Difference between revisions of "Intraductal papilloma of the breast"

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#redirect [[Breast_pathology#Intraductal_papilloma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Intraductal_papilloma_histopathology_(1).jpg
| Width      =
| Caption    = Intraductal papilloma. [[H&E stain]].
| Synonyms  = breast papilloma
| Micro      = true papillae (nipple-shaped structures with fibrovascular cores), intraductal proliferation of epithelial and myoepithelial elements, +/-hyalinization
| Subtypes  =
| LMDDx      = 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]].
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[breast]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = +/-nipple discharge
| Symptoms  =
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        = usually excision
}}
'''Intraductal papilloma of the breast''', also '''papilloma''' and '''[[intraductal papilloma]]''', is a relatively common benign [[breast pathology|pathology of the breast]].


==General==
*May cause nipple discharge.<ref>{{Cite journal  | last1 = Zervoudis | first1 = S. | last2 = Iatrakis | first2 = G. | last3 = Economides | first3 = P. | last4 = Polyzos | first4 = D. | last5 = Navrozoglou | first5 = I. | title = Nipple discharge screening. | journal = Womens Health (Lond Engl) | volume = 6 | issue = 1 | pages = 135-51 | month = Jan | year = 2010 | doi = 10.2217/whe.09.81 | PMID = 20050819 }}</ref>
*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.<ref name=pmid24444467>{{Cite journal  | last1 = Weisman | first1 = PS. | last2 = Sutton | first2 = BJ. | last3 = Siziopikou | first3 = KP. | last4 = Hansen | first4 = N. | last5 = Khan | first5 = SA. | last6 = Neuschler | first6 = EI. | last7 = Rohan | first7 = SM. | last8 = Franz | first8 = JM. | last9 = Sullivan | first9 = ME. | title = Non-mass-associated intraductal papillomas: is excision necessary? | journal = Hum Pathol | volume =  | issue =  | pages =  | month = Nov | year = 2013 | doi = 10.1016/j.humpath.2013.10.027 | PMID = 24444467 }}</ref>
==Microscopic==
Features:
*True papillae - nipple-shaped structures with fibrovascular cores.
*Intraductal proliferation of epithelial and myoepithelial elements.<ref name=pmid2123505>{{Cite journal  | title = Adenoma of Nipple. | journal = Br Med J | volume = 1 | issue = 5330 | pages = 563 | month = Mar | year = 1963 | doi =  | PMID = 20789667 | PMC = 2123505 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2123505/?page=1 }}</ref>
Notes:
*Lacks florid hyperplasia.<ref>URL: [http://surgpathcriteria.stanford.edu/breast/nippleadenoma/printable.html http://surgpathcriteria.stanford.edu/breast/nippleadenoma/printable.html]. Accessed on: 6 August 2011.</ref>
*May degeneration and hyalinize to form a ''sclerosing papilloma''.
*When many ducts are involved the process is termed 'papillomatosis'.
DDx:
*Intraductal papilloma with [[florid epithelial hyperplasia]].
*Intraductal papilloma with [[atypical ductal hyperplasia]]. †
*Intraductal papilloma with [[ductal carcinoma in situ]]. †
*[[Ductal carcinoma in situ]] - papillary variant
*[[Invasive papillary carcinoma of the breast]].
† Size criteria are different in papillomas.
===Images===
<gallery>
Image:Intraductal_papilloma_histopathology_(1).jpg | IP. (WC/KGH)
Image:Intraductal papilloma histopathology (2) smooth muscle actin.JPG | IP - SMA. (WC/KGH)
Image:Intraductal_papilloma_histopathology_(3)_p63.JPG | IP - p63 (WC/KGH)
Image:Breast IntraductalPapillomatosis LP CTR.jpg|Breast - Intraductal Papillomatosis with some usual type epithelial hyperplasia - Low power (SKB)
Image:Breast IntraductalPapillomatosis MP2 CTR.jpg|Breast - Intraductal Papillomatosis with some usual type epithelial hyperplasia - Medium power (SKB)
Image:Breast IntraductalPapilloma LP PA.JPG|Breast - Intraductal Papilloma - Low power  (SKB)
Image:Breast IntraductalPapilloma MP PA.JPG|Breast - Intraductal Papilloma - Medium power (SKB)
Image:Breast IntraductalPapilloma HP PA.JPG|Breast - Intraductal Papilloma - High power (SKB)
Image:Breast IntraductalPapilloma LP (2) PA.JPG|Breast - Intraductal Papilloma - Low power (SKB)
Image:Breast IntraductalPapilloma Histiocytes MP PA.JPG|Breast - Intraductal Papilloma - Histiocytes - High power (SKB)
</gallery>
==IHC==
Features:<ref name=pmid22612506>{{Cite journal  | last1 = Furuya | first1 = C. | last2 = Kawano | first2 = H. | last3 = Yamanouchi | first3 = T. | last4 = Oga | first4 = A. | last5 = Ueda | first5 = J. | last6 = Takahashi | first6 = M. | title = Combined evaluation of CK5/6, ER, p63, and MUC3 for distinguishing breast intraductal papilloma from ductal carcinoma in situ. | journal = Pathol Int | volume = 62 | issue = 6 | pages = 381-90 | month = Jun | year = 2012 | doi = 10.1111/j.1440-1827.2012.02811.x | PMID = 22612506 }}
</ref>
*[[CK5/6]] +ve.
*[[p63]] +ve.
*MUC3 weak.
*ER weak.
**Strong in [[DCIS]].
==Sign out==
<pre>
Right Breast, Partial Mastectomy:
- Intraductal papilloma.
- Proliferative fibrocystic changes.
- NEGATIVE for malignancy.
</pre>
==See also==
*[[Breast pathology]].
*[[Papillary hidradenoma]].
*[[Intraductal papilloma]].
==References==
{{Reflist|2}}
[[Category:Breast pathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 21:18, 9 May 2016

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 of the breast, also papilloma and intraductal 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]

Sign out

Right Breast, Partial Mastectomy:
- Intraductal papilloma.
- Proliferative fibrocystic changes.
- NEGATIVE for malignancy.

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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