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Is Surgical Excision Warranted After Benign, Concordant Diagnosis of Papilloma at Percutaneous Breast Biopsy?

Laura Liberman1, Carmen Tornos2, Renata Huzjan1, Lia Bartella1, Elizabeth A. Morris1 and D. David Dershaw1

1 Director of Breast Imaging Research Programs, Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
2 Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.


Figure 1
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  		Fig. 1A —56-year-old woman with left breast bloody nipple discharge. Mediolateral oblique mammogram of left breast shows 0.8-cm lobulated, predominantly circumscribed mass in left breast, upper outer quadrant.

 

Figure 2
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  		Fig. 1B —56-year-old woman with left breast bloody nipple discharge. Mediolateral oblique mammogram obtained during left breast ductography shows opacification of retroareolar duct leading to mass and filling defect in mass.

 

Figure 3
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  		Fig. 1C —56-year-old woman with left breast bloody nipple discharge. Mediolateral oblique left mammogram obtained after stereotactic 11-gauge vacuum-assisted biopsy shows complete removal of imaging target. Air and localizing clip are present at biopsy site.

 

Figure 4
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  		Fig. 1D —56-year-old woman with left breast bloody nipple discharge. Histologic analysis of stereotactic biopsy material shows benign papilloma. (H and E)

 

Figure 5
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  		Fig. 1E —56-year-old woman with left breast bloody nipple discharge. Mediolateral oblique left mammogram obtained 22 months after biopsy shows interval development of new mammographic mass at biopsy site, corresponding to palpable lump denoted by radiopaque skin marker.

 

Figure 6
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  		Fig. 1F —56-year-old woman with left breast bloody nipple discharge. Histology slide from surgical excision shows benign papilloma centrally and infiltrating ductal carcinoma at periphery. Review of all slides from surgical excision yielded revealed infiltrating ductal carcinoma, poorly differentiated, measuring 1.8 cm, and ductal carcinoma in situ, admixed with papilloma. Patient had lumpectomy and sentinel node biopsy, with negative sentinel lymph nodes. (H and E)

 

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