Ask an Expert: View a Question

Ask an Expert is a free question-and-answer service about breast cancer and breast health that is available on weekends. If you'd like to ask a question or comment, please visit us again on Saturday or Sunday. In the meantime, please search the existing topics using the search tool at the top of the page. It's quite possible that one of our many existing topics already addresses your question.

If you would like a consultation with a breast specialist at the Johns Hopkins Avon Foundation Breast Center, call 443-997-8282. It is possible to get an appointment for a second opinion within a few days of contacting us.

We hope you find the information helpful!

ForumQuestionsAsk a Question
Intraductal Papillomas
General questions about intraductal papillomas.
1,312 Ask a Question

AskedPublicly Submitted Question
5/9/2017I previously submitted a question in which I described a conflict between a CNB pathology result (intraductal papiloma with focal point atypia) and the result of a lumpectomy to remove the lesion. Unfortunately, the answer I received assumed I am a Johns Hopkins patient, which I am not. As a result, I would like advice on whether or not to pursue this apparent "discordance" (and how):

In summary, I had surgery on Feb 2016 and again on the same breast in April 2017 because the first excision attempt failed to recover both the clip and the lesion (papiloma). This year's surgery recovered the clip but what is adjacent to the clip is NOT the papiloma found at the time of the original CNB (October 2015). Despite not one but two surgeries on this location, no papiloma has been found.

Selected quotes from the 2017 pathology report:

Sections reveal vaguely nodular areas of fibrosis, cyst formation, apocrine metaplasia and ordinary ductal hyperplasia.

Addendum comment: Adjacent to the grossly noted biopsy clip and nodular area there is focal inflammation and necrosis consistent with prior biopsy site. Residual papiloma is not identified. The final diagnosis is unchanged.

The only pathology finding in the vicinity of the clip is as follows:

Lesion Size: 1.5 cm superficial to deep x 0.6 cm cephalad to caudal x 0.5 cm medial to lateral.
Lesion Description: A poorly circumscribed firm, fibrous-appearing focus with glistening pink-white cut surfaces. Does not appear to be a discrete mass.
Clip: Present, a small gray metallic coil-shaped clip is appreciated cephalad to the leison, approximately 0.4 cm to the superficial cephalad margin"

Question: Is it possible for my CNB in 2015 to have wholly removed the papiloma, thus explaining why it has failed to show up on two attempts at excision? At this point, should I accept the results or seek out a second opinion? (I am in Southern California.)

Thank you.
RepliedJHU's Breast Center Reply
5/9/2017If my recall is correct my suggestion was to request that the radiology and pathology quality assurance committee review your case since there was discordance. This wasn't suggested assuming you are a Hopkins patient. If you were a Hopkins patient this would have automatically been done. you can still request this to be done no matter where your surgery and subsequent pathology was performed. make sure they include the original core needle biopsy showing the papilloma. everyone needs to be in agreement that the original path results were correct before looking for the papilloma in either surgical specimen.

Please note: This service is not intended to provide primary medical advice concerning specific medical care or treatment. Ask an Expert is a free service operated by health care professionals at the Johns Hopkins Avon Foundation Breast Center. Due to the volume of questions and their complexity, there are times when medical oncologists, surgeons, radiation oncologists or oncology nurses are consulted for their input. These individuals volunteer their time for this service and will respond as soon as they are able. Please do not post or send the same question to us in multiple locations or categories.

The contents of this portion of the website cannot be used as a substitute for a consultation with your doctor or other healthcare provider. It also may not represent the opinions of other Johns Hopkins professionals. It is a free service performed on volunteer time and intended to provide feedback to questions posted by consumers however should not be used as a directive or instructions to now follow. Seeing your own medical provider is always important in getting your needs and questions addressed. In the majority of cases, a clinical examination, review of pathology slides and xrays, along with other medical information is needed to truly provide a consultative service. If you wish to receive a formal consultation with our physicians please call 443-997-8282 for surgical appointments and 410-955-8964 for medical or radiation oncology appts. For breast imaging, call 410-955-4100.


© The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System, All rights reserved.