Intraductal papilloma of breast

Intraductal papillomas, or more specifically solitary intraductal papillomas of the breast, are benign breast lesions. Papillomas are the most common intraductal mass lesions of the breast.

Typically present in women in their late reproductive or postmenopausal 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 (serosanguineous) nipple discharge of fewer than six months duration. The bloody nipple discharge is thought to be due to twisting of the papilloma on its fibrovascular pedicle, leading to necrosis, ischemia, and intraductal bleeding.

Intraductal papillomas are broadly classified into central and peripheral types, with the central ones usually being solitary and subareolar in location within a major duct, while 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 blocking 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 of the nipple in 90% of cases. Those that are present in peripheral ducts away from the nipple have a 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 subareolar in location), or a cluster of calcifications.

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

Galactography 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. Color Doppler will demonstrate a vascular stalk.

A dilated duct can be frequently visible sonographically.

Most centers treat solitary intraductal papillomas with surgical excision, even after benign biopsy, to exclude components of atypia or neoplasia. However, there is some controversy surrounding this, with some groups suggesting that clinical follow-up is sufficient if there is no atypia (including ADH) on core biopsy 7.

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 tumors that can occur in the large ducts, specifically:

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
Breast imaging and pathology
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Article information

rID: 13160
System: Breast
Synonyms or Alternate Spellings:
  • Intraductal papilloma
  • Solitary intraductal papilloma of the breast
  • Solitary intraductal papilloma of breast
  • Solitary intraductal papilloma

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