Case 7 Clinical history This 44 year old woman had had two previous biopsies from the right breast which showed multiple benign duct papillomas with associated epithelial hyperplasia, but no atypia. Close follow-up was carried out and a further palpable lump occurred, in the same quadrant as the previous biopsies. Repeat excision biopsy performed. Histological appearances - A-C The sections show multiple duct papillomas in association with fibrocystic change, including florid epithelial hyperplasia of usual type. In addition, there are focal areas in which the epithelial proliferation has an incomplete cribriform pattern, without significant nuclear atypia. Interpretation In our view the architectural pattern was insufficiently developed for a definite diagnosis of low grade DCIS of cribriform type. A diagnosis of multiple papillomas with atypical ductal hyperplasia (ADH) was made. Management In view of the increased risk of subsequent invasive carcinoma from multiple duct papillomas, especially when associated with ADH and the history of multiple biopsies the patients was advised to undergo a subcutaneous mastectomy. She declined and close follow-up was therefore maintained. Three years later she developed another palpable lesion and, following needle core biopsy, a subcutaneous mastectomy was performed. Histological appearances - D-F In addition to further background epithelial proliferative changes as noted above, intermediate grade DCIS is present, together with a grade 1 invasive carcinoma of tubular mixed type. Final diagnosis Multiple ductal papillomas with associated ductal carcinoma in situ and invasive carcinoma. Learning points · Multiple duct papillomas give an increased risk for subsequent invasive carcinoma. · The risk is increased by the presence of associated ADH. · Close follow-up of such patients should be carried out. |
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