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.
Typically present in women in their late reproductive or post-menopausal years (with an average age at presentation of 48 years), although increasing use of breast ultrasound has resulted in more frequent detection of papillary lesions in younger, asymptomatic women.
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.
Intraductal 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.
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 atypia or malignancy.
Mammograms are frequently normal (particularly 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 cluster of calcifications.
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.
Papilloma may be seen as a well-defined solid nodule or intraductal mass which may either fill a duct or be partially outlined by fluid - either within a duct or by forming a cyst. Colour doppler will demonstrate a vascular stalk.
A dilated duct can be frequently visible sonographically.
Treatment and prognosis
Most centres treat solitary intraductal papillomas with surgical excision, even after benign biopsy, to exclude components of atypia or neoplasia. There is however some controversy surrounding this, with some groups suggesting that clinical followup is sufficient if there is no atypia (including ADH) on core biopsy7.
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.
The differential includes other solid tumours that can occur in the large ducts, specifically:
- ductal carcinoma in situ
- invasive ductal carcinoma with an in situ component.
- papillary carcinoma of the breast can mimic an intraductal papilloma (particularly on ultrasound).
For ultrasound appearances also consider:
- inspissated secretions within a dilated duct may mimic papillomas, but have no associated vascularity
- complex breast abscess with debris: solid component mobile
- fat necrosis: also no Doppler vascularity
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- 2. Ganesan S, Karthik G, Joshi M et-al. Ultrasound spectrum in intraductal papillary neoplasms of breast. Br J Radiol. 2006;79 (946): 843-9. doi:10.1259/bjr/69395941 - Pubmed citation
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- 5. Woods ER, Helvie MA, Ikeda DM et-al. Solitary breast papilloma: comparison of mammographic, galactographic, and pathologic findings. AJR Am J Roentgenol. 1992;159 (3): 487-91. AJR Am J Roentgenol (abstract) - Pubmed citation
- 6. Eiada R, Chong J, Kulkarni S et-al. Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances. AJR Am J Roentgenol. 2012;198 (2): 264-71. doi:10.2214/AJR.11.7922 - Pubmed citation
- 7. Agoff SN, Lawton TJ. Papillary lesions of the breast with and without atypical ductal hyperplasia: can we accurately predict benign behavior from core needle biopsy?. Am. J. Clin. Pathol. 2004;122 (3): 440-3. doi:10.1309/NAPJ-MB0G-XKJC-6PTH - Pubmed citation
Synonyms & Alternative Spellings
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|Solitary intraductal papilloma of the breast||✓|
|Solitary intraductal papilloma of breast||✗|
|Solitary intraductal papilloma||✓|