What is Intraductal Papilloma?
An intraductal papilloma is an example of a benign breast tumor. It usually develop along with degenerative changes of the breast and is commonly seen in women who are over 40 years of age [1, 2].
The breasts are composed of lobules and ducts and they are surrounded by fatty tissues. It is the lobules that yields the milk while the ducts delivers the produced milk to the nipple. An intraductal papilloma is a lump that is similar to a wart that forms in the ducts. These formations are usually found near the nipple although it may develop anywhere in the breast. It usually form in one breast only but it can also develop n both breasts simultaneously [1, 2, 3]. Figure 1 shows an example of intraductal papilloma.
Types
Solitary intraductal papilloma
This variation of intraductal papilloma forms in the larger milk ducts that are found near the nipple. The patient may feel this small lump either behind or beside the nipple. Having this type of papilloma does not increase the risk for breast cancer unless other changes such as atypical hyperplasia have been noted. The prognosis for patients with this type of papilloma is good once it is surgically removed [3, 4, 5].
Multiple papilloma
These formations are found in the milk ducts that are far from the nipple. They present as clusters of little tumors found in the smaller milk ducts. Aside from the lump that is felt, this type of papilloma cause any other symptoms. However, the presence of multiple papilloma is associated with increased risk for the development for breast cancer. This risk is associated with a precancerous breast condition known as atypical hyperplasia. Women who are over 40 years old that have developed multiple papilloma may discussed with her physician about her increased risk for breast cancer [3, 4, 5].
Causes and Risk Factors
Although the causes and risk factors associated to this condition are still unknown, intraductal papilloma commonly develop in women who are older than 40 years of age [3, 4, 5].
Causes of abnormal nipple discharge
Signs and Symptoms
A woman may feel these papilloma as either single lump near the nipple or as cluster of smaller lumps that is farther from the nipple area. These lumps may have a diameter of around 1-2cm but some of them may be larger. Some women may not be able to feel the presence of these lumps. There are also others who may experience discomfort or pain associated with the papilloma. Solitary papilloma can cause nipple discharge that can be clear or bloody. A woman may notice the appearance of the discharge on their clothes [1, 2, 5, 6].
Diagnosis
Health history and physical examination
The patient may seek consultation once the lump in the breast is felt or it may be discovered during a routine breast examination. The physician will identify other symptoms that may be present such as pain and nipple discharge. The size of the lump will also be monitored to identify any increase in its size [1, 2, 3].
Imaging tests
If the physician is suspecting an intraductal papilloma, he may order an imaging test such as a breast ultrasound. This test is more effective in visualizing the papilloma compared to a mammogram [1, 2, 3].
Discharge analysis
If nipple discharge is present, the physician may collect a sample of the discharge and perform a microscopic examination to look for the presence of tumor cells [1, 2, 3].
Breast biopsy
Performing a biopsy on the papilloma will identify the type of cell present and rule out the possibility of cancer. The biopsy may be done by inserting a needle into the breast or through a surgical procedure. A surgical biopsy may be more invasive but it will allow the physician to analyse the breast tissue more thoroughly [1, 2, 3].
Treatment
The treatment for intraductal papilloma is surgical removal. The procedure will be performed while the patient is under either general or local anesthesia depending on the location and size of the papilloma to be excised. The physician may use absorbable sutures to close the operative wound. This type of suture will be absorbed by the body and does not need to be removed.
If non-absorbable sutures are utilized, the patient may come back after a few days to have these sutures removed. The physician will tell the patient if there is a need to have the sutures removed. This procedure may leave a scar in the breast but it will fade in due time. All the tissues that were removed during the procedure and will be examined. The result of the biopsy will indicate if the patient requires further treatment [1, 2, 3].
Prevention
There is no known way to prevent intraductal papilloma from occurring but it could be detected early through regular self-breast examination and undergoing breast screening. The symptoms of this condition is similar to other breast tumor so women are advised to seek consultation once a lump is noted in their breasts [2].
References
- Breast Cancer Care. (2015, July). Intraductal Papilloma. Retrieved from Breast Cancer Care: https://www.breastcancercare.org.uk/information-support/have-i-got-breast-cancer/benign-breast-conditions/intraductal-papilloma
- Herndon, J., & Reed-Guy, L. (2015, December 18). Intraductal Papilloma. Retrieved from Healthline: http://www.healthline.com/health/intraductal-papilloma#Overview1
- Halls, S. (2016, June 11). Papilloma and Papillomatosis. Retrieved from Moose & Doc Breast Cancer: http://breast-cancer.ca/papily/
Medline Plus. (2016, June 7). Intraductal papilloma. Retrieved from Medline Plus: https://www.nlm.nih.gov/medlineplus/ency/article/001238.htm - American Cancer Society. (2009, September 16). Fibrosis and simple cysts. Retrieved from American Cancer Society: http://www.cancer.org/healthy/findcancerearly/womenshealth/non-cancerousbreastconditions/non-cancerous-breast-conditions-intraductal-papillomas
- Kang, O. (2016). Intraductal papilloma of breast. Retrieved from Radiopaedia: http://radiopaedia.org/articles/intraductal-papilloma-of-breast
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