CASE REPORT: Multiple Bilateral Papillomatosis

BACKGROUND: Breast papilloma is a benign tumor that affects women between the third and fifth decades of life. The article reports a patient of 41 years with multiple bilateral papillomatosis. She underwent breast-conserving surgery with rapid recurrence of the lesions. We performed a bilateral mastectomy with immediate breast reconstruction. For the high evidence of malignant transformation in multiple papillomatosis, and their association with intraductal carcinoma and recurrence of lesions, there is a strong tendency to radical surgery with preservation of the skin and papillary-areola complex. When the option is to conservative surgery, follow up with annual mammography should be done. REPORT: Female patient, 41 years, reported multiple nodules in both breasts, in greater numbers to the right, which gradually emerged about 20 years. Childless with menarche at 15 years and had no cases of malignancy or in cases similar to your family. Reports that at age 20 palpated lump in right breast that was diagnosed as fibrocystic breast disease after ultrasonography. At 30, she noticed new nodules in both breasts, with different consistency of the above, sought medical assistance at the time, but did not follow the proposed therapy. At 39 years, held two nodes resection of the right breast with histopathologic diagnosis of multiple atypical papilloma and was then referred to Mastology Service of Hospital Geral de Fortaleza. The patient underwent biopsy in March 2006 which showed papillomatous lesion the breast suggestive of papilloma stromal sclerosis associated with sclerosing adenosis. Immunohistochemistry performed in May 2006 were positive for p63 and calponin, no expression for cytokeratin. In July 2006 held bilateral resection of the lesions, however, there was early recurrence of the lesions and the patient underwent bilateral nipple sparing mastectomy in July 2007 and immediate bilateral breast reconstruction with silicone prosthesis. No postoperative complications. DISCUSSION: Since there is no consensus regarding the treatment of injuries, but based on evidence from the literature that consider multiple papilloma a premalignant lesion and every breast ductal system is affected, prophylactic mastectomy was performed in order to increase overall survival and free of disease of the patient. Associated with this, the patient experienced a rapid recurrence of the lesions, which reinforced the indication of radical surgical treatment.