Papillary Lesion of the Breast in a Young Girl Suspicious to Juvenile Papillomatosis, Clinical Decision Making in a Multi-disciplinary Team and Review of the Literature

Abstract

Background: Papillary lesions of the breast are a heterogeneous group of neoplasms, the diagnosis and treatment of which is challenging. Typically surgical excision is recommended for papillary lesions after core needle biopsy (CNB) to rule out concurrent malignancy when a diagnosis of papilloma with atypia is yielded on CNB. For papilloma without atypia, however, making a decision about excision versus observation is challenging.
Case Presentation: A 14-year-old female with nipple discharge, and a 2 cm mass in the right breast, with the pathology of intra-ductal papilloma without atypia on CNB presented. The question to be answered by multi-disciplinary team was the best management of this papillary lesion and whether the follow up was adequate or excision was mandatory.
Question: What is the best plan for management of the young patient according to the primary pathology report of Juvenile Papillomatosis?
Conclusion: Histoathology review of CNB specimen in rare and high risk lesions may have some advantages. On the other hand, in high risk circumstances, the excision of the lesion is recommended. Thus, in this case, the multi-disciplinary team recommended excision of the lesion.