• Еуромедик, Булевар уметности 29, Београд
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INTRADUCTAL PAPILLOMA

Прим др Милош Почековац

 Др Сава Стајић

Др Јасна Илић

Др Драган Стојановић

What are intraductal papillomas?

Intraductal papillomas of the breast are benign lesions with an incidence of about 2-3%(1).

     They are divided into two main categories: solitary (central) papillomas and multiple (peripheral) papillomas. They may be associated with ductal hyperplasia, atypical ductal hyperplasia (ADH) or lobular hyperplasia(2).

The clinical picture of intraductal papilloma is bloody content on the nipple or a palpable mass behind the nipple in solitary papillomas. The cause of the bleeding is thought to be the pressure of the papilloma on the fibrovascular stroma, which leads to necrosis, ischemia and eventually bleeding.

Solitary papillomas

Solitary (central) intraductal papillomas are tumors of the main lactiferous ducts, near the nipple, which can block the ducts leading to their expansion. They most often occur in women aged 30 to 50. These lesions are generally less than 1 cm in diameter, usually 3 to 4 mm. Occasionally, they can be larger than 4 or 5 cm.

     Histologically, these tumors are composed of multiple, granular papillae, each with a central fibrovascular stroma covered by a layer of epithelial cells. A layer of myoepithelial cells is often seen between the epithelial cells and the connective tissue

Multiple papillomas

Multiple papillomas are located on the periphery of the breast and are usually found in younger women. They are the most common cause of bloody nipple discharge in women aged 20-40 and are generally not seen on mammograms due to their small size. They can be detected by ultrasound. Galactography is the finest test, as the changes are small and unnoticeable, but it is somewhat invasive.

     We confirm the diagnosis with core biopsy and histopathological examination. Excision of the mammary duct is the treatment of choice(3).

     Papilloma recurrences are possible and are associated with the presence of proliferative breast lesions (including common ductal hyperplasia, atypical ductal hyperplasia, and lobular neoplasia) in the surrounding breast tissue. Epithelial atypia, even of ductal carcinoma in situ (DCIS), has no prognostic significance or impact on outcome when limited to a solitary or central papilloma. Therefore, if papilloma atypia is found on excisional biopsy, the surrounding breast tissue should be carefully examined for further monitoring of the patient (4).

According to the consensus of American pathologists, women with intraductal papilloma have 1.5-2 times higher risk for the development of invasive cancer during their lifetime (1).

The presence of atypical ductal hyperplasia (ADH) in the papilloma and surrounding breast tissue is associated with an increased risk of recurrence (5) or invasive cancer (6).

The risk of breast cancer is particularly high (seven times) in women with multiple or peripheral papillomas with atypia (7,8,9), as well as in people with a positive family history (10).

Treatment of intraductal papilloma is surgical excision, together with the duct in which it is located, in order to avoid a large number of diagnostic procedures (11).

ULTRASOUND AND MAMMOGRAPHY VERIFIED INTRADUCTAL PAPILLOMA

surgically exstracted intraductal papiLloma

Литература

1. Cilotti A, Bagnolesi P, Napoli V, Lencioni R, Bartolozzi C (November 1991). “[Solitary intraductal papilloma of the breast. An echographic study of 12 cases]”. La Radiologia Medica (in Italian). 82 (5): 617–20.

2. Cyr AE, Novack D, Trinkaus K, Margenthaler JA, Gillanders WE, Eberlein TJ, et al. Are we overtreating papillomas diagnosed on core needle biopsy? Ann Surg Oncol. 2011;18:946–951.

3. Ahmadiyeh N, Stoleru MA, Raza S, Lester SC, Golshan M (August 2009). “Management of intraductal papillomas of the breast: an analysis of 129 cases and their outcome”. Annals of Surgical Oncology. 16 (8): 2264–9

4. MacGrogan G, Tavassoli FA. Central atypical papillomas of the breast: a clinicopathological study of 119 cases. Virchows Arch 2003;443:609– 617

5. Raju U, Vertes D (1996) Breast papillomas with atypical ductal hyperplasia: a clinicopathologic study. Hum Pathol 27:1231–1238

6. Page DL, Salhany KE, Jensen RA, Dupont WD (1996)Subsequent breast carcinoma risk after biopsy with atypia ina breast papilloma. Cancer 78:258–266

7. Song-Hee Han, Milim Kim, Yul Ri Chung, Bo La Yun, Mijung Jang, Sun Mi Kim,Eunyoung Kang, Eun-Kyu Kim, and So Yeon Park– Benign Intraductal Papilloma without Atypia on Core Needle Biopsy Has a Low Rate of Upgrading to Malignancy after Excision- J Breast Cancer. 2018 Mar; 21(1): 80–86. Published online 2018 Mar 23.

8.  Tarallo, V; Canepari, E; Bortolotto, C (June 2012). “Intraductal papilloma of the breast: A case report”. Journal of Ultrasound. 15 (2): 99–101.

9. Lewis JT, Hartmann LC, Vierkant RA, et al. An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol 2006;30(6):665–672.

10. Schacht DV, Yamaguchi K, Lai J, Kulkarni K, Sennett CA, Abe H. Importance of a personal history of breast cancer as a risk factor for the development of subsequent breast cancer: results from screening breast MRI. AJR Am J Roentgenol. 2014;202:289–292.

11. Niinikoski L, Hukkinen K, Leidenius MHK, Ståhls A, Meretoja TJ – Breast Lesion Excision System in the diagnosis and treatment of intraductal papillomas – A feasibility study- Eur J Surg Oncol. 2018 Jan;44(1):59-66.