Nov - Dez - English

iant

sclerosing

papilloma

mimicking

locally

advanced

breast

carcinoma

ssoc

ras

2014; 60(6):518-519

519

The core biopsy showed a benign complex papillary le-

sion. Since the radiologic and pathologic divergence did not

allow a definitive diagnosis ofmalignancy, an ultrasound-gui-

ded stereotactic needle biopsywas scheduled. The open biopsy

was performed in a vegetative intracystic lesion (Figures 1B

and 1C) and pathologic findings showed a papillary neopla-

sia with atypical cells. Due to atypical findings and the neces-

sity to evaluate the whole lesion,

1-4

the patient underwent a

simplemastectomy with sentinel lymph node dissection. No

reconstructive surgery was considered because of the lesion

size and tumor characteristics. The macroscopic assessment

showed a 7.5 x 6.0 cm solid-cyst lesion, with a 3.8 cm solid

component (Figure 3A). Themicroscopy revealed a sclerosing

papilloma harboring ductal carcinoma

in situ

in about 30%of

the lesion (Figures 3B and 3C), with free margins and absen-

ce of lymph node metastasis. Immunohistochemistry for

myoepithelial cells was performed in order to exclude

foci

invasion in the periphery of the lesion (Figure 3D).

Figure 3

Pathologic findings. Macroscopic finding: (A) Gross

examination showed a large solid-cystic tumor. Microscopic findings:

(B) papillary neoplasia with sclerotic stroma (HE, 40x); (C) areas

containing carcinoma

in situ

(HE, 200x); (D) Immunohistochemistry

positive for myoepithelial cells (Calponin, 200x).

Mammary extensive papillomatous lesions represent

a clinical challenge, especially when observing a highly sus-

picious malignant tumor based on clinical and radiologi-

cal findings.

As core biopsy showed a benign lesion, an

open biopsy in the vegetative intracystic lesion was perfor-

med to improve material sampling. So, when a definitive

diagnosis of malignancy cannot be done because of discor-

dant findings, sampling limitations of a core biopsy

open biopsy, or limited sensibility of breast images,

5,6

re-

section of the entire lesion is mandatory

1-4,6

due to high as-

sociation with malignancy.

1,2,4

The open biopsy was an at-

tempt to improve the pathological results that were

hindered by limitation of diagnostic procedures and dis-

cordant findings. Also, the indication for diagnostic mas-

tectomy,

as seen in this case, is a fact that must be tho-

roughly discussed with the patient.

eferences

Sydor MK, Wilson JD, Hijaz TA, Massey HD, Paredes ESS. Underestimation

of the presence of breast carcinoma in papillary lesions initially diagnosed

at core-needle biopsy. Radiology 242(1):58-62.

Liberman L, Tornos C, Huzjan R, Bartella L, Morris EA, Dershaw DD. AJRIs

surgical excision warranted after benign, concordant diagnosis of papilloma

at percutaneous breast biopsy? ARJ. 2006; 186(5):1328-1334.

Ueng SH, Mezzeti T, Tavassoli FA. Papillary neoplasms of the breast. Arch

Pathol Lab Med. 2009; 133(6):893-907.

4. Youk JH, Kin EK, Kwak JY, Son EJ. Atypical papilloma diagnosed by

sonographically guided 14-gauge core needle biopsy of breast mass. AJR.

2010;194(5):1397-492.

LamWWM, Chu MCW, Tang APY, Tse G, Ma TKF. Role of radiologic features

in the management of papillary lesions of the breast. AJR 2006;186(5):1322-

1327.

Eliada R, Chong H, Lylmarni S, Goldberg F,Muradai S. Papilllary lesions of

the breast: MRI, ultrasound, and mammographic appearances. AMJ J

Roentgenol.2012; 183(2): 264-71.

Fenoglio C, Raffaele L. Sclerosing papillary proliferations in the female

breast. A benign lesion often mistaken for carcinoma. Cancer 1974; 33(3):

691-700.