| disease | Intraductal Papilloma |
This disease is also associated with localized papillary growth caused by excessive estrogen stimulation. It can be divided into two types: solitary (intraductal papilloma) and multiple (intraductal papilloma). It can occur in adult women of any age, but is most commonly seen in those aged 40 to 50, and is rare in men. The malignant transformation rate of solitary cases is approximately 6%. Intraductal papillary tumor diseases are often multiple, occurring in the small or terminal ducts at the periphery of the breast and may involve different ducts of multiple breast lobules. Their biological characteristics lean toward malignant transformation, with a high malignancy rate of 30–40%, and they can be considered precancerous lesions.
bubble_chart Etiology
The cause of the disease has not been determined, but many scholars believe that it is also related to excessive estrogen stimulation leading to localized papillary growth. It can be divided into two types: solitary (intraductal papilloma) and multiple (intraductal papillary tumor diseases).
bubble_chart Clinical Manifestations
Most patients experience no discomfort, only intermittent and spontaneous nipple discharge, which may be bloody or serous. However, if a larger tumor blocks the lactiferous duct, it can cause pain and a palpable mass. Once the accumulated blood is discharged, the mass shrinks, and the pain alleviates or disappears. This phenomenon may recur repeatedly. Most patients seek medical attention due to nipple discharge, which can be bloody, serous, or alternating between the two. A few patients may discover a lump near the nipple.
Intraductal papillomas are usually small and generally cannot be palpated, though sometimes a small nodule may be felt in the areolar region, and light pressure may cause bloody or coffee bean-like discharge from the nipple.
If a small lump or nodule is palpated beneath the areola or at its edge, and blood or serous fluid is discharged upon light pressure, a diagnosis can be made. If no lump is palpable, using the finger pressure method—pressing the areolar area clockwise with the tip of the index finger—may reveal discharge from a single duct orifice on one side of the nipple, which also confirms the diagnosis. In some cases, a nodule may be palpable, but no discharge occurs upon pressure.
X-ray examination: Mammary ductography often reveals the location and size of the tumor, with some reports indicating a diagnostic accuracy rate of up to 93.7%.
Discharge cytology: A smear of nipple discharge may show red blood cells and epithelial cells, with occasional findings of cancer cells.
bubble_chart Treatment Measures
Treatment measures; Although intraductal papilloma is a benign tumor, 6-8% of cases may become malignant, so early excision is recommended.
Local excision is not recommended due to difficulties in preoperative localization and a high postoperative recurrence rate (38.4%).
Breast wedge resection is relatively thorough, with a low chance of recurrence and minimal impact on breast appearance. Pathological examination of the excised tissue should still be routinely performed.
Subcutaneous gland excision or total mastectomy is suitable for women aged 40-50 with intraductal papilloma tumor diseases, as these cases are often multifocal and have a high malignant transformation rate, making local and wedge resections prone to higher recurrence rates. Pathological examination remains essential.
Intraductal papillary carcinoma: A mass is usually palpable beneath the areola, often larger than 1 cm. Pressure on the mass may result in bloody discharge from the corresponding mammary duct orifice. The surface of the mass is irregular, often adherent to the skin, difficult to move, and non-tender. Axillary lymph nodes may be enlarged or metastatic. The duct may show dilation and destruction, and pathological examination can confirm the diagnosis.
Mammary duct ectasia: Nipple discharge may exude from multiple duct orifices, typically clear or yellow in appearance. In some cases, multiple small nodules can be palpated beneath the areola, aligned with the mammary ducts, with indistinct borders and often adherent to the skin, accompanied by tenderness. Axillary lymph nodes may be enlarged but are soft and tender. Mammary ductography reveals dilated and thickened ducts without hyperplasia or destruction, no space-occupying lesions within the ducts, and cytological smears often show no specific findings.
