Ductal papilloma

Question 1

How common is it?

Answer 1

2-3% incidence

Question 2

What causes it?

Answer 2

Breast aging and changes

Question 3

What risk factors are there?

Answer 3

Central types develop near the nipple, generally in women nearing the menopause.
Peripheral types are often multiple papilloma’s, and are found in younger women

Question 4

How does it present?

Answer 4

They are the most common cause of bloody nipple discharge in women aged 20-40 and generally do not show up on mammography due to their small size. You may feel a small lump or notice a discharge of clear or bloodstained fluid from the nipple. Generally, intraductal papilloma’s aren’t painful but some women can have discomfort or pain around the area. Also they don’t increase the risk of breast cancer

Question 5

Signs on examination?

Answer 5

Often too small to be palpated or felt

Question 6

Investigations?

Answer 6

Intraductal papilloma’s can be found by chance following routine breast screening (a mammogram or breast x-ray), after breast surgery or if you go to your GP (local doctor) with symptoms. You would then be referred and you would have your triple assessment. If you’re under 40 you’re more likely to get an ultrasound. FNA. Core needle biopsy.

Question 7

Treatment?

Answer 7

Excision is sometimes performed, microdochectomy (removal of breast duct) is the treatment of choice. Also a total duct excision is also a possibility, but it is quite difficult to find all of the ducts.

Question 8

Differential?

Answer 8

Cancer