Singh Pallavi, Misra Vatsala, Singh Premala A, Mehrotra Ravi
Department of Pathology, Moti Lal Nehru Medical College, Allahabad, India.
Indian J Pathol Microbiol. 2010 Jan-Mar;53(1):112-4. doi: 10.4103/0377-4929.59197.
Intraductal papilloma is characterized by proliferation of epithelial and myoepithelial cells overlying fibro-vascular stalks creating an arborescent structure within the lumen of duct. Some times multiple papillomas with florid proliferation of epithelium may be confused with malignancy. A case of multiple intraductal papillomas of breast with ulceration of overlying skin and large lump leading to clinical diagnosis of malignancy is documented here.
A 45-year-old female presented with ulcerated mass of six months duration in the left breast. On examination, a firm, immobile lump of 8x 10 cm in size involving nipple with excoriation of surrounding skin and serosanguinous discharge from nipple was present. There was no axillary lymphadenopathy. No family history of carcinoma breast was present. Fine needle aspiration smears showed benign cellular changes with apocrine metaplasia. Biopsy from an area adjacent to nipple showed intraductal papilloma. Simple mastectomy showed lobulated dirty white mass with well circumscribed nodules below the nipple and areola. On histology with immunohistochemistry a diagnosis of multiple intraductal papillomas was made. Patient is on regular follow-up and doing well.
The case highlights the problem in differentiating marked papillomatosis from a malignant lesion of breast and importance of biopsy with immunohistochemistry in such cases for proper management.
导管内乳头状瘤的特征是上皮细胞和肌上皮细胞在纤维血管蒂上增生，在导管腔内形成树枝状结构。有时，上皮细胞呈旺盛增生的多发性乳头状瘤可能会与恶性肿瘤相混淆。本文记录了一例伴有皮肤溃疡和巨大肿块的乳腺多发性导管内乳头状瘤病例，该病例最初临床诊断为恶性肿瘤。
一名45岁女性，左乳有一个持续6个月的溃疡性肿块。检查发现，有一个大小为8×10厘米的坚硬、固定肿块，累及乳头，乳头周围皮肤有擦伤，乳头有浆液性血性溢液。腋窝无淋巴结肿大。无乳腺癌家族史。细针穿刺涂片显示良性细胞改变伴大汗腺化生。乳头旁区域活检显示为导管内乳头状瘤。单纯乳房切除术显示为分叶状灰白色肿块，乳头和乳晕下方有边界清晰的结节。经组织学检查及免疫组化，诊断为多发性导管内乳头状瘤。患者正在接受定期随访，情况良好。
该病例突出了区分显著乳头状瘤病与乳腺恶性病变的问题，以及在此类病例中进行活检及免疫组化检查对于正确治疗的重要性。
