Juvenile papillomatosis of the breast
Juvenile papillomatosis (JP) of the breast is a relatively common benign localized proliferative lesion in the breast.
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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 containing multiple small cysts (<2 cm) within a dense fibrous stroma (therefore sometimes termed Swiss cheese disease by pathologists). Lesions can vary in size, usually range from 1 to 8 cm.
Radiographic features
Breast ultrasound
They can appear as an ill-defined, inhomogeneous 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 prominent intraductal pattern.
Galactography
May show a multiple irregular filling defects within the breasts.
Breast MRI
Signal characteristics according to one report include 2:
- T1: hypointense lobulated mass
- T2: may show presence of multiple small internal cysts, best shown on this sequence and considered the most specific feature
- T1 C+ (Gd): may show marked rapid enhancement 11
- dynamic sequence: shows a benign enhancement profile
Treatment and prognosis
Despite being a benign entity, it is considered by some to be a marker for familial breast cancer. Approximately 10% of those with papillomatosis are thought to develop breast cancer later in life 10.
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