Breast - nonmalignant
Benign tumors / changes
Papilloma of breast

Author: Hind Nassar, M.D. (see Authors page)

Revised: 10 August 2017, last major update April 2010

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Papilloma of the breast [title]

Cite this page: Nassar, H. Papilloma of breast. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastpapilloma.html. Accessed November 20th, 2017.
Definition / general
  • Intraductal proliferation of epithelial and myoepithelial cells overlying fibrovascular stalks
Terminology
  • "Papillomatosis" is a confusing term because it may refer to hyperplasia or multiple papillomas
Epidemiology
  • Common; mean age 48 years
Etiology
  • Arises from large or small ducts (arising from terminal duct lobular unit)
  • May be related to ductal adenoma
Clinical features
  • Central or peripheral
  • Central (large duct): close to nipple within principal lactiferous ducts, 90% solitary, 70% associated with nipple discharge; usually ages 30 - 49 years but any age
  • Peripheral: often clinically occult, discovered by mammographic calcifications
  • Single papillomas: no increased risk of subsequent malignancy with or without associated ADH / ALH (Am J Surg Pathol 2006;30:665) although in one study, 16% contained carcinoma (Eur J Surg Oncol 2010;36:384)
  • Multiple papillomas: increased risk of subsequent malignancy, particularly if ADH / ALH is present (Am J Surg Pathol 2006;30:665)
    • 5 or more papillomas are associated with coexisting atypical (ALH / LCIS, ADH) or malignant breast lesions, also recurrence and contralateral disease (Hum Pathol 2003;34:234)
  • Atypical papillomas: distinction from papillary DCIS is based on size of atypical area or % of papilloma
    • 4x increased risk of invasive carcinoma compared to papillomas without atypia, usually near site of original papilloma (Cancer 1996;78:258)
Radiology images

Images hosted on PathOut server:

Mammogram, contributed by Dr. Mark R. Wick

Case reports
Treatment
Gross description
  • Well circumscribed, polypoid intraductal mass, usually < 3 cm, soft, hemorrhagic
  • Often infarcted
Gross images

Images hosted on PathOut server:

Intracystic, contributed by Dr. Mark R. Wick



Images hosted on other servers:

Polypoid intraductal mass

Hemorrhagic cyst with tan tumor

Microscopic (histologic) description
  • 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)
  • Infracted 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
Microscopic (histologic) images

Scroll to see all images:


Images hosted on PathOut server:

Apocrine intraductal papilloma with large nuclei and prominent nucleoli

Fusion of adjacent papillae, gland-like spaces

Resembles sclerosing adenosis

Infarcted papilloma


With fibroblasts

Small ducts surrounded by hyalinized fibrous tissue

Squamous metaplasia


With spindle cells

Vessels but not spindle cells are actin+

With LCIS spreading in a pagetoid manner beneath ductal epithelium (plaque-like pattern)



Images hosted on other servers:

Arising in a small duct

Fibrocystic changes

Palpable subareolar mass

Intricate branching fronds


Irregular glandular spaces

Two cell pattern

Multiple nodules and stromal fibrosis

Epithelial and myoepithelial cells

Stromal fibrosis resembles invasion


Central papilloma

Papilloma with florid ductal hyperplasia

Encysted papilloma with hyperplasia

Peripheral papilloma


Within lymph node

Solid type

Atypia / malignancy

Apocrine intra-
ductal papilloma
with large nuclei /
prominent nucleoli


Papilloma with atypia

Papilloma with separate focus of ADH

Papilloma with severe atypia

With micropapillary DCIS


In a dilated duct, H&E

Within ectatic duct, H&E

Inner layer of columnar cells

Various images

p63

Smooth muscle actin


CD10 and smooth muscle actin

Cytology description
  • High positive predictive value (Diagn Cytopathol 2006;34:818)
  • Infarcted papillomas: early stages show numerous degenerated cells with smudged nuclei, ghost cells and necrotic debris; late stages show clusters of fibroblasts, ductal cells and necrotic debris (Diagn Cytopathol 2006;34:373)
Cytology images

Images hosted on other servers:

Leishman-Giemsa

FNA

Polygonal cells

Columnar and polygonal cells

Molecular / cytogenetics description
  • Clonal
Videos


Histopathology breast - intraductal papilloma
Differential diagnosis