Ductal Papilloma

Question 1

What is ductal papilloma?

Answer 1

Small, benign tumour that forms in a milk duct in the breast.

The tumour consists of glandular and fibrous tissue + blood vessels

Papilloma = epithelial tissue which form outward finger like projections

Usually develops naturally as breast ages

Question 2

Who does ductal papilloma commonly affect?

Answer 2

Women between 35-55 years.

No risk factors for ductal papilloma

Question 3

What are the different types of ductal papillomas?

Answer 3

1. Solitary ductal papilloma : single tumour in a large milk duct felt as a small lump near the nipple
   => common cause of clear or bloody nipple discharge esp when it’s from one breast
   => sometimes painful
   => not assoc. with breast cancer
2. Multiple papillomas : clusters of small tumours in small ducts further away from the nipple
   => less likely to cause nipple discharge
   => linked to higher risk of breast cancer
3. Papillomatosis (sometimes grouped with ductal papillomas) : abnormal overgrowth of cells in milk ducts - assoc. with higher risk of breast cancer

Question 4

What are the symptoms of ductal papilloma?

Answer 4

Breast enlargement ; breast lump

Nipple discharge

Usually not painful but some women may experience discomfort / pain around the area

Question 5

How is ductal papilloma diagnosed?

Answer 5

Breast ultrasound - more effective in showing papillomas than mammogram (<40yrs)

Fine needle aspiration to rule out cancer

Surgical biopsy if nipple discharge

Microscopy of nipple discharge

Ductogram - X-ray with contrast dye injected into breast ducts

Question 6

How do you treat ductal papilloma?

Answer 6

Surgery to remove the papilloma and affected milk duct

=> Excision biopsy

=> Vacuum assisted excision biopsy - under ultrasound guidance, the tumour and affected duct is sucked through a probe by the vaccum into the collecting chamber

If symptoms persist:

=> Removal of affected ducts (microdochectomy)

=> Removal of all the major ducts (total duct excision)

Question 7

What is the prognosis for ductal papilloma?

Answer 7

Good prognosis once papilloma has been removed

=> follow-ups sometimes post surgery for people with atypical cells in their ductal papilloma or people with multiple ductal papilloma