Benign multiple papillary lesions of the breast

Case contribution: Dr Radhiana Hassan


  • A 44 years old lady
  • No known medical illness
  • Complained of right breast mass for the past 2 years
  • Gradually increase in size and associated with occasional pain.
  • No nipple discharge. No family history of breast cancer.

Mammogram findings:

  • An area of increased density seen in the right breast (arrows)
  • No obvious mass lesion is seen
  • No clustered microcalcificaton
  • No stromal distortion

Ultrasound findings:

  • A lobulated hypoechoic lesion is seen at upper quadrant of right breast
  • Associated mild posterior shadowing
  • It measures approximately 30 x 15 x 13 mm.
  • Increased in vascularity within.
  • Smaller lesion is seen adjacent to this lesion, with possible connecting duct
  • No dilated duct is seen

Diagnosis: Benign intraductal papillary lesion (HPE proven)


  • Intraductal papillomas are the most common masses within the milk ducts of the breast.
  • They are benign tumors but may contain areas of atypia or carcinoma.
  • Multiple intraductal papillomas arise from the terminal ductal lobular units and therefore are usually peripherally located in the breast.
  • They are less common than solitary intraductal papillomas and rarely associated with a nipple discharge, and they typically present as a palpable mass.
  • Unlike solitary papillomas, multiple intraductal papillomas are usually associated with atypia, DCIS, or malignancy. Some studies have shown that in patients with multiple papillomas, up to 80.4% may have either coexisting atypical lesions (atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, lobular carcinoma in situ) or neoplastic lesions
  • On mammography, small papillomas can be occult, particularly when located in the retroareolar regions. Larger lesions may appear as a round- or oval-shaped mass with well-circumscribed margins.
  • On galactography, intraductal papillomas appear as well-defined mural-based filling defects with smooth or lobulated contours.
  • On ultrasound, intraductal papillomas may appear as well-defined solid nodules or mural-based nodules within a dilated duct. On color Doppler imaging, flow may be detected within the papilloma arising from a vascular feeding pedicle.


  • Papillary lesions of the breast at
Author: radhianahassan