Unusual recurrent metastasizing benign breast papilloma: a case report

Abstract

Background: 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. Case presentation: 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. Conclusions: 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.

Treating papillary tumors of the breast—role of adjuvant treatment—a narrative review

“…Even if these lesions are diagnosed on VAB there is a high possibility of them being malignant and therefore, surgical excision is warranted (8) There is no role of any form of adjuvant treatment in benign papillary lesions even when associated with atypia provided they have been adequately excised. Some case reports in the literature do suggest the role of adjuvant treatment (9). However, they are single case reports especially describing multiple recurrent benign lesions.…”

Papillary Neoplasm of Breast-Changing Trends in Diagnosis and Management

“…The peripheral papillomas arise in the terminal duct lobular units and are often discovered incidentally on imaging studies and risk of carcinoma is even higher than solitary papilloma. And very rarely, benign papillomas of breast presenting with local or distant metastases have been reported [10][11][12][13][14][15][16][17][18]. However, behavior and management of papillary carcinoma whether in situ or invasive remain a matter of debate.…”

Puzzling Papillomas: A Case of an Intraductal Papilloma Mimicking an Abscess

“…Intraductal breast papillomas are benign tumors that fall within the spectrum of papillary breast lesions [ 1 ]. Despite constituting less than 2% of breast lesions [ 2 ], they are important as they are high-risk malignancy precursor lesions [ 3 ]. Most patients with papillomas are asymptomatic but they can occasionally present with a palpable abnormality and bloody or clear nipple discharge [ 1 ].…”