Papillary lesions of breast represent a range of lesions. Intraductal papilloma and its association with nipple discharge are well known. However, multiple papillomatosis has quite distinct characteristics and decision making can be somewhat challenging. We report a case of multiple papillomatosis in association with ductal carcinoma in situ (DCIS). Patient opted for ipsilateral mastectomy and prophylactic mastectomy of contralateral breast. Her decision of having prophylactic mastectomy was vindicated by presence of incidental DCIS in the contralateral breast. To our knowledge, this is the first reported case of multiple papillomatosis with DCIS of breast, along with incidental synchronous papillomatosis of contralateral breast with DCIS. The case illustrates few distinct features of multiple papillomatosis of breast and exemplifies how a patient's choice is so paramount in decision making process. Patients should be fully informed of the treatment options of the condition, and their wishes should be fully taken into account while making the final decision. 1. Introduction Papillary lesions of breast have varied morphological, radiological, and pathological features. Such lesions are characterized by formation of epithelial fronds that have both the luminal epithelial and the outer myoepithelial cell layers, supported by a fibrovascular stroma [1]. Papillomas of the breast can be divided into solitary papillomas, juvenile papillomatosis, and multiple papillomatosis [2]. Their malignant potentials vary and may have an impact on patients’ decision making process. We report a case of multiple papillomatosis of breast where patient’s choice of treatment was affected by the anxiety of risk of malignancy and decided to opt for prophylactic mastectomy. 2. Case Report A 41-year-old woman presented with chief complaint of a lump in right breast of eight weeks duration. Her maternal aunt had breast cancer at age fifty-five. On examination, a firm 2.5 × 2？cm2 mass was felt in upper outer quadrant (UOQ) of right breast. Mammogram showed round soft tissue opacity in OUQ of right breast (M2). Ultrasound scan showed a solid nodule suggestive of fibroadenoma measuring 21 × 17 × 17？mm3 in the lateral aspect (U3) of right breast (Figure 1). Figure 1: Ultrasound scan of the upper outer quadrant lesion of the right breast. Fine-needle aspiration cytology of UOQ lesion of the right breast was noted to be C4, but core biopsy showed benign papillary proliferation (B3). Excision biopsy of the lesion demonstrated multiple papillomatosis containing areas of atypical ductal
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