Breast Pathology-Pitfalls
-Displaced epithelium can go to lymphatics (rare)
-Index lesion is an intraductal papilloma
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Intraductal papilloma (IDP) without atypia-Management
- Varies depending on imaging or clinical presentation
- Asymptomatic IDP can undergo active imaging surveillance
- Symptomatic IDP-surgical excision can be considered in this situation
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Low grade metaplastic carcinoma
Beaware🛑✋
They have a tendency to arise in association with sclerosing adenosis or intraductal papilloma
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Non-invasive lobular neoplasia in intraductal papilloma (IDP)
- Usualmente atypical lobular hyperplasia (ALH), rarely classic LCIS
- Florid or pleomorphic LCIS: Vary rare
- Do not report as atypical IDP- The term "atypical papilloma" is reserved for intraductal papilloma (IDP) with atypical ductal hyperplasia (ADH), and ADH in IDP is the preferred terminology.
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Adenomyoepithelioma in core needle biopsy mandates surgical excision regardless of atypia
Close morphologic similarity to intraductal papilloma
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Encapsulated Papillary Carcinoma (EPC) almost 100% infacted after core needle biopsy could be misdiagnosed as infarcted intraductal papilloma
Lesson: Always evaluate infarcted areas and any residual viable cells
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Usual ductal hyperplasia (UDH)-Uncommon patterns
- Reactive squamous metaplasia
- Necrosis when within an intraductal papilloma. If your are outside of intraductal papilloma and you are considering a diagnosis of UDH with necrosis, be careful, reevaluate histology and remember differential diagnosis like intermediate grade DCIS
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Breast-biopsy site
If the index lesion is benign (this case is an intraductal papilloma) be very wary of calling the displaced epithelium as invasive carcinoma
The displaced epithelium should be confined within the fibrosis/biopsy site reaction
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A 12-year-old male, a tumor occupying the nostrils extends through the left sphenopalatine fossa to the ipsilateral infratemporal fossa and extends intracranially. JUVENILE NASOPHARYNGEAL ANGIOFIBROMA #PathTwitter#PediPath#path