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Intraductal Papillomas
General questions about intraductal papillomas.
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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.

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