Intraductal papilloma of the breast

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Intraductal papilloma of the breast
Diagnosis in short

Intraductal papilloma. H&E stain.
Synonyms breast papilloma
LM true papillae (nipple-shaped structures with fibrovascular cores), intraductal proliferation of epithelial and myoepithelial elements, +/-hyalinization
LM DDx intraductal papilloma with florid epithelial hyperplasia, intraductal papilloma with atypical ductal hyperplasia, intraductal papilloma with ductal carcinoma in situ, invasive papillary carcinoma of the breast.
Site breast
Signs +/-nipple discharge
Prevalence common
Prognosis benign
Treatment usually excision

Intraductal papilloma, also papilloma, is a relatively common benign pathology of the breast.

General

  • May cause nipple discharge.[1]
  • Similar to papillary hidradenoma of the vulva.
  • Usually excised to exclude malignancy.
    • Risk very low if not associated with a mass or suspicious radiologic findings - conservative management may be reasonable.[2]

Microscopic

Features:

  • True papillae - nipple-shaped structures with fibrovascular cores.
  • Intraductal proliferation of epithelial and myoepithelial elements.[3]

Notes:

  • Lacks florid hyperplasia.[4]
  • May degeneration and hyalinize to form a sclerosing papilloma.
  • When many ducts are involved the process is termed 'papillomatosis'.

DDx:

† Size criteria are different in papillomas.

Images

  • IP. (WC/KGH)

  • IP - SMA. (WC/KGH)

  • IP - p63 (WC/KGH)

  • Breast - Intraductal Papillomatosis with some usual type epithelial hyperplasia - Low power (SKB)

  • Breast - Intraductal Papillomatosis with some usual type epithelial hyperplasia - Medium power (SKB)

  • Breast - Intraductal Papilloma - Low power (SKB)

  • Breast - Intraductal Papilloma - Medium power (SKB)

  • Breast - Intraductal Papilloma - High power (SKB)

  • Breast - Intraductal Papilloma - Low power (SKB)

  • Breast - Intraductal Papilloma - Histiocytes - High power (SKB)

IHC

Features:[5]

  • CK5/6 +ve.
  • p63 +ve.
  • MUC3 weak.
  • ER weak.

See also

References

  1. ↑ Zervoudis, S.; Iatrakis, G.; Economides, P.; Polyzos, D.; Navrozoglou, I. (Jan 2010). "Nipple discharge screening.". Womens Health (Lond Engl) 6 (1): 135-51. doi:10.2217/whe.09.81. PMID 20050819.
  2. ↑ Weisman, PS.; Sutton, BJ.; Siziopikou, KP.; Hansen, N.; Khan, SA.; Neuschler, EI.; Rohan, SM.; Franz, JM. et al. (Nov 2013). "Non-mass-associated intraductal papillomas: is excision necessary?". Hum Pathol. doi:10.1016/j.humpath.2013.10.027. PMID 24444467.
  3. ↑ "Adenoma of Nipple.". Br Med J 1 (5330): 563. Mar 1963. PMC 2123505. PMID 20789667. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2123505/?page=1.
  4. ↑ URL: http://surgpathcriteria.stanford.edu/breast/nippleadenoma/printable.html. Accessed on: 6 August 2011.
  5. ↑ Furuya, C.; Kawano, H.; Yamanouchi, T.; Oga, A.; Ueda, J.; Takahashi, M. (Jun 2012). "Combined evaluation of CK5/6, ER, p63, and MUC3 for distinguishing breast intraductal papilloma from ductal carcinoma in situ.". Pathol Int 62 (6): 381-90. doi:10.1111/j.1440-1827.2012.02811.x. PMID 22612506.
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