Intraductal Papilloma

Question 1

What is it?

Answer 1

An intraductal papilloma is a warty lesion that grows within one of the ducts in the breast. It is the result of the proliferation of epithelial cells. The typical presentation is with clear or blood-stained nipple discharge.

Intraductal papillomas are benign tumours; however, they can be associated with atypical hyperplasia or breast cancer.

Question 2

Presentation?

Answer 2

Intraductal papillomas can occur at any age, but most often occur between 35-55 years.

Intraductal papillomas are often asymptomatic. They may be picked up incidentally on mammograms or ultrasound.

They may present with:

Nipple discharge (clear or blood-stained)
Tenderness or pain
A palpable lump

Question 3

Diagnosis ?

Answer 3

Patients require triple assessment with:

Clinical assessment (history and examination)
Imaging (ultrasound, mammography and MRI)
Histology (usually by core biopsy or vacuum-assisted biopsy)

Ductography may also be used. This involves injecting contrast into the abnormal duct and performing mammograms to visualise that duct. The papilloma will be seen as an area that does not fill with contrast (a “filling defect”).

Question 4

Management

Answer 4

Intraductal papillomas require complete surgical excision. After removal, the tissue is examined for atypical hyperplasia or cancer that may not have been picked up on the biopsy.