title: Uniqueness of ductal carcinoma in situ of the breast concurrent with papilloma: implications from a detailed topographical and histopathological study of 50 cases treated by mastectomy and wide local excision.
abstract: OBJECTIVE
  To clarify the diagnostic clues of ductal carcinomas in situ (DCIS) associated with papilloma and optimal clinical management of papilloma diagnosed on core needle biopsy (CNB).
  
  
  RESULTS
  A total of 50 surgically resected cases were examined histopathologically and topographically. Thirty-nine cases (78%) spread in segmental fashion. Papilloma and DCIS were intermingled closely in 44 cases (88%), occupying the same areas in varying proportions from DCIS-predominant to papilloma-predominant. The two components occupied discrete areas and collided focally in six cases (12%). Most were non-high-grade. Cribriform and solid architectures with fibrovascular stroma were frequent. The cribriform pattern was unique, consisting of fused tubules separated by fibrovascular stroma. Intraductal myoepithelial cells were present to varying degrees in 40 cases (80%). In 38 cases (76%), points were identified where papilloma and DCIS coexisted or collided within a single lumen (CC point). Forty-eight cases (96%) had either intraductal myoepithelial cells or CC points, implying that DCIS and papilloma existed in the same duct system. Radiology showed segmental abnormalities in 83% of the available cases.
  
  
  CONCLUSIONS
  Intraductal myoepithelial cells do not always guarantee benignity. Surgical resection is recommended for papilloma in CNB when radiology shows segmental abnormalities.
authors.affiliation: Department of Advanced Diagnosis, Division of Pathology, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Suzuko
authors.initials: S
authors.lastname: Moritani
authors.forename: Shu
authors.initials: S
authors.lastname: Ichihara
authors.forename: Masaki
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Tokiko
authors.initials: T
authors.lastname: Endo
authors.forename: Mikinao
authors.initials: M
authors.lastname: Oiwa
authors.forename: Misaki
authors.initials: M
authors.lastname: Shiraiwa
authors.forename: Takako
authors.initials: T
authors.lastname: Morita
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sato
authors.forename: Takako
authors.initials: T
authors.lastname: Hayashi
authors.forename: Aya
authors.initials: A
authors.lastname: Kato
authors.forename: Akari
authors.initials: A
authors.lastname: Iwakoshi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D018300:Papilloma, Intraductal / Q000473:pathology* / Q000601:surgery
keywords: ductal carcinomas in situ; myoepithelial cell; papilloma; papilloma with ductal carcinomas in situ; sick lobe