOSE: This study assessed the incidence and cancer rate of probably benign lesions detected on bilateral whole-breast screening ultrasound (US), which corresponded to US Breast Imaging Reporting and Data System (BI-RADS) category 3, and evaluated the proper management of those lesions. METHODS: This study was approved by the Institutional Review Board in our institution, which waived informed patient consent. We retrospectively reviewed US images of 1,666 patients who underwent bilateral whole-breast screening US as a supplemental screening test to negative screening mammography or screening US only. The incidence, clinical course, and cancer rate of screening US-detected probably benign lesions corresponding to US BI-RADS category 3 were investigated, and the size and multiplicity of screening US-detected category 3 lesions were evaluated. RESULTS: Probably benign lesions corresponding to US BI-RADS category 3 were detected in 689 of 1,666 patients (41.4%) who underwent screening US. Among them, 653 had follow-up US images for at least 24 months, and among these 653, 190 (29.1%) had multiple bilateral category 3 lesions. Moreover, 539 of 1,666 patients (32.4%) had lesions ≤1 cm in size and 114 of 1,666 (6.8%) had lesions >1 cm (median, 0.82 cm; range, 0.3–4.2 cm). Four of the 653 patients (0.6%) showed suspicious interval changes and were categorized into BI-RADS category 4. Biopsy analysis confirmed only one lesion as invasive ductal carcinoma at the 6-month follow-up; another lesion was an intraductal papilloma and the remaining two were fibroadenomas. Overall cancer rate of the screening US-detected BI-RADS category 3 lesions was 0.2%. CONCLUSION: The incidence of category 3 lesions detected on screening US only was very high, but the cancer rate was very low. Therefore, in an average-risk population, routine screening US is preferable over short-term follow-up for BI-RADS category 3 lesions detected on whole-breast screening US.

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.

A Case Report: Cavitary Infarction Caused by Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Pancreatic Intraductal Papillary Mucinous Neoplasm

Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.

Automated breast volume scanning in the diagnosis of breast intraductal papilloma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the value of automated breast volume scanning (ABVS) in the diagnosis of breast intraductal papilloma (IDP).</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>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.</p>

A Case of Multiple Eyelid Trichilemmoma Associated with Cowden Syndrome

PURPOSE: To report a case of multiple eyelid trichilemmomas associated with Cowden syndrome. CASE SUMMARY: A 27-year-old woman presented with multiple upper and lower eyelid skin masses that developed over several years. The masses were as large as whitish millet, and were around the upper and lower eyelid margin and the face. The patient had previously undergone subtotal thyroidectomy for a thyroid mass and a mass excision for extremity hemangioma. Excisional biopsy was performed for the diagnosis, and trichilemmoma was diagnosed based on histopathologic examination. Consequently, multiple trichilemmoma associated with Cowden syndrome was diagnosed, and breast evaluations for existence of further masses were recommended. On breast examinations, intraductal papilloma and fibroadenoma were detected. CONCLUSIONS: The trichilemmoma was a hair-follicle benign tumor that also appeared on the skin around the eyelid. If multiple trichilemmoma is diagnosed, an association with Cowden syndrome should be considered as well as presence of masses in other organs.

Adenomatosis erosiva de pezón: reporte de un caso / Erosive adenomatosis of the nipple: a case report

La adenomatosis erosiva del pezón es un tumor raro y benigno que se origina a partir de los conductores lactíferos del pezón y afecta principalmente a mujeres de mediana edad. Clínicamente se presenta como eritema, costras, erosiones, ulceraciones o nódulos, con o sin exudación serosa o sanguinolenta, pudiendo ser asintomática o presentar prurito, sensibilidad o dolor. La biopsia de piel es necesaria para llegar al diagnóstico, pues clínicamente puede ser indistinguible de la enfermedad de Paget. Histológicamente, su principal diagnóstico diferencial es el de adenocarcinoma de mama. El tratamiento es usualmente quirúrgico. Presentamos el caso de un paciente de 32 años de edad con una lesión inicialmente eritematosa y luego costrosa en el pezón derecho de 8 años de evolución.

Erosive adenomatosis of the nipple is a rare and benign tumor of the lactiferous ducts of the breast that affects primarily middle-aged women. Erythema, crusts, erosions, ulcerations or nodules, with or without serous or bloody discharge, are common clinical findings; pruritus, tenderness or pain may occur or it can be asymptomatic. Since the lesions are clinically indistinguishable from PagetÆs disease of the breast, a skin biopsy is mandatory for diagnosis. Adenocarcinoma of the breast is the main histologically differential diagnosis. Surgical resection is the treatment of choice. We present such a case in a 32-year-old woman with an 8-year history that begun as an erythematous, crusty lesion on her right nipple.

Exame citológico do derrame papilar, fibroadenoma, lipoma, cistos mamários, papiloma intraductal e câncer de mama / Cytological examination of nipple discharge, fibroadenoma, lipoma, breast cysts, intraductal papilloma and breast cancer

O diagnóstico precoce de câncer de mama é realizado pelo autoexame das mamas, exame clínico das mamas, mamografia e pelo exame de ultrassonografia. Porém, outros exames que se destinam à confirmação cito-histopatológico consistem na citologia de material colhido por punção aspirativa, histopatologia do material colhido por punção aspirativa por agulha grossa e biópsia. A citologia é um importante instrumento de diagnóstico em diversas patologias pela sua simplicidade e precisão, tendo uma sensibilidade elevada. Esse exame é indispensável ao diagnóstico das lesões palpáveis da mama e junto com o exame físico e mamográfico fornecem o tríplice diagnóstico, elevando ainda mais a sensibilidade de detecção de qualquer patologia mamária, sem ter a necessidade de um procedimento mais agressivo. O objetivo desse estudo foi revisar algumas doenças das mamas com ênfase ao diagnóstico citopatológico. Foi realizada uma revisão da literatura em livros e artigos científicos de revistas impressas e eletrônicas disponíveis, que continham descrições dos aspectos citomorfológicos das patologias da mama.

Dynamic contrast-enhanced MSCT findings of intraductal papillary neoplasm of the bile ducts / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the findings of contrast-enhanced multislice computed tomography (MSCT) that characterize intraductal papillary neoplasms of bile ducts (IPNB).</p><p><b>METHODS</b>The MSCT findings and clinical data of 16 cases of IPNB proven by surgical pathology were reviewed retrospectively.</p><p><b>RESULTS</b>Among the 16 cases, nine were adenoma (multi-lesions, n = 5; single lesions, n = 4) and seven were adenocarcinoma (multi-lesions, n = 4; single lesions, n = 3). Among the nine adenoma cases, seven showed nodules or masses in the expanding intrahepatic bile ducts with asymmetrical low density on plain scan, and two showed obvious expansion of biliary ducts and the inner wall of bile ducts was rough. All seven of the adenocarcinoma cases showed nodules or masses in the expanding intrahepatic bile ducts with asymmetrical low density-like adenoma. When contrast enhancement was applied, the nine adenoma cases manifested slight-to-moderate degrees of asymmetrical enhancement. For the seven adenocarcinoma cases, two showed asymmetrical enhancement similar to that of the adenoma cases and five showed continued enhancement; one case showed malignant infiltration of the bile duct and evident damage in the adjacent hepatic tissue. The CT plain scan findings for the two groups (adenoma and adenocarcinoma) were not significantly different (t = -1.17, P = 0.2632). Significantly different findings were obtained with the MSCT imaging analysis for the arterial phase (t = 6.53, P less than 0.01) and the portal vein phase (t = 5.63, P less than 0.01). All cases showed asymmetrical expansion of intrahepatic biliary ducts, diffuse or local, and four cases showed moderate expansion of the common bile duct. One adenocarcinoma case showed intumescence in the celiac lymph node by moderate asymmetrical enhancement.</p><p><b>CONCLUSION</b>MSCT is helpful for the differential diagnosis of IPNB from other hepatic lesions.</p>

Intraductal papilloma of the breast in association with preoncogenic gene of breast cancer

We reported a case of an African American woman who went to the hospital with palpable right breast lump with bloody nipple discharge at University of Texas Medical Branch at Galveston. The modalities of breast imagings included mammography and ultrasonography. The method used for viral identification was Linear Array HPV genotyping test. Intraductal papilloma revealed as high density tubular or rounded lobular masses with partially circumscribed, obscured margins and clustered punctate microcalcifications on mammograms. Ultrasound showed as intraductal masses with dilated ducts. The core biopsy demonstrated duct filled with papillary lesion and post excision revealed intraductal papilloma. HPV DNA types 16, 33, 58 and 71 were detected after use of Linear Array HPV genotyping test.

Clinicopathologic and immunohistochemical study of 187 cases of intraductal papillary neoplasm of breast / 中华病理学杂志

<p><b>OBJECTIVE</b>To evaluate the diagnostic approach and criteria for intraductal papillary neoplasms of breast.</p><p><b>METHODS</b>According to the criteria of 2003 WHO classification, 187 cases of intraductal papillary neoplasm of breast were identified and enrolled into the study. The clinical and histologic features were reviewed and immunohistochemical study for CD10, p63, CK14, CK5/6, CK7, MGB1 and p53 were carried out on 53 cases.</p><p><b>RESULTS</b>Amongst the 187 cases studied, there were 128 cases of intraductal papilloma, 16 cases of atypical intraductal papilloma and 43 cases of intraductal papillary carcinoma. They showed a spectrum of morphologic features including epithelial and stromal hyperplasia and secondary changes. The expression of myoepithelial markers, including CD10 and p63, significantly decreased in ascending order from intraductal papillomas, atypical intraductal papillomas and intraductal papillary carcinomas (P < 0.001). The expression of basal cell markers, including CK5/6 and CK14, showed a mosaic pattern in benign lesions and significantly decreased or was absent in atypical and carcinomatous lesions (P < 0.001). In contrast, the luminal cell marker CK7 expressed in the three groups with no statistically significant difference (P = 0.06). On the other hand, the expression of MGB1 in intraductal papillary carcinomas was much lower than that in the other two groups (P = 0.002 and P = 0.007). The staining for p53 was negative in all of the three groups.</p><p><b>CONCLUSIONS</b>Intraductal papillary neoplasms of breast represent a heterogeneous group of lesions with various morphologic appearances. Correlation with immunostaining results for myoepithelial markers, basal-type cytokeratins and luminal epithelial markers are helpful in arriving at a definitive diagnosis.</p>

Tumores papilares intraductales del seno / Intraductal papillary tumors of the breast

Introducción. Los tumores papilares intraductales del seno son un grupo heterogéneo de lesiones que se caracterizan por una configuración papilar en el examen macroscópico o microscópico. El objetivo del estudio fue caracterizar los tumores papilares intraductales del seno en relación con sus principales manifestaciones clínicas, características patológicas y métodos diagnósticos. Materiales y métodos. Durante seis años se registró la información de 72 pacientes con tumores papilares intraductales del seno. Todos los pacientes con secreción por el pezón eran candidatos para la resección total de los conductos terminales, si cumplían los siguientes criterios clínicos: secreción espontánea por pezón, unilateral y persistente, o secreción serosa (como agua de roca) o hemorrágica por pezón. Cuando la manifestación clínica era una masa palpable, el algoritmo de manejo se basó en el enfoque de triple diagnóstico. Ante un hallazgo discordante entre los criterios clínico, radiológico y patológico, se indicó la resección completa de la lesión.Resultados. El tipo de papiloma benigno más frecuente fue el tumor papilar intraductal, seguido del carcinoma papilar no invasivo y del papiloma atípico. La secreción hemorrágica por pezón fue la manifestación clínica más frecuente de los tumores papilares intraductales y era la indicación quirúrgica fundamental para su diagnóstico. La mayoría de papilomas benignos intraductales fueron únicos. Conclusión. La historia clínica y el examen físico fueron la piedra angular para el diagnóstico certero. En presencia de secreción espontánea por pezón, persistente, unilateral, hemorrágica o serosa, se recomienda hacer resección total de los conductos terminales, aun cuando la mamografía y la ecografía mamaria sean reportadas como normales. En presencia de una masa palpable, la evaluación ideal es la de triple diagnóstico. La colaboración estrecha entre el patólogo y el cirujano de seno es vital para el manejo correcto de estas lesiones.

Introduction: intraductal papillary tumors of the breast are a heterogeneous group of lesions characterized by a papillary configuration in macroscopic or microscopic examination or both. Objectives: To characterize the main intraductal papillary tumors of the breast in relation to its main clinical manifestations, pathological characteristics and diagnostic methods of detection. Materials and Methods: During 6 years of continuous and systematic manner the authors recorded information of 72 patients with intraductal papillary tumors of the breast. All patients with nipple secretion were candidates for resection of terminal ducts if they met the following clinical criteria: nipple discharge spontaneous, unilateral, persistent, o nipple serous secretion (such as water rock) or hemorrhagic. Patient whose clinical manifestation was the presence of palpable mass, management algorithm was based on the triple diagnostic approach. A finding discordant between clinical and radiological-pathological, we recommended complete resection of the lesion. Results: Benign papillomas were type of breast intraductal tumor papillary most frequent followed by non-invasive papillary carcinomas and atypical papillomas subsequently. Nipple secretion hemorrhagic manifestation was the most frequent of intraductal papillary tumors and was critical to the surgical diagnosis.Most benign intraductal papillomas were single. Conclusion: Clinical history and physical examination were the cornerstone for the diagnosis of intraductal papillary tumors of the breast.Total duct excision is idicated in presence of nipple discharge spontaneous, unilateral, persistent, o nipple serous secretion (such as water rock) or hemorrhagic, even, when mammography and breast ultrasound are reported as normal. In the presence of a palpable mass, the ideal evaluation is of triple diagnosis approach.Close collaboration between surgeon and breast disease is vital to proper management of these lesions.

Nipple adenoma of breast: a masquerader of malignancy

Nipple adenoma is a benign condition simulating malignancy such as breast carcinoma and/or Paget's disease clinically. In this study 19 cases diagnosed as nipple adenoma over a period of 14 years are described. The diagnosis was confirmed by histology alone. All patients were females with age ranging from 23 to 63 years. Most of the cases presented clinically with in duration and ulceration accompanied by pain and itching. The diagnosis was clinically suspected in only 3 cases. This highlights the importance of histological diagnosis in all suspicious breast lesions. In one case, the clinical and histological diagnosis was incorrect leading to mastectomy. Complete local excision with clear margins is curative

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.