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).
Papilloma, Intraductal ; Salivary Glands

Intraductal papillomas are the most common subtype of papillomas, which are benign neoplasms of the breast. An intraductal papilloma is usually found as a solitary mass which originates in the major duct of the breast. Intraductal papilloma cases are frequently presented as nipple discharge and most commonly occur in individuals between the ages of 30 and 55 years. Few reports exist regarding cases of intraductal papillomas in children. We report a case of an intraductal papilloma, with imaging findings, which occurred in the breast of an 11-year old girl and presented as bloody nipple discharge.
Breast ; Breast Neoplasms ; Child ; Female ; Humans ; Nipples ; Papilloma ; Papilloma, Intraductal

Intraductal papillary tumors of the breast exhibit bloody discharge with often no evidence of a palpable tumor, making discrimination between benign and malignant lesions sometimes difficult for pathologists and surgeons. So the technique used in removing the offending ductal system should be fully diagnostic, adequately therapeutic and cosmetically. Microdochectomy has been accepted treatment for intraductal papilloma of the breast. We performed dye-injection microdochectomy on intraductal papilloma of the breast in 15 patients. This procedure utilizes lacrimal probe and 24-gauge medicut that are gently advanced into the offending duct and methylene blue dye is injected to outline the involved duct for easy dissection through a circumareolar incision. Because we could perform dye-injection microdochectomy safely, rapidly and effectively, we think that this procedure is standard treatment of intraductal papilloma of the breast.
Breast* ; Discrimination (Psychology) ; Humans ; Methylene Blue ; Papilloma, Intraductal*

PURPOSE: For the accurate diagnosis of non-palpable breast lesions with microcalcification, a localization and biopsy procedure should be performed by using mammography. Recently, a stereotactic vacuum-assisted biopsy has been reported as a convenient and accurate method for a procedure. This study was performed to determine whether the upright add-on type stereotactic biopsy was suitable for the diagnosis of microcalcified breast lesions in Korean women. METHODS: Between April 2002 and March 2003, an upright add-on type stereotactic vacuum-assisted biopsy was performed in 21 cases with microcalcification; that had been categorized from 2 to 5 according to the BI-RADS (Breast Imaging Reporting and Data System). The microcalcified lesions in biopsy specimens were confirmed with tissue mammogram and a pathological review performed. RESULTS: The pathological findings revealed fibrocystic changes in 15 cases, intraductal papilloma in 1 and ductal carcinoma in situ (DCIS) in 5. There were no malignancy among the BI-RADS category 2 & 3 cases, but DCIS was found in 2 (25%) out of 8 BI-RADS category 4 cases, and in all 3 (100%) of BI-RADS category 5 cases. The malignancy detection rate among the cases with microcalcification with a BI-RADS category above 4 was 45.4% (5/11). CONCLUSION: An upright add-on type stereotactic vacuum assisted biopsy is an accurate, safe and very convenient tool for the diagnosis of breast lesions with microcalcification.
Biopsy* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis* ; Female ; Humans ; Mammography ; Papilloma, Intraductal ; Vacuum

PURPOSE: Architectural distortion is a suspicious abnormality for the diagnosis of breast cancer. The aim of this study was to investigate the clinical significance of sonographically detected architectural distortion. MATERIALS AND METHODS: From January 2006 to June 2008, 20 patients were identified who had sonographically detected architectural distortions without a history of trauma or surgery and abnormal mammographic findings related to an architectural distortion. All of the lesions were pathologically verified. We evaluated the clinical and pathological findings and then assessed the clinical significance of the sonographically detected architectural distortions. RESULTS: Based on the clinical findings, one (5%) of the 20 patients had a palpable lump and the remaining 19 patients had no symptoms. No patient had a family history of breast cancer. Based on the pathological findings, three (15%) patients had malignancies. The malignant lesions included invasive ductal carcinomas (n = 2) and ductal carcinoma in situ (n = 1). Four (20%) patients had high-risk lesions; atypical ductal hyperplasia (n = 3) and lobular carcinoma in situ (n = 1). The remaining 13 (65%) patients had benign lesions, however, seven (35%) out of 13 patients had mild-risk lesions (three intraductal papillomas, three moderate or florid epithelial hyperplasia and one sclerosing adenosis). CONCLUSION: Of the sonographically detected architectural distortions, 35% were breast cancers or high-risk lesions and 35% were mild-risk lesions. Thus, a biopsy might be needed for an architectural distortion without an associated mass as depicted on breast ultrasound, even though the mammographic findings are normal.
Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Humans ; Hyperplasia ; Mammography ; Papilloma, Intraductal

PURPOSE: Diagnosing benign or malignant papillary lesions of the breast through core needle biopsy (CNB) is often difficult. The purpose of this study was to identify the predictive factors of malignancy. METHODS: We retrospectively reviewed the pathology database and found 80 consecutive patients who had been diagnosed with breast papillary lesions prior to surgery at two medical centers from May 2004 through May 2009. Those patients who had undergone CNB and had been diagnosed with either intraductal papilloma or malignant lesions following surgical excision were included. RESULTS: Forty-five cases were diagnosed as intraductal papilloma and 24 cases as malignant lesions. Malignancy was found to be related to being older than 60 years (p<0.01), having bloody nipple discharge (p=0.05), and a tumor size of more than 1 cm (p<0.01). Further, irregular shape (p<0.01) and uncircumscribed margin (p<0.01) on mammogram and irregular shape (p=0.04), calcification (p<0.01), and isoechoic pattern (p<0.01) on ultrasonogram were significantly related to malignancy. CONCLUSION: Our study revealed that particular clinical factors and imaging findings correlated with malignant lesions. However, larger prospective studies are still necessary to establish treatment plans for patients diagnosed with papillary lesions on CNB.
Biopsy, Large-Core Needle ; Biopsy, Needle ; Breast ; Humans ; Nipples ; Papilloma ; Papilloma, Intraductal ; Retrospective Studies

PURPOSE: We wanted to determine the underestimation rate of ultrasound (US)-guided 14-gauge core needle biopsy for papillary neoplasms that were treated with subsequent surgical excision or vacuum-assisted biopsy (VAB) and we also wanted to evaluate the sonographic findings of papillary neoplasms. METHODS: A retrospective review of the US-guided core needle biopsies of 984 consecutive lesions from January 2004 to April 2006 revealed 29 (3%) papillary neoplasms. Twenty five lesions were further excised by surgery (n=16) or VAB (n=9). The remaining 4 lesions were not further excised and they were excluded from this study. We evaluated the concordance between results of core needle biopsy and the final pathologic results. We reevaluate the sonographic findings of the papillary neoplasms included in our study. RESULTS: The pathologic results of core needle biopsy were benign in 21 and atypical in four. Of the 21 benign papillomas, none were revealed as carcinoma after further excision. Just one lesion showed focal atypical ductal hyperplasia (ADH) after VAB. Three intraductal papillomas with ADH underwent surgical excision (n=3) or VAB (n=1), and they were proved to be the same pathologic entities with (n=1) or without (n=3) lobular neoplasia. The sonographic findings were as follows: four intraductal masses, four intracystic masses, four solid masses with peripheral anechoic rims, five extraductal masses adjacent to dilated ducts, six pure solid masses, and two mixed masses. CONCLUSION: US-guide 14-gauge core needle biopsy for papillary neoplasm showed no underestimation after surgical excision or VAB in our study, and the procedure proved to be reliable for the assessment of papillary neoplasm if the imaging and pathologic findings were concordant. Papillary neoplasms showed variable sonographic findings.
Biopsy ; Biopsy, Large-Core Needle ; Breast ; Hyperplasia ; Papilloma ; Papilloma, Intraductal ; Retrospective Studies

PURPOSE: It is well recognized that distinguishing benign papillary lesions from malignant papillary lesions on core needle biopsy may pose difficult diagnostic problems. This study was conducted to define the potential role of ultrasoundguided core biopsy for the diagnosis of papillary lesions of the breast. METHODS: Twelve hundred and seventy nine women consecutively underwent 14-gauge core biopsy between January 2004 and December 2006. Of the 1,279 patients, 42 patients (3.2%) had papillary lesions of the breast on core needle biopsy. Of these 42 patients, 35 patients underwent surgical excision or sono-guided vacuum assisted excision. We compared the pathologic results of the excised specimens with the pathologic results on core needle biopsy. RESULTS: Of the 35 patients, 23 patients underwent surgical excision and 12 patients underwent sono-guided vacuum assisted excision. Three patients with intraductal papilloma without atypism on the core needle biopsy were confirmed to have intraductal papilloma accompanied with atypism by the final pathology. All 4 patients with papillomatosis or intraductal papilloma with atypism at core needle biopsy were confirmed to have intraductal papilloma with atypism by the final pathology. There were no patients identified to have breast cancer. CONCLUSION: Our results revealed the accuracy of core needle biopsy for making the diagnosis of papillary lesions of the breast. Surgical excision may not always be necessary for papillary lesion of the breast that is diagnosed on core needle biopsy. Surgical excision is considered in patients with papillomatosis or papillary lesions with atypism seen on core needle biopsy.
Biopsy ; Biopsy, Large-Core Needle* ; Breast Neoplasms ; Breast* ; Diagnosis ; Female ; Humans ; Papilloma ; Papilloma, Intraductal ; Pathology ; Vacuum

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.
Biopsy, Large-Core Needle* ; Breast ; Breast Neoplasms ; Humans ; Papilloma ; Papilloma, Intraductal*

Benign and malignant papillary neoplasms of the breast may be difficult to distinguish in both cytologic and histologic preparations. To define the cytologic features of benign and malignant papillary lesions, we retrospectively reviewed 18 cases of fine needle aspirates from histologically confirmed cases of papilloma or papillary carcinoma of the breast. This study included 3 intraductal papillary carci nomas, 3 invasive papillary carcinomas, and 12 intraductal papillomas. All cases were evaluated for presence or absence of papillary fragments, bloody background, apocrine metaplasia, macrophages, and degree of cellularity, atypia, and single isolated columnar epithelial cells. Papillary fragments were present in all cases. The background of the smear was bloody in all 6 carcinomas, but in only 7 out of 12 papillomas. Markedly increased cellularity was present in 4 carcinomas(67%) and 7 papillomas(58%). Single cells were present in 5 carcinomas(83%) and 8 papil lomas(67%). The majority of papillomas and papillary carcinomas had mild to moderate atypia, and severe atypia was noted in one case of intraductal papillary carcinoma and one case of invasive papillary carcinoma. Apocrine metaplasia was absent in all cases of papillary carcinomas, but present in 8 papillomas(67%). Macrophages were noted in 4 carcinomas and were present in all cases of papillomas. The constellation of severe atypia, bloody background, absence of apocrine metaplasia and/or macrophages were features to favor carcinoma. Malignant lesions tended to show higher cellularity and more single isolated cells. The cytologic features mentioned above would be helpful to distinguish benign from malignant papillary lesions of the breast. However, because of overlapping of cytologic features, surgical excision should be warranted in all cases of papillary lesions of the breast to further characterize the tumor.
Breast* ; Carcinoma, Papillary ; Epithelial Cells ; Macrophages ; Metaplasia ; Needles ; Noma ; Papilloma ; Papilloma, Intraductal ; Retrospective Studies