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Case 5 Clinical history This 31 year old patient presented with a palpable mass in the left breast. Imaging (ultrasound) was indeterminate. NCB showed some papillary structures - uncertain malignant potential - B3. In view of this a diagnostic excision biopsy was performed. Histological appearances - A-D The section shows a nodular lesion with a complex pattern of changes, with a mixture of papillary areas, adenomatous structures including sclerosing adenosis, cysts with apocrine change and associated fibrosis. Some focal entrapped tubules are present. The papillary and adenomatous foci are composed of epithelial structures with a bilaminar configuration and there is no nuclear atypia. Differential diagnosis Florid fibrocystic change Complex sclerosing lesion Complex sclerosing papillary lesion (Ductal adenoma) Papillary carcinoma in situ The bilaminar pattern and lack of nuclear atypia rule out a malignant process. It is highly likely that the benign processes noted above form a spectrum, with considerable overlap with complex sclerosing lesions. Because of the presence of a significant number of papillary structures, and the overall nodular nature we prefer to use the term 'complex sclerosing papillary lesion'. Final diagnosis Complex sclerosing papillary lesion Further management No follow up required Learning points · Immunostaining with anti-smooth muscle actin is useful in confirming a bilaminar pattern and excluding malignancy. · Terminology in these lesions should be based on the dominant architectural pattern. |