Introduction
Papillomas are outward growths seen on breasts. They can be single or multiple. They can be observed in single breasts or both breasts. It can occur at the tip of the breast or can develop outwardly. Juvenile papillomatosis is a benign condition but has a higher risk of developing into a cancerous lesion. It is seen in young females lactating at or below thirty years of age. The discharge from nipples often characterizes such growths. The patient identifies the condition accidentally after the onset of symptoms or during other diagnostic procedures.
What Is Juvenile Papillomatosis?
Juvenile papillomatosis is also known as “Swiss cheese disease” because of the formation of giant vascular structures between the cells. These are benign lesions. It is characterized by a pigmented lesion that causes bloody discharge from the nipples. This is a rare condition and affects women below the age of thirty. Juvenile papillomatosis is caused due to abnormal multiplication, giving rise to growths. The growth starts from the duct of the mammary gland. The ducts are seen at the free end of the breasts towards the nipple. Therefore, the growth is observed at the periphery of the breasts. These lesions are not well defined. It appears unilaterally or bilaterally. It usually occurs in groups of fewer than five growths and is rarely seen as a single growth. Such abnormal growths are associated with an increased risk of breast cancer.
What Are the Common Types of Intraductal Papilloma Seen?
Intraductal papillomas can be of two types:
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Central Intraductal Papillomas: These arise from the large lactiferous ducts and are usually seen as single lesions. It is seen around the areola region and produces discharge from the nipples like blood.
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Peripheral Intraductal Papilloma: This is seen around the terminal duct of the nipples. It is usually seen as multiple lesions or papillomatosis lesions. It is observed during incidental detection without any mass formation or discharge noted.
What Are the Signs and Symptoms Observed in Juvenile Papillomatosis?
The signs and symptoms associated with this condition are as follows:
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Occasionally serous or bloody nipple discharge.
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Seen as multiple growths.
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Pain in the breast.
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It arises from the periphery or is seen at the nipples.
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Multiple masses are noted.
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It is seen as a solid localized lesion.
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Mobile masses are seen at the periphery of the breasts.
How Are the Cells of Juvenile Papillomatosis Seen Under the Microscope?
The cells of juvenile papillomatosis differ from normal cells. Some of the commonly observed features are as follows:
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The cells show papillary growth.
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The ducts from which these cells multiply are projected outward in a fibrovascular pattern. The cells are made up of epithelial and myoepithelial cells. The numerous secretory glands in the breast tissue, known as the apocrine glands, show abnormal multiplication of cells or apocrine metaplasia.
What Are the Treatments Done to Cure Juvenile Papillomatosis?
Juvenile papillomatosis of the breast is considered to be a benign growth. This condition is mostly associated with a family history of breast cancer. About ten percent of these tumor growths have a high capacity to turn into a malignant condition. Some of the commonly practiced treatment modalities are as follows:
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Surgery: The tumor is surgically removed and confirmed by a microscopic study of the surrounding tissue for any tumor cells left behind.
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Follow Up: The patient with juvenile papillomatosis is advised to undergo regular screening of breasts for some years to analyze the growth. A thorough physical examination of the breast must be done by the patient or under the guidance of health care professionals.
How Can Papillomatosis Growth Be Identified?
Patients often observe the growth due to the symptoms shown. Various scans and other imaging techniques can be used to detect the abnormality. Some of the diagnostic tests performed are as follows:
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Ultrasound (USG): During ultrasonography, the image captured shows solid masses with extensive cystic components. These are complex growths. The cell structure shows heterogeneous and increased internal vascularity of cells. The ducts show microcalcifications. Ultrasonography is also used to rule out similar conditions mimicking papillomatosis, like fibroadenoma, phyllodes tumor, cystic fibrosis, and other malignancies like papillary cancer.
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Markers: Various tumor markers differentiate benign cells from malignant cells, such as IHC-CK5, p63, calponin, and alpha-smooth muscle actin markers.
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Biopsy: The patient is advised for a code biopsy if the lesion is big or a vacuum-assisted biopsy for a much smaller lesion. Sometimes, the physician may advise an excisional biopsy for a therapeutic procedure or diagnostic purposes. The histopathological examination of tissue under the microscope shows characteristic features similar to fibroadenoma, which has abnormal multiplication of apocrine glands or sweat glands. The cells also show features like clogged ducts and distorted lobules of breast ducts. The cysts are lobular and can vary from two to eight centimeters in size.
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Mammogram: In a mammogram, the lesion shows ill-defined borders and an amorphous structure. The intraductal structure shows microcalcifications. The lesion usually shows negative on mammography. Women below the age group of thirty-five are usually not advised for mammograms due to the high incidence of radiation exposure. According to the American Cancer Society (ACS), there are various screening guidelines to be followed as they can interfere with women's overall health. Mammograms in young women can also lead to short life expectancy and heart, kidney, liver, or lung failures. Also, the chances of false-positive results are high in young women due to dense breast structure. Periodic exposure to mammograms for more than ten years can lead to false-positive findings at some point. Inform the doctor if any previous mammograms were done. Mammograms are not hundred percent accurate and hence require other confirmatory tests of diagnostic value.
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Galactography: This shows multiple irregular filling defects in the breast ducts.
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Breast Magnetic Resonance Imaging (MRI): The radiological study shows the extent of tumors and is divided into various tumor staging, such as:
- T1: It shows big lobulated spaces in between the cells.
- T2: It shows multiple small internal cysts at the site of the lesion.
- T1 C+ (Gd): During this stage, the proliferation of cells may occur and is very rapid.
- Dynamic Sequence: In this stage, the mass shows distinct benign proliferation of cells.
Conclusion
Juvenile papillomas of the breast are rare citations and are mostly linked with predisposing factors like a history of breast cancer in the family. This benign lesion has a high potential of turning into malignancy. Most of the time, it is detected accidentally, along with other tests. The prognosis is uncertain since the lesion is benign in nature and can reoccur. However, the chances of recurrence after the surgery is also high. Multiple lumps are more prone to developing into cancerous lesions. Any discomfort or symptoms should be immediately brought to notice and treated.
