Fact-sheet: Papilloma of breast
Updated on 09/17/2021 at 12:16 PM
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Definition
Ultrasound is generally the first imaging modality used when ductal pathology is suspected.
• The lactiferous ducts are usually not visible
• When visible:
– Thin anechoic tubular structures
– Wider in the retroareolar region, with a diameter that decreases progressively and regularly toward the periphery.
– No area of ductal distension
– Diameter on the order of 1-2mm, <3mm
A type of ductal epithelial proliferation characterized by the formation of budding
projections within the ductal lumen ("papillae").
Papillae are defined by the presence of a fibrovascular core lined by an
epithelial layer identical to normal breast epithelium (an outer epithelial layer and an inner myoepithelial layer).
Can develop in any lactiferous duct, from the retroareolar region to the TDLU.
Two entities are distinguished:
Solitary/single papilloma
Multiple papillomas
The associated breast cancer risk differs between these two entities
Clinical features
Clinical presentation: Solitary papilloma Perimenopause (50 years); Asymptomatic; Unipore serous or bloody nipple discharge; Occasionally a palpable periareolar nodule. Clinical presentation: Multiple papillomas - Identical to that of the solitary papilloma: asymptomatic or nipple discharge (rarer) or palpable mass - but earlier onset: younger or middle-aged women (40 years) - 25% bilateral - Risk of recurrence
Ultrasound
• Ultrasound: Solitary papilloma - Echogenic intraductal nodule with well-defined or polylobulated margins, within a duct that may or may not be dilated. Close to the nipple: <3cm - Associated pathologies may include: - Ductal hyperplasia with or without atypia - Ductal carcinoma in situ - A vascular pedicle can sometimes be demonstrated on color Doppler, confirming the tumoral nature of the lesion. → Differential diagnosis: intraductal secretions: Doppler – • Ultrasound: Multiple papillomas - Located >3cm from the nipple - Hypoechoic mass (generally smaller than the central papilloma, hence without ductal dilation)