Papillary duct hyperplasia of the breast in children and young adults.

Papillary duct hyperplasia (papilloma and/or papillomatosis) are relatively common breast lesions in adult women. However, they are rarely seen in women younger than 30 years of age or in children. This report presents the findings in 38 children and young adult women aged 10 to 26 years (average, 17 years). Six (16%) were younger than 14 years of age and 31 (82%) were 20 years or younger. Three types of papillary duct hyperplasia were described as papilloma (9 cases), papillomatosis (9 cases), and sclerosing papillomatosis (20 cases). None of these lesions exhibited the prominent cystic component of juvenile papillomatosis (JP) and most lacked other features of JP such as apocrine metaplasia and stasis. Other than a slightly older average age at diagnosis for sclerosing papillomatosis, no significant clinical differences were found related to the patterns of papillary duct hyperplasia. Thirteen percent reported a positive family history for breast carcinoma. No carcinomas have been detected in the 38 patients (follow-up, 14-307 months) and only one subsequent carcinoma was described after an interval of 22 years among 36 other cases reported in the literature. A family history of breast carcinoma is reported in 28% of JP cases and 5% have associated carcinoma. Further follow-up will be necessary to fully define the natural history of papillary duct hyperplasia in these young patients. There appear to be sufficient morphologic and clinical differences from JP to warrant a separate diagnostic term for this group of lesions. Treatment should be local excision.