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Intraductal papilloma of breast

Intraductal papilloma (or more specifically solitary intraductal papilloma of the breast) is a benign breast lesion. Papillomas are the most common intraductal mass lesions of the breast. 

Epidemiology

Most typically occur in women in their late reproductive or post-menopausal years (with a average age at presentation of 48 years). 

Clinical presentation

Patients typically report a bloody or clear (serosanguinous) nipple discharge of less than 6 months duration. The bloody nipple discharge is thought to be due to twisting of the papilloma on its fibrovascular pedicle, leading to necrosis, ischaemia, and intra ductal bleeding.

Pathology

Intra ductal papillomas are broadly classified into central and peripheral types with central ones usually being solitary and subareolar in location within a major duct, whilst peripheral types tending to be multiple within the terminal duct lobular unit.

Solitary intraductal papillomas are 2-3 mm and appear as broad-based or pedunculated polypoid epithelial lesions that may obstruct and distend the involved duct. They may cause cysts by obstructing the duct. 

Solitary intraductal papillomas should be distinguished pathologically and clinically from papillomatosis of the breast, a condition in which multiple papillomas exist in more than one duct system and which is considered a premalignant condition. 

Sub types
Location

Papillomas often present in the subareolar region. They arise within 1 cm from the nipple in 90% of cases. Those that are present in peripheral ducts away from the nipple have greater incidence of malignancy.

Radiographic features

Mammography

Mammograms are frequently normal (particualrly with small intraductal papillomas. When imaging findings are present, they include solitary or multiple dilated ducts, a circumscribed benign-appearing mass (often sub areolar in location), or a suspicious cluster of calcifications.

Galactography: ductography

Galactography usually reveals a filling defect or other ductal abnormality, such as ectasia (usually between the nipple and filling defect) , obstruction, or irregularity. However, these findings are non-specific. 

Galatography may outline the number, location, extent, and distance from the nipple. 

Breast ultrasound 

Papillomas may be seen as a well-defined, smooth-walled, solid, hypoechoic mass or a lobulated, smooth-walled, cystic lesion with some solid components. A dilated duct can be frequently visible sonographically. 

Treatment and prognosis

The treatment for solitary intraductal papillomas is duct excision. Given the increased risk of malignancy over a woman's lifetime when this lesion is diagnosed, compliance with screening recommendations for such patients is strongly advisable.

According to a consensus committee of the College of American Pathologists, women with this lesion have a relative risk of 1.5-2 times for developing invasive breast carcinoma in their lifetime.

Differential diagnosis

The differential includes other solid tumours that can occur in the large ducts, specifically:

For ultrasound appearances also consider:

See also

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