Raju U, Vertes D
Department of Pathology, Henry Ford Hospital, Detroit, MI, USA.
Hum Pathol. 1996 Nov;27(11):1231-8. doi: 10.1016/s0046-8177(96)90320-2.
Breast papillomas with areas of atypical proliferation reminiscent of ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH) are rare, but pose considerable diagnostic difficulty when encountered. The clinicopathologic features of 20 women 27 to 78 years of age with papillomas having atypical proliferations are reviewed. They presented with palpable masses or nipple discharge. Histologically, parts of all lesions had features of papillomas with a biphasic proliferation of benign epithelial cells and myoepithelial (ME) cells. Part of the lesion in each papilloma also had an expansile proliferation of larger uniform cells having evenly spaced, round nuclei and a solid to subtle cribriform growth pattern, similar to ADH or DCIS. These lesions tended to be large, complex or multiple. Twelve patients had 4 to 20 years of follow-up after biopsy only. One each had concurrent and previous contralateral breast carcinoma. Two developed invasive carcinoma of the contralateral breast in 15 and 18 years, respectively. Two developed DCIS on the same side in 2 and 8 years. Six had recurrent papillomas with (5) or without (1) ADH in 1 to 7 years all of whom had no further problems. Only 3 of 12 patients are event free. In contrast, only 8 recurrent papillomas, and 1 ipsilateral invasive carcinoma and 2 contralateral carcinomas occurred in 60 patients with papillomas without ADH in 4 to 18 years. Thus, the patients having ADH within papillomas seem to have greater likelihood of subsequent disease such as recurrences or overt neoplasia, but the length of follow-up and number of patients are not large enough to provide definitive answers. Because none of the patients developed invasive carcinoma on the same side, conservative management with close observation similar to that following a diagnosis of ADH seems to be appropriate.
伴有不典型增生区域、类似原位导管癌（DCIS）和非典型导管增生（ADH）的乳腺乳头状瘤较为罕见，但一旦遇到，会带来相当大的诊断困难。本文回顾了20例年龄在27至78岁、患有伴有不典型增生乳头状瘤的女性患者的临床病理特征。她们表现为可触及的肿块或乳头溢液。组织学上，所有病变的部分区域具有乳头状瘤的特征，即良性上皮细胞和肌上皮（ME）细胞呈双相增生。每个乳头状瘤的部分病变还具有较大的均匀细胞的膨胀性增生，这些细胞具有均匀分布的圆形核，呈实性至细微筛状生长模式，类似于ADH或DCIS。这些病变往往较大、复杂或为多发。12例患者活检后仅进行了4至20年的随访。其中1例同时患有对侧乳腺癌，1例既往有对侧乳腺癌。2例分别在15年和18年后发生了对侧乳腺浸润性癌。2例分别在2年和8年后同侧发生了DCIS。6例在1至7年后出现了复发性乳头状瘤，其中5例伴有ADH，1例不伴有ADH，所有这些患者均未出现进一步问题。12例患者中只有3例无事件发生。相比之下，60例无ADH的乳头状瘤患者在4至18年中仅出现了8例复发性乳头状瘤、1例同侧浸润性癌和2例对侧癌。因此，乳头状瘤内伴有ADH的患者似乎更有可能发生后续疾病，如复发或明显的肿瘤形成，但随访时间和患者数量不足以提供明确答案。由于所有患者同侧均未发生浸润性癌，与ADH诊断后相似的密切观察的保守治疗似乎是合适的。
