Intraductal papilloma (breast MRI)

Case contributed by Bahman Rasuli
Diagnosis certain


Left-sided nipple discharge.

Patient Data

Age: 25 years
Gender: Female

The focal dilated duct extends from the nipple posteriorly toward the mid-zone of the left breast over a length of 44 mm is seen associated with an 8*13 mm large intraductal enhancing mass at the wall of the duct, a finding suggestive for intraductal papilloma. 

Time–signal intensity curve of the tumor shows rapid initial enhancement with typical washout pattern.

The region of non-mass like enhancement is present at lower outer part (8 O'clock) of the left breast, 72 mm far from the nipple in the posterior zone, with type I kinetic curve in favor of benign lesion such as FCC patch.

A few foci of enhancement also are seen in the breasts.

Case Discussion

Intraductal papilloma is similar to invasive ductal carcinoma in the some of the MRI features such as irregular borders, rapid and conspicuous initial enhancement, a washout enhancement pattern as well as a low ADC value on DWI. 

Understanding the MRI feature of intraductal papilloma (relatively lower early-phase enhancement rate compared with IDC and the evolution of its enhancement pattern from homogeneous or heterogeneous enhancement to rim enhancement in some cases) that can differentiate intraductal papillomas from small invasive ductal carcinoma.

Regarding the imaging findings and dynamic curve, US-guided biopsy was recommended and histopathology revealed: arborescent structures composed of fibrovascular stalks covered by a layer of myoepithelial cells compatible with intraductal papilloma.

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