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Juvenile papillomatosis of the breast

Juvenile papillomatosis (JP) of the breast is a relatively common benign localised proliferative lesion in the breast.

Epidemiology

As the name implies, it is mainly seen in young women (mean age ~ 19 - 23 years 4,6) and is unusual in women over 30 years old. 

Clinical presentation

Patients present with a firm, well-defined, mobile mass often in the periphery of the breast. There is usually no nipple discharge.

Pathology

Juvenile papillomatosis is a papillary proliferation of the ductal epithelium which partly fills up smaller ducts and distends them to a degree. Gross pathology often shows a well-circumscribed mass containning multiple small cysts (< 2 cm) within a dense fibrous stroma (therefore sometimes termed swiss cheese disease by pathologists). Lesions can vary in size, usually ranging from 1 to 8 cm. 

Radiographic features

Breast ultrasound

They can appear as an ill-defined, inhomogenous hypoechoic mass with multiple small (up to 4 mm) predominantly peripheral cysts. Microcalcifications may be seen at sonography 5.

Mammography

These lesions are usually negative on mammography 4-5. Occasionally mammograms may show pleomorphic or amorphous microcalcifications, an asymmetric density or a prominant intraductal pattern. 

Galactography

May show a multiple irregular filling defects within the breasts.

Breast MRI

Signal characteristics according to one report include

  • T1 : hypo-intense lobulated mass
  • T2 : may show presence of multiple small internal cysts, best shown on this sequence and is considered the most specific feature
  • T1 C+ (Gd) : may or may not show marked rapid enhancement 11
  • dynamic sequence : shows a benign enhancement profile.  

Complications

Despite being a benign entity, it is considered by some to be a marker for familial breast cancer. Approximately 10%10 of those with papillomatosis are thought to develop breast cancer later in life.

See also

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