Intraductal papilloma
Intraductal papilloma is a benign papillary tumor of a single lactiferous duct beneath the areola and is the most common cause of unilateral bloody or serosanguinous nipple discharge in the nonlactating patient, confirmed by age-based breast imaging plus core needle biopsy and treated with surgical excision of the involved duct because of an associated risk of atypia or ductal carcinoma in situ.
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What this article covers
- Overview
Intraductal papilloma is a benign papillary tumor arising within a single lactiferous duct, almost always beneath the areola, composed of papillary epithelial cells growing from the duct wall into the lumen.
- Epidemiology
Intraductal papilloma can occur at any age after menarche but is most common in middle-aged adults, roughly the 40s to 50s.
- Risk factors
Middle age (40s to 50s): the peak incidence window for solitary intraductal papilloma.
- Pathophysiology
A papillary proliferation of ductal epithelial cells grows from the duct wall into the lumen, forming a frond-like intraluminal tumor within a single subareolar duct.
- Clinical features
Unilateral, spontaneous, serous or serosanguinous nipple discharge from a single duct is the hallmark and presenting complaint in a middle-aged, nonlactating woman.
- Differential diagnosis
Invasive ductal carcinoma: unilateral bloody discharge with a hard, palpable mass more typical; risk rises with age, so imaging and biopsy are mandatory to exclude it.
- Diagnosis
There is no formal clinical diagnostic criteria set; the diagnosis is confirmed histologically: core needle biopsy of the imaging-identified lesion establishes the diagnosis, and surgical excision is…
- Management
First, obtain histologic confirmation with core needle biopsy or fine-needle aspiration of the imaging-localized lesion, with clip placement if there is any concern for malignancy on imaging.
- Complications
Missed coexisting ductal carcinoma in situ or invasive carcinoma if excision is deferred or core biopsy alone is relied upon without excision, the most serious potential consequence of undertreatment.
- Prognosis
Excellent after excision: a solitary intraductal papilloma without atypia is cured by excision of the involved duct.
- Prevention
There is no primary prevention for intraductal papilloma itself; it is not associated with a modifiable risk factor.
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- Breast cancer
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Paget disease of the breast is an intraepidermal adenocarcinoma of the nipple that signals an underlying ductal carcinoma in nearly every case. Diagnosis is confirmed by full-thickness nipple biopsy, and first-line treatment is surgical excision of the nipple-areolar complex with radiation and, for hormone-receptor-positive disease, adjuvant tamoxifen or an aromatase inhibitor.