Jain Amit L, Mullins Janice, Smith Justin R, Valasareddy Poojitha, Miller Emily, Chaudhry Amina, Ryder Julie, Hare Felicia, Ranganath Harsha, Berry Michael, Robins David, Schwartzberg Lee, Vidal Gregory A
Internal Medicine Division, University of Tennessee Health Science Center, 956 Court Avenue, H314, Memphis, TN, 38163, USA.
Division of Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
J Med Case Rep. 2020 Feb 19;14(1):33. doi: 10.1186/s13256-020-2354-7.
Papillary breast lesions may be benign, atypical, and malignant lesions. Pathological and clinical differentiation of breast papillomas can be a challenge. Unlike malignant lesions, benign breast papillomas are not classically associated with lymph node and distant metastasis. We report a unique case of a recurrent, benign breast papilloma presenting as an aggressive malignant tumor.
Our patient was a 56-year-old postmenopausal African American woman who was followed in the breast clinic with a long history of multiple breast papillomas. She underwent multiple resections over the course of 7-9 years. After being lost to follow-up for 2 years, she once again presented with a slowly enlarging left breast mass. Subsequent imaging revealed a predominantly cystic mass in the left breast, as well as a suspicious hypermetabolic internal mammary node and a hypermetabolic nodule in the pretracheal space. Biopsy of the internal mammary node demonstrated papillary neoplasm with benign morphology and immunostains positive for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2/Neu. Due to the clinical picture concerning for malignancy, the patient was then started on endocrine therapy with palbociclib and letrozole before surgery. She then underwent simple mastectomy and sentinel lymph node dissection with negative nodes and pathology once again revealing benign papillary neoplasm. She underwent adjuvant chest wall radiation for 6 weeks and received letrozole following completion of her radiation therapy. She was without evidence of disease 30 months after surgery.
We present an unusual case of multiple recurrent peripheral papillomas with entirely benign histologic features exhibiting malignant behavior over a protracted period of many years, with an invasion of pectoralis musculature and possibly internal mammary and mediastinal nodes. Her treatment course included multiple surgeries (ultimately mastectomy), radiation therapy, and endocrine therapy.
乳腺乳头状病变可能是良性、非典型性和恶性病变。乳腺乳头状瘤的病理和临床鉴别可能具有挑战性。与恶性病变不同，良性乳腺乳头状瘤通常与淋巴结及远处转移无关。我们报告了一例独特的复发性良性乳腺乳头状瘤病例，其表现为侵袭性恶性肿瘤。
我们的患者是一名56岁绝经后非裔美国女性，在乳腺门诊接受随访，有多年多发性乳腺乳头状瘤病史。在7至9年的时间里，她接受了多次切除术。在失访2年后，她再次出现左乳肿块缓慢增大。随后的影像学检查显示左乳主要为囊性肿块，以及可疑的代谢活跃的乳内淋巴结和气管前间隙的代谢活跃结节。乳内淋巴结活检显示为乳头状肿瘤，形态良性，雌激素受体、孕激素受体和人表皮生长因子受体2/Neu免疫染色呈阳性。由于临床表现令人担忧为恶性肿瘤，患者在手术前开始接受哌柏西利和来曲唑的内分泌治疗。随后她接受了单纯乳房切除术和前哨淋巴结清扫术，淋巴结阴性，病理再次显示为良性乳头状肿瘤。她接受了6周的辅助胸壁放疗，并在放疗结束后接受来曲唑治疗。术后30个月无疾病证据。
我们报告了一例不寻常的病例，即多个复发性外周乳头状瘤，组织学特征完全良性，但在多年的漫长病程中表现出恶性行为，侵犯胸肌组织，可能还侵犯了乳内和纵隔淋巴结。她的治疗过程包括多次手术（最终为乳房切除术）、放疗和内分泌治疗。
