INTRADUCTAL PAPILLOMA

Primarius Milos Pocekovac MD, PhD

Sava Stajic MD, MSc

 Jasna Ilic MD

Dragan Stojanovic MD

What are intraductal papilloma?

Intraductal papilloma is a benign lesion of incidence around 2-3%.
They are divided into two categories: solitary (central) papilloma and  multiple (peripheral) papilloma. They can be related to ductal hyperplasia, atypical ductal hyperplasia or lobular hyperplasia.

Clinical finding of intraductal papilloma is a blood content on the nipple or a palpable mas right behind it in solitary papilloma. It is believed that the cause of bleeding is the pressure of papilloma on the firbovascular stroma which leads to necrosis and consequently bleeding.

Solitary papilloma

Solitary or central intraductal papillomas are tumors of the main lactiferous ducts, close to the nipple, that can block the canals leading to their widening. Most often they appear in women aged between 30 to 50 years. These lesions are usually smaller than 1cm in diameter, mostly 3 to 4mm. Occasionally they can be bigger from 4 to 5cm.  

Histologically, these tumors are made from multiple granulated papillas, each with a central fibrovascular stroma covered in multiple layers of epithelial calls. Between the epithelial cells and connective tissue often there is a myoepithelial cell layer.

Multiple papilloma

Multiple papillomas are found in the periphery of the breast in younger women. They are the most common cause of bloody content coming from the nipple in women aged from 20 to 40 years of age. They are usually not detectable on mammogram due to their size. They can be discovered upon ultrasound. Galactography is the most precise test, that can detect even small and non-palpable lesions, but it is invasive

Core biopsy and histological confirmation is necessary. Excision of the breast canal is the treatment of choice.

Relapse of papilloma is possible and connected to the presence of proliferative lesions of breast (including ductal hyperplasia, atypical ductal hyperplasta or lobular neoplasia) in the surrounding breast tissue. Atypia in the epithelial cells even in the in situ intraductal carcinoma (DCIS), has no prognostic significance on the outcome, when it is limited to solitary or central papilloma. Because of this if the atypia is found on excision biopsy, the surrounding tissue should be closely monitored and followed up.  

According to the consensus of American pathologists, women with intaductal papilloma have a relative risk for breast cancer 1,5 to 2 times larger for developing invasive carcinoma during their life span.

Presence of atypical ductal hyperplasia in the papilloma or the surrounding tissue is connected to the risk of relapse or even invasive carcinoma.

Risk of breast cancer is very high (7 times higher) in women with multiple or proliferative papilloma with atypia. This is also in women with positive family history.

Treatment of intraductal papilloma is a surgical excision, that includes the canal in which it is found, to avoid a large number of diagnostic procedures.