Ductal papilloma

Question 1

Define a ductal papilloma.

Answer 1

Wart like lump that develops in one or more of the milk ducts in the breast.

Usually close to the nipple but can be found anywhere in the body.

Question 2

Who does it affect?

Answer 2

Most common in women over 40 and usually develop naturally as the breast ages.

Question 3

What is the aetiology of a ductal papilloma?

Answer 3

· Can be associated with atypical hyperplasia – abnormal growth of cells.

Question 4

What are the possible risk factors of a ductal papilloma?

Answer 4

· CENTRAL&raquo_space;> develop near the nipple, generally in women nearing the menopause.

· PERIPHERAL&raquo_space;> often multiple papilloma’s, younger women.

Question 5

What are the common presenting symptoms?

Answer 5

· Bloody discharge.
· Generally do not show up on mammogram due to their small size.
· Often too small to be palpated or felt o/e.
· Generally not painful but may have some pain or discomfort in that area.

Question 6

What is the 1st line investigation for a suspected ductal papilloma?

Answer 6

· MAMMOGRAM – may be negative.

· BREAST ULTRASOUND – dilated duct with oval mass.

· BREAST DUCTOGRAM – filling defect of duct.

Question 7

What other investigations may be done to confirm the diagnosis?

Answer 7

BREAST BIOPSY – papillary growth pattern: benign papilloma or atypia, papillar ductal carcinoma in situ or invasive papillary carcinoma.

Question 8

What is the treatment option?

Answer 8

· EXCISION – microdochectomy (removal of breast duct).

Total Duct Excision – possibility, difficult to find all of the ducts.