Necrosis in the breast is more frequently associated with
malignancies than benign conditions. In the latter, it may be diffuse as seen in
infarcts, postpartum changes, and after
anticoagulant therapy, or focal as in florid adenosis and juvenile
papillomatosis. The goal of this study was to find other benign entities associated with
necrosis. Using our pathology database from January 1994 to March 2003, we identified 10 cases of florid duct
hyperplasia associated with
luminal necrosis. Clinical information was collected and all slides were reviewed. The age of the patients ranged from 36 to 94 years (mean, 53.2 years). All patients underwent an initial excisional biopsy except for one who had a core biopsy. Patients presented with a palpable mass (6 cases) a radiographic density (3 cases), or nipple discharge (1 case). Findings correlated with the presence of an
intraductal papilloma with adjacent or associated florid duct
hyperplasia. Within the central
luminal spaces of the florid duct
hyperplasia, cellular debris associated with
necrosis was present and was morphologically identical to that seen in comedo
intraductal carcinoma. In fact, in two of the four consultation cases, these lesions were initially diagnosed as comedo
carcinoma. Re-excision performed in three cases showed no atypia or
malignancy. It is important to recognize the presence of comedo-like
necrosis in florid duct
hyperplasia associated with or adjacent to
intraductal papillomas of the breast and not to misinterpret these findings as
intraductal carcinoma. The
necrosis may be secondary to reactive changes within the
intraductal papilloma.