Breast papillary neoplasms are a heterogeneous group of proliferative epithelial lesions. Although precise classification can be challenging at times, application of established diagnostic criteria, often combined with immunohistochemical markers, typically allows for accurate categorization. This article focuses on papillary epithelial neoplasms of the breast, classified according to the World Health Organization 5th Edition of Tumors of the Breast, with preliminary insights into the upcoming 6th Edition. Emphasis is placed on unresolved issues and the differential diagnosis with other breast and cutaneous neoplasms.