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mammary intraductal papilloma

Tuesday 3 July 2012

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Definition: Intraductal proliferation of epithelial and myoepithelial cells overlying fibrovascular stalks.

Images

- http://webpathology.com/case.asp?case=280

Digital case

- JRC:5242 : Intraductal papilloma of the breast (intraductal papillomatosis).
- JRC:5244 : Intraductal papilloma of the breast (intraductal papillomatosis).
- JRC:5246 : Intraductal papilloma of the breast (intraductal papillomatosis) in male breast.
- JRC:5247 : Intraductal papilloma of the breast (intraductal papillomatosis).
- JRC:5252 : Intraductal papilloma of the breast (intraductal papillomatosis).
- JRC:5254 : Intraductal papilloma of the breast (intraductal papillomatosis).
- JRC:5255 : Intraductal papilloma of the breast (intraductal papillomatosis).
- JRC:5256 : Intraductal papilloma of the breast (intraductal papillomatosis).
- JRC:5257 : Intraductal papilloma of the breast (intraductal papillomatosis).

Macroscopy

- Well circumscribed, polypoid intraductal mass, usually @<@ 3 cm, soft, hemorrhagic
- Often infarcted

Microscopy

- Small, well-circumscribed polypoid nodules occur in a dilated duct.
- Multiple papillomatous nodules and stromal fibrosis.
- Papillary proliferation with irregular glandular spaces.
- Solid area consisting of both epithelial and myoepithelial cells.
- The stromal fibrosis can simulates invasive carcinoma.
- Multiple papillae in complex arborizing pattern with well-developed vascular connective tissue core surrounded by epithelial and myoepithelial cells
- Benign nuclei, frequent apocrine metaplasia, inflammation
- May arise within a large cystic duct, have comedo-type necrosis without DCIS (Ann Diagn Pathol 2004;8:276), rarely sebaceous metaplasia (Virchows Arch 2001;438:505)
- Infarcted cases may have squamous metaplasia or appear pseudoinfiltrative due to fibrosis (Hum Pathol 1984;15:764)
- Fibrosis at edge of papillomas may entraps glands and resemble invasion (Semin Diagn Pathol 2010;27:13)
- Glandular proliferation within stalks may resemble cribriform DCIS
- Needle biopsies can deposit clusters of benign cells in a distribution that resembles invasive carcinoma

Variants

- solid intraductal papilloma

  • Fusion of papillary fronds creates secondary lumens.
  • Myoepithelial cells are clearly seen at the periphery of the lumens

Differential diagnosis

- papillary DCIS

  • delicate or absent fibrovascular core,
  • often atypical nuclei
  • or atypical mitotic figures,
  • pseudostratification,
  • usually no apocrine metaplasia;
  • other DCIS may be present,
  • 71% have no/incomplete myoepithelal layer,
  • 76% are 34betaE12 negative,
  • 67% are positive for neuroendocrine markers (Virchows Arch 2007;450:539)

- micropapillary DCIS
- invasive papillary carcinoma

  • invasion into stroma,
  • no myoepithelial layer

Links

- http://webpathology.com/case.asp?case=280

See also

- intraductal papillomatosis

Open references

- Diagnostic dilemmas in Intraductal papillomas of the breast - Experience at Sultan Qaboos University Hospital in the Sultanate of Oman. Aljarrah A, Malik KA, Jamil H, Jaffer Z, Sawhney S, Lakhtakia R. Pak J Med Sci. 2015 Mar-Apr;31(2):431-4. doi : 10.12669/pjms.312.6476 PMID: 26101505 (Free)

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