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Intraductal papilloma of the breast (view source)

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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]]
Michael
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