Solitary large intraductal papilloma in a fourteen year old girl

L. Brown1, Hilary Dobson2, D. T. Hansell1
1 Department of Surgery Stobhill Hospital
2 West of Scotland Breast Screening Service


Introduction

Although a wide range of breast pathology is encountered in the young adolescent period, intraduct papillomas are less frequently seen. The majority of palpable abnormalities in this age range are fibroadenomas, with papillomas being seen more commonly in middle age.

Case Report

A 14 year old girl presented to the breast clinic with a palpable lump on her left breast. Clinically this was felt to represent a fibroadenoma and an ultrasound was also suggestive of this. She underwent a core biopsy of this and this showed normal breast tissue with part of a myxoid fibroadenoma. She was therefore reassured and we arranged to see her in 3 months to see if the lesion was regressing.

Following the core biopsy however she started to get large amounts of clear nipple discharge on this side. A nipple smear was performed which showed macrophages with scattered groups of ductal cells, suggestive of an underlying papillomatous lesion. A repeat ultrasound at this point showed that the lesion had increased in size, but had otherwise not changed appearance. There was also evidence of a slightly dilated duct.

In view of the nipple discharge and increase in size she had surgery to remove the palpable abnormality; this was done as a day case with no adverse effects.

The final pathology showed a benign intraduct papilloma, which was fully excised.

Following this the nipple discharge has resolved and there has been no recurrence of the palpable abnormality.

Discussion

This case shows many features of the presentation of a papilloma. It was interesting to see the nipple discharge start after the biopsy suggesting disruption of the lesion, the slight duct dilatation on USS and the presence of cells in the discharge all pointing towards the diagnosis. Intraductal papillary lesions of the breast occur most commonly in the 5th and 6th decades of life1. There have been reported cases of multiple duct papillomas in the under 16 group2 as well as cases of solitary intraduct papillomas in the 16-35 group3. Although rare it is important to remember the diagnosis of intraductal papilloma in the under 16s.

 

References

  1. Mulligan, AM, O'Malley, FP. Papillary Lesions of the Breast: A Review. Adv Anat Pathol. 14(2):108-19, 2007 Mar.
  2. Batchelor JS, Farah G. Fisher C. Muliple breast papillomas in adolescence. J Surg Oncol. 54(1):64-6, 1993 Sep.
  3. Cilotti, A. Bagnolesi, P. Napoli, V. Lencioni, R. Bartolozzi, C. Papilloma intraduttale solitario della mammella. Studio ecografico di 12 casi. Radiol Med (Torino). 82(5):617-20, 1991 Nov.