Benign Intraductal Papilloma Diagnosed on Imaging-Guided Breast Biopsy: Upgrade Rate to Carcinoma and to High-Risk Lesion

Objective: To determine the upgrade rates to carcinoma and to high-risk lesion (HRL) of benign intraductal papilloma (IDP) diagnosed on core needle biopsy (CNB) at Phramongkutklao (PMK) Hospital and to identify clinical or radiologic factors associated with the upgrading. Materials and Methods: Benign IDPs diagnosed on CNB between 2012 and 2020 were retrospectively reviewed. The ones with subsequent surgical excision or with more than two years of imaging follow-up to confirm benignity were included. The upgrade rates to carcinoma and to HRL were determined. Clinical and radiologic factors associated with the upgrade were analyzed. Results: Fifty-six benign IDPs diagnosed on CNB including 41 with subsequent excision and 15 with follow-up management were included. Of the 56 lesions, four (7.14%) were upgraded to carcinoma including three DCIS and one DCIS with grade 1 invasive carcinoma. Upgrade to HRL was found in two lesions (3.57%). No factor was found to be associated with the upgrading. Conclusion: At PMK Hospital, the upgrade rates of benign IDP diagnosed on CNB to carcinoma and to HRL were 7.14% and 3.57%, respectively. No factor was found to be associated with the upgrading. All upgraded cancers were of the early stage and low grade. Case-by-case management is recommended, based on these results together with patient’s risk, patient’s concern, and follow-up compliance. Keywords: Benign intraductal papilloma; Breast carcinoma; Breast biopsy; High risk lesion; Upgrade

An Unusual Breast Mass in a 13-year-old Girl: a Case Report

BackgroundIn puberty breast intraductal papilloma was rare, but the pathological changes of intraductal papilloma combined with intraductal fibroadenoma in the duct lumen were even less reported. Herein we reported a case of adolescent benign breast disease that contained the two features of neoplasm in the same duct and discussed its clinical course.Case presentationA 13-year-old adolescent female presented to our hospital with spontaneous bloody discharge of the left nipple. On clinical examination, a 2.5cmx1.5cm mass could be palpable under the left nipple, and a single-hole bloody discharge could be seen by squeezing the mass. Surgical resection of the mass and part of the breast duct was confirmed by postoperative pathology as intraductal papilloma and intracanalicular type fibroadenoma, with cystic changes of ductal epithelium hyperplasia. After 15 months of follow-up, there was no evidence of recurrence.ConclusionsIntraductal fibroadenomatosis may be a new pathological subtype in which multiple histologic characteristics can be seen in the same duct. Surgical resection is the only effective treatment. Its etiology is still unknown, and it remains to be accumulated more cases for further exploration.