Papillary lesions of the breast remain a challenge in the practice of surgical pathology, and this difficulty is further magnified by the abundance of varying terminologies. Furthermore, the management of benign papillomas diagnosed on core needle biopsy remains controversial. This article reviews the spectrum of papillary lesions of the breast with a focus on terminology and the diagnostic features of each entity. Diagnostic pitfalls and the use of immunohistochemistry are discussed. Management of papillary lesions diagnosed on image-directed core biopsies is also reviewed.