Papillary Lesions of the Breast

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Papillary lesions of the breast are common
  • These highly vascular lesions:
    • Are intraductal and may transform into malignant variants
  • In benign papillary lesions:
    • A vascular stalk may be demonstrated on color Doppler scanning while multiple feeding vessels may be seen when imaging malignant papillary lesions
  • When papillary lesions infarct, the vascular stalk will not be demonstrated
  • The ability to reliably distinguish papilloma, in-situ papillary carcinoma, and invasive papillary carcinoma:
    • Is not possible with ultrasound and is quite challenging even on core biopsy
  • Open surgical biopsy:
    • May need to be performed to distinguish malignant from benign papillary lesions
  • An “acorn” cyst is lined with papillary apocrine metaplasia:
    • Which can form a mural nodule:
      • The nodule in an acorn cyst is less echogenic than papillomas or papillary carcinomas, is usually concave, following the contour of the cyst (thus the appearance of a cap on an acorn) instead of convex, and does not have a vascular stalk
    • The mural nodule caused by papillary apocrine metaplasia also would not extend into the duct as the papillary lesion shown in the image does
  • Tubular adenomas and fibroadenomas:
    • Have a similar sonographic appearance and are frequently round or oval, although tubular adenomas can be fusiform or spindle shaped
    • Both lesions occur during reproductive years and would not commonly present as a new finding in a postmenopausal patient
  • References
    • Jagmohan P, Pool FJ, Putti TC, Wong J. Papillary lesions of the breast: imaging findings and diagnostic challenges. Diagn Interv Radiol. 2013;19(6):471-478.
    • Wyss P, Varga Z, Rössle M, Rageth CJ. Papillary lesions of the breast: outcomes of 156 patients managed without excisional biopsy. Breast J. 2014;20(4):394-401.
    • Stavros AT. Breast Ultrasound. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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