“Bilateral Giant Papillomas of the Breast- 15 Year Natural History” A Case Report and
Literature Review
Danon Garrido, MD, Lucy M. De La Cruz, MD, Alberto Zarak, MD, Beth-Ann Lesnikoski, MD.
Department of Surgery,University of Miami Miller School of Medicine Regional Campus, Atlantis
Florida
Introduction/Background
Intraductal papillary lesion of the breast belongs to a wide group of pathologic findings termed as
papillary lesions of the breast. Diverse morphological appearance, clinical presentation, imaging
findings, clinical behavior, and clinical significance characterize this group of lesions.1 Intraductal
papilloma without atypia found on core needle biopsy remains a controversial issue in terms of
surgical management, since some studies suggest that these lesions do not require excision due to
low risk of developing further malignancy.2
Case Presentation
A 63 year-old Haitian woman presents to clinic complaining of an enlarging right breast mass for
the past two years which she initially noted a small mass under the nipple fifteen years ago and had
previous negative mammograms in her home country. She denied personal or family history of
breast/ovarian cancer; Multiparous, denied OCP use or hormonal replacement therapy.
On clinical exam there was no erythema, no skin thickening and no peau d’orange in either breast.
Nipples were everted without spontaneous discharge or retraction. Right breast had macro
lobulated mass 20cm by palpation with the nipple areolar complex on the inferior surface of the
mass. The left breast mass at the 3 o’clock subareolar position which appeared to be approximately
5.0 x 2.0 cm by palpation.
Ultrasound showing 10.7 x 10.3 x 13.4 cm exophytic mass of the right breast and left breast
9.0x8.0x11.0cm mass at the 3 o’clock position in the subareolar region. Vacuum assisted biopsy of
both lesions (left breast- intraductal papilloma and florid adenosis and right breast -intraductal
papilloma with atypia ). An MRI 12 x 9 cm multiloculated cystic mass on the right with papillary
type mural masses on the lateral cyst wall highly suggestive of malignancy; on the left there was a 6
x 1.5 cm cm tubular dilated ductal structure with an adjacent 6 mm enhancing lesion. Pathology
reports were not felt to be concordant. Excision was recommended.
Surgical treatment with wide local excision and batwing mastopexy of the right breast and simple
wide local excision on the left. Pathology of the right mass revealed a low-intermediate nuclear
grade ductal carcinoma in situ arising within, and extensively involving an 8cm intraductal
papilloma. Pathology of the left mass revealed an intraductal papilloma with associated lactiferous
duct ectasia. Post-operatively, the patient recovered without complications.
Discussion
The majority of current studies suggest intraductal papilloma has a risk of developing a concurrent
high risk lesion and thus recommend resection. There is of course some controversy. Our patient
presents a unique example of the natural course a papilloma can take. While this is only one patient,
this example of such a slow and mostly benign course may cause us to re-consider mandatory
excision in the management of asymptomatic intraductal papilloma diagnosed on core needle
biopsy.