benign ductal disease Flashcards
definition of papilloma
solitary or multiple benign lesions that arise from the epithelium of ducts
definition of duct ectasia
subareolar periductal chronic inflammatory condition defined by dilated mammary ducts which are eventually clogged
aetiology of papilloma
unknown
aetiology of duct ectasia
inspissated luminal secretion stasis leading to periductal inflammation and fibrous obliteration
ducts become blocked and the secretions stagnate
harmless, age-related breast change - causes milk duct under vessel to be clogged with thick, sticky substance
epidemiology of papilloma
peak incidence - 40-50yrs
solitary lesions - 48yrs
multiple lesions - 41yrs
epidemiology of duct ectasia
most common in perimenopausal women
40-50yrs
sx of papilloma
it is a benign growth in the duct system
can cause discharge
they’re fragile so bleed = leaking blood
solitary lesions
- most common cause of bloody discharge
- large, central lesion
- palpable breast tumour close to or behind the nipple
multiple lesions
- usually asymptomatic but may cause nipple discharge in rare cases
- peripheral lesions, smaller than solitary papilloma
sx of duct ectasia
unilateral greenish/brown or bloody discharge
nipple inversion
firm, stable, painful mass under the nipple (may mimic breast cancer)
may progress to a breast abscess
signs of papilloma
mass small - not always palpable
signs of duct ectasia
firm, stable, painful mass under the nipple
Ix for papilloma
if discharge even if single duct, mammograph/US can be normal
so have to do surgery - Microdochectomy (removal of the duct) to see if benign or not
can test the fluid - cytology - look at the cells.
- some centres see if the cells are normal, bad or ugly - here they just see if there are ductal cells and if there are they remove the duct
US - dilated duct with oval mass
breast ductogram - filling defect of duct
biopsy - papillary growth pattern: benign papilloma, or atypua, papillary ductal carcinoma in situ, or invasive papillary carcinoma
if lesion is palpable - core needle biopsy is confirmatory and rules out malignancy. shows papillary cells with fibrovascular core
otherwise - ductogram - A mammogram with contrast injection to visualize the breast milk ducts. This test allows for better visualization of small lesions (compared to regular mammogram) and helps to guide core needle biopsy.
ix for duct ectasia
mammogram and/or US - noninvasive imaging modalities can determine duct diameter
if suspicious/inconclusive findings - perform biopsy: shows a central cavity filled with neutrophils and secretion surrounded by inflamed and/or fibrotic breast parenchyma, with obliteration of the ducts
mx of papilloma
microdochectomy - removal of lactiferous duct
