Intraductal Papillomas: Neutraluminal
- Intraductal papillomas
Intraductal papillomas are benign breast lesions usually affecting the lactiferous ducts, but smaller peripheral ducts may also be involved.
They’re wart-like growths of gland tissue along with fibrous tissue and blood vessels (called fibrovascular tissue).
The larger lesions may present with intramural fragile masses but smaller ones may be evident only on microscopic examination.
Papillomas may be solitary or multiple.,The distinction is important as the multiple form is more frequently associated with atypical hyperplasia and DCIS, the latter usually of low grade type, which should be recorded separately. This malignant change may be focal within the lesion, and therefore extensive sampling may be required to detect it.
Solitary papillomas or solitary intraductal papillomas : are single tumors that usually occurs centrally in …show more content…
subareolar ducts, often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast.
They may be felt as a small lump behind or next to the nipple.
multiple papillomas: latter are more likely to be peripheral and involve terminal duct lobular units, found in small ducts in areas of the breast farther from the nipple. In this case, there are often several growths. These are less likely to cause nipple discharge and usually bilateral.
Papillomatosis is a type of cell overgrowth (hyperplasia) in which there is very small areas of cell growth within the ducts, but they aren’t as distinct as papillomas are.
Intracystic papilloma’ is used to describe a papilloma in a widely dilated duct. These tumours should simply be classified as papilloma on the form. To distinguish these tumours from encysted papillary carcinoma.
Diagnosis
Ductograms are sometimes helpful in finding papillomas. If the papilloma is large enough to be felt, a biopsy can be done (where tissue is removed to look at under the microscope).
Imaging Appearances:
- Mammogram: Can appear as an asymmetry, mass, calcification, or can be mammographically occult.
- Ultrasound: Most commonly an intraductal mass with surrounding dilated ducts, usually demonstrate internal vascularity on color Doppler imaging sometimes with hypervascular stalk.
- MRI: May see high signal on T1 due to blood products.
• T2 hyperintense dilated ducts.
• Variable enhancement kinetics.
• Usually linear or clumped non masslike enhancement.
- Ductography: Intraluminal filling defect.
Microscopically, the papilloma consists of proliferation of ductal epithelium rested on fibrovascular stroma.
Epithelial component consist of cuboidal to columnar cells without pleomorphism, nuclear atypia or mitotic figures.
Myoepithalial layer is also preserved. Some papillomas have more complex structure accompanied by epithelial hyperplasia.
Absence of myoepithelial layer is a useful marker for recognition of the malignant transformation.
Epithelial hyperplasia without cytological atypia is often present and should not be recorded separately.
Atypical hyperplasia is rarely seen and, when present, should be recorded separately under ‘Epithelial proliferation’. Epithelial nuclei are usually vesicular with delicate nuclear membranes and inconspicuous nucleoli.
Apocrine metaplasia is frequently observed, but should not be recorded separately on the reporting form. Squamous metaplasia is sometimes seen, particularly near areas of
infarction.
Sclerosis and haemorrhage are not uncommon and, where the former involves the periphery of the lesion, may give rise to epithelial entrapment with the false impression of invasion. The benign cytological features of such areas should enable the correct diagnosis to be made.
The usual treatment is to remove the papilloma and the part of the duct it’s in.
They do not raise breast cancer risk unless there are other changes, such as atypical hyperplasia.
Ductal adenoma: a lesion exhibit a variable appearance which overlaps with other benign breast lesions. They may resemble papillomas except that they exhibit an adenomatous rather than a papillary growth pattern. These cases should be grouped under papilloma on the form. Indeed, some tumours may exhibit papillary and adenomatous features. Some ductal adenomas may show pronounced central and/or peripheral fibrosis and overlap with complex sclerosing lesions.
Adenoma of the nipple (subareolar duct papillomatosis) should not be classified as papilloma in the screening form but specified under ‘Other benign lesions’. This should be distinguished from the rare syringomatous adenoma of the nipple composed of ducts and tubules with an apparent infiltrative pattern.
Intraductal papillomas are benign breast lesions usually affecting the lactiferous ducts, but smaller peripheral ducts may also be involved.
They’re wart-like growths of gland tissue along with fibrous tissue and blood vessels (called fibrovascular tissue).
The larger lesions may present with intramural fragile masses but smaller ones may be evident only on microscopic examination.
Papillomas may be solitary or multiple.,The distinction is important as the multiple form is more frequently associated with atypical hyperplasia and DCIS, the latter usually of low grade type, which should be recorded separately. This malignant change may be focal within the lesion, and therefore extensive sampling may be required to detect it.
Solitary papillomas or solitary intraductal papillomas : are single tumors that usually occurs centrally in …show more content…
subareolar ducts, often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast.
They may be felt as a small lump behind or next to the nipple.
multiple papillomas: latter are more likely to be peripheral and involve terminal duct lobular units, found in small ducts in areas of the breast farther from the nipple. In this case, there are often several growths. These are less likely to cause nipple discharge and usually bilateral.
Papillomatosis is a type of cell overgrowth (hyperplasia) in which there is very small areas of cell growth within the ducts, but they aren’t as distinct as papillomas are.
Intracystic papilloma’ is used to describe a papilloma in a widely dilated duct. These tumours should simply be classified as papilloma on the form. To distinguish these tumours from encysted papillary carcinoma.
Diagnosis
Ductograms are sometimes helpful in finding papillomas. If the papilloma is large enough to be felt, a biopsy can be done (where tissue is removed to look at under the microscope).
Imaging Appearances:
- Mammogram: Can appear as an asymmetry, mass, calcification, or can be mammographically occult.
- Ultrasound: Most commonly an intraductal mass with surrounding dilated ducts, usually demonstrate internal vascularity on color Doppler imaging sometimes with hypervascular stalk.
- MRI: May see high signal on T1 due to blood products.
• T2 hyperintense dilated ducts.
• Variable enhancement kinetics.
• Usually linear or clumped non masslike enhancement.
- Ductography: Intraluminal filling defect.
Microscopically, the papilloma consists of proliferation of ductal epithelium rested on fibrovascular stroma.
Epithelial component consist of cuboidal to columnar cells without pleomorphism, nuclear atypia or mitotic figures.
Myoepithalial layer is also preserved. Some papillomas have more complex structure accompanied by epithelial hyperplasia.
Absence of myoepithelial layer is a useful marker for recognition of the malignant transformation.
Epithelial hyperplasia without cytological atypia is often present and should not be recorded separately.
Atypical hyperplasia is rarely seen and, when present, should be recorded separately under ‘Epithelial proliferation’. Epithelial nuclei are usually vesicular with delicate nuclear membranes and inconspicuous nucleoli.
Apocrine metaplasia is frequently observed, but should not be recorded separately on the reporting form. Squamous metaplasia is sometimes seen, particularly near areas of
infarction.
Sclerosis and haemorrhage are not uncommon and, where the former involves the periphery of the lesion, may give rise to epithelial entrapment with the false impression of invasion. The benign cytological features of such areas should enable the correct diagnosis to be made.
The usual treatment is to remove the papilloma and the part of the duct it’s in.
They do not raise breast cancer risk unless there are other changes, such as atypical hyperplasia.
Ductal adenoma: a lesion exhibit a variable appearance which overlaps with other benign breast lesions. They may resemble papillomas except that they exhibit an adenomatous rather than a papillary growth pattern. These cases should be grouped under papilloma on the form. Indeed, some tumours may exhibit papillary and adenomatous features. Some ductal adenomas may show pronounced central and/or peripheral fibrosis and overlap with complex sclerosing lesions.
Adenoma of the nipple (subareolar duct papillomatosis) should not be classified as papilloma in the screening form but specified under ‘Other benign lesions’. This should be distinguished from the rare syringomatous adenoma of the nipple composed of ducts and tubules with an apparent infiltrative pattern.