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<p>Intraductal papilloma (IDP) is a common benign papillary lesion of the breast, but giant variants exceeding 5&#xa0;cm are exceptionally rare and often pose a diagnostic dilemma. Their unusual size, complex imaging features, and overlap with malignant papillary neoplasms make accurate diagnosis particularly challenging.&#xa0;A 63-year-old woman presented with a one-year history of a right breast lump measuring 8 × 7&#xa0;cm. Examination revealed a firm retroareolar mass with palpable axillary nodes. Ultrasonography showed a complex solid-cystic lesion (BIRADS IV-B). FNAC and biopsy suggested a papillary neoplasm with possible atypia. Immunohistochemistry confirmed intact myoepithelial cells (p63, CK5/6, SMA, calponin) and heterogeneous ER positivity, consistent with intraductal papilloma. Wide local excision was performed, and histopathology confirmed a giant IDP without atypia or malignancy.&#xa0;Giant IDPs, though benign, closely simulate malignant papillary tumors and risk misdiagnosis. Multimodal evaluation with histopathology and IHC is essential. Complete surgical excision remains the standard of care to ensure diagnosis, rule out carcinoma, and prevent recurrence.</p>

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When Benign Mimics Malignancy: A Case of Giant Intraductal Papilloma

  • 期刊论文

  • 发表日期：

    2026年1月7日

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  • Reshmi Sultana,
  • Tushar M. Parmeshwar,
  • Nynasindhu Akula,
  • Immanuel Pradeep

摘要

Intraductal papilloma (IDP) is a common benign papillary lesion of the breast, but giant variants exceeding 5 cm are exceptionally rare and often pose a diagnostic dilemma. Their unusual size, complex imaging features, and overlap with malignant papillary neoplasms make accurate diagnosis particularly challenging. A 63-year-old woman presented with a one-year history of a right breast lump measuring 8 × 7 cm. Examination revealed a firm retroareolar mass with palpable axillary nodes. Ultrasonography showed a complex solid-cystic lesion (BIRADS IV-B). FNAC and biopsy suggested a papillary neoplasm with possible atypia. Immunohistochemistry confirmed intact myoepithelial cells (p63, CK5/6, SMA, calponin) and heterogeneous ER positivity, consistent with intraductal papilloma. Wide local excision was performed, and histopathology confirmed a giant IDP without atypia or malignancy. Giant IDPs, though benign, closely simulate malignant papillary tumors and risk misdiagnosis. Multimodal evaluation with histopathology and IHC is essential. Complete surgical excision remains the standard of care to ensure diagnosis, rule out carcinoma, and prevent recurrence.