Papillary lesions

 DUCT PAPILLOMA

• Papillomas are benign epithelial tumors arising with in the cystically dilated duct , located usually in the central part of the breast but can occur at the periphery also.
• They are solitary and can be multiple also.
• common presenting symptom is nipple discharge ( can be bloody).
•  Papillomas can occur at any age but more common in 6th decade.

Mammography – smooth irregular mass with or without calcifications

Gross –

• Nodule protruding into the  duct lumen giving the appearance of an encapsulated lesion.
• Papillomas are soft to firm in consistency and some times friable also.
• Surface of these lesions are bossylated.
• Size may vary from 1cm to 10cm

Microscopy –

• Papillomas consist of branching stromal fronds with fibrovascular core, lined by cuboidal to columnar epithelium and myoepithelial cells.
• The changes which can occur in papillomas are –
•            Hyperplasia of epithelium lining the stromal fronds
•            Solid intraductal papilloma
•            Hyperplastic epithelium forming secondary lumens, microlumens and                focal sollid areas.
•           Apocrine metaplasia and squamous metaplasia
•           Infarction due to ischemia
•           mild pleomorphism with nuclear hyperchromasia and mitotic activity
  

  Intraductal papilloma : Papilloma within the cystically dilated duct lined by cuboidal to flattened epithelium (H&E,50)

  

  Duct papilloma: Papilloma in the cystically dilated duct lined by cuboidal to low columnar epithelium (arrow head) (H&E,X100).

   

Duct Papilloma: Epithelial hyperplasia forming secondary lumens and micropapillae. one foci shows apocrine metaplasia of ductal epithelial cells (arrow head) (H&E,X100).