Objective: Complex summary addressing current view of the intraductal papillary lesions of breast, especially focused on morphology, exact terminology and clinicopathological aspects of effective therapy. Design: Review article. Setting: Biopsy Lab s.r.o. and Šikl’s Department of Pathology, Charles University and Faculty Hospital, Pilsen. Methods: Summarized recent data, diagnostic principals and clinicopathological recommendations of papillary breast lesions created comprehensive guide for daily diagnostic and therapeutic practice. Results: The group of papillary tumors of the breast includes various lesions with different biologic potential. They are all presenting as pure intraductal lesions, but in case of multiple peripheral distribution imply possible risk for aggressive behavior. The reason is frequent occurrence of atypical ductal hyperplasia/intraductal (in situ) carcinoma in the adjacent tissue. Spectrum of secondary changes further complicates the diagnosis of papillary tumors, especially in core needle biopsy. Atypical papilloma is still very controversial issue and it essentially means situation when atypical ductal hyperplasia/conventional ductal in situ carcinoma arises in preexisting papillomas or extends to it from neighborhood. Generally, papillary lesions are suitable for effective conservative treatment in the case of proper clear resection margin. Finding of benign papilloma in core biopsy remains unsolved question yet.

        Key words: breast, intraductal papillary lesions, papillomas, atypical papilloma, intracystic papillary carcinoma