Multiple papillomas tend to occur in peripheral ducts and present with a palpable mass associated in rare cases with nipple discharge. The diagnosis is usually made on core or excision biopsy. Inadequate excision results in a high local recurrence rate. There is a 10-33% risk of subsequent ipsilateral breast carcinoma in patients with multiple peripheral papillomas. Therefore, long-term follow-up with mammographic screening is recommended in these patients.
Juvenile papillomatosis is a rare, benign, localized proliferative condition encountered mainly in young women (average age of 23 years). Patients usually present with a palpable mass and no associated nipple discharge. The incidence appears to be higher in women with a family history of breast cancer.
Mammography is very rarely performed, as the majority of patients are under the age of 35 years, and the appearances are likely to be nonspecific and unhelpful.
Ultrasound can reveal an hypoechoic mass or an area containing multiple small cysts and dilated ducts.
The excised lesion is a firm, discrete mass and does not have a well-circumscribed outline. The size varies between 1 and 8 cm. The cut surface has the appearance of “Swiss cheese” due to the presence of multiple cysts that measure 1-2 cm. These are separated by firm yellow and white areas.
These lesions are composed of a constellation of cysts, ducts showing florid epithelial hyperplasia, which occasionally have atypical features, and prominent stroma, which may be sclerotic or cellular.
Complete excision of the underlying area with an adequate margin is the treatment of choice. Inadequate excision will invariably lead to local recurrence. The overall long-term risk of carcinoma remains uncertain; therefore, long-term follow-up is recommended.
A.D. Purushotham, P. Britton and L. Bobrow
A prospective study of benign breast disease and the risk of breast cancer. JAMA 2002