DUCTAL PAPILLOMA

Question 1

Common or rare?

Answer 1

Rare

Question 2

Benign or malignant?

Answer 2

Benign

Question 3

3 types:

Answer 3

1. Inverted ductal papilloma
2. Sialadenoma papilliferum
3. Intraductal papilloma

Question 4

Where can a intraductal papilloma be?

Answer 4

a. central - near the nipple, solitary and often arise in the period nearing menopause
b. peripheral - multiple papillomas in peripheral breast. Younger women. Higher risk of malignancy.
c. Most common cause of bloody nipple discharge in women aged 20-40. Small size, so often don’t show up on mammography. Masses often too small to be palpated or felt, so a galactagram is necessary to rule out the lesion.
d. Excision or microdochectomy (removal of a breast duct) is the treatment of choice.

Question 5

Solitary or multiple?

Answer 5

Can be either

Question 6

What is the incidence?

Answer 6

2-3%

Question 7

What is it the most common cause of?

Answer 7

Most common cause of bloody nipple discharge in women aged 20-40

Question 8

Intraductal papilloma is most common in which age group?

Answer 8

35 and 55

Question 9

How can it present but often doesn’t?

Answer 9

can present as a lump, but is often too small to palpate, may change upon pressure

Question 10

Most common symptom?

Answer 10

nipple discharge which may be clear or bloody.

Question 11

Most common presentation?

Answer 11

Nipple discharge with no palpable lump

Question 12

What other symptoms are there?

Answer 12

• Breast enlargement
• Breast pain
• Central or peripheral mass often too small to be palpated or felt
• Bloody nipple discharge
• Usually asymptomatic and found incidentally on breast biopsies

Question 13

What investigations?

Answer 13

• Mammogram should be performed but may not show a papilloma (too small).
o Galactogram (Ductography (also called galactography or ductogalactography) is a special type of contrast enhanced mammography used for imaging the breast ducts.)
• USS: more accurate imaging technique to view these small lesions.
• A physical breast examination should be performed to rule out malignancy elsewhere which may be a cause of bloody discharge.
• Fine needle aspiration/breast biopsy: A biopsy would be performed of the lump to screen for malignancy
• Examination of nipple discharge: The discharge, if present, can be studied to see if the cells are cancerous.

Question 14

What is the management?

Answer 14

Surgical excision followed by biopsy to confirm that it is not cancer.
If discharge is still a problem, can remove some of the breast ducts.

Question 15

What is the prognosis? (what indicates good or poor prognosis?)

Answer 15

Excellent if solitary and central.

Peripheral and multiple associated with higher risk of breast cancer, esp. < 35yrs.