Juvenile Papillomatose der Mamma

Juvenile
papillomatosis of the breast. Ultrasound image. Panoramic view. Palpation area in the upper inner quadrant of the right breast showing a multicystic mass.
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Juvenile
papillomatosis of the breast. Ultrasound image. Palpation area with multiple small cysts. The mass is non-well circumscribed.
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Juvenile
papillomatosis of the breast. Axial fat-suppressed T2WI (fat suppressed). Multiple small clustered cysts in the upper inner quadrant of the right breast.
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Juvenile
papillomatosis of the breast. Axial T1WI. The mass is hypointense.
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Juvenile
papillomatosis of the breast. Axial post gadolinium T1WI (fat suppressed) showing a pattern of slow and progressive enhancement (type I curve).
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Juvenile
papillomatosis of the breast. Axial post gadolinium kinetic curve showing progressive uptake curve (type 1).
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Juvenile
papillomatosis of the breast. Axial DWI. High signal with high values on ADC.
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Juvenile
papillomatosis of the breast. ADC. High signal with high values (1.7x10-3mm/s).
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Juvenile
papillomatosis of the breast. Sagittal view. Segmental distribution of the mass (larger diameter 6 cm).
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Juvenile
papillomatosis of the breast • Emmental (Swiss) cheese - creative commons (photograph) - Ganzer Fall bei Radiopaedia
Knipe H, Emmental (Swiss) cheese - creative commons (photograph). Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-38767 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Juvenile papillomatosis (JP) of the breast is a relatively common benign localized proliferative lesion in the breast.

Epidemiology

As the name implies, it is mainly seen in young women (mean age ~19-23 years ) 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 .

Mammography

These lesions are usually negative on mammography . 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:

  • T1: hypointense lobulated mass
  • T2: may show presence of multiple small internal cysts, best shownon this sequence and considered the most specific feature
  • T1 C+ (Gd): may show marked rapid enhancement
  • 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 .

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