What is Intraductal Papilloma?
Intraductal papilloma is a type of non-cancerous tumor that grows in the milk ducts of the breast. This growth is due to the abnormal multiplication of cells lining these ducts. Largely, a single intraductal papilloma develops behind the nipple, affecting the main milk duct. However, multiple papillomas can occur in any part of the breast, affecting the smaller ducts.
This type of tumor can develop in women of all ages. Risk factors include use of birth control methods, hormone replacement therapy, long-term exposure to estrogen, and family history of breast tumors. Symptoms in some women may include unexpected clear or bloody discharge from the nipple. Sometimes, a woman might feel a lump in the breast, but most women with intraductal papillomas don’t show any symptoms. Particularly, small intraductal papillomas often don’t have any signs or symptoms.
It’s crucial to examine an intraductal papilloma closely because of the chance it could hide a hidden breast cancer. This type of tumor is seen as high-risk as it could be associated with atypia (abnormal cells), ductal carcinoma in situ (DCIS, a type of non-invasive breast cancer), or invasive breast cancer. The typical treatment is surgical removal of the tumor.
What Causes Intraductal Papilloma?
An intraductal papilloma is a type of non-cancerous breast tumor. It is considered high-risk because it can be related to atypia (abnormal cells), DCIS (ductal carcinoma in situ, a type of early breast cancer), and carcinoma (cancer).
Certain risk factors can make a person more likely to develop a breast tumor. These can include using birth control, hormone replacement therapy, exposure to estrogen over a person’s lifetime, and having a family history of breast cancer.
Risk Factors and Frequency for Intraductal Papilloma
Intraductal papilloma, while able to affect women of all ages, is most frequently found in those between 35 and 55 years old. It’s less common in men. It accounts for less than 10% of all non-cancerous breast conditions and less than 1% of all breast cancers.
Signs and Symptoms of Intraductal Papilloma
Intraductal papillomas are often discovered in different ways, depending on the individual’s age and the number of these potentially harmless growths in the breast ducts (the parts of the breast that carry milk to the nipple). Single papillomas are more common in individuals around menopause and tend to cause nipple discharge, which may be clear or bloody. Often, these single growths are situated behind the nipple. In some cases, they could be found in younger patients during an ultrasound, even if they have no noticeable symptoms. Multiple papillomas, on the other hand, mostly originate from the terminal duct lobular unit (a part of the breast anatomy). They are more likely to manifest as a noticeable lump in the breast rather than causing nipple discharge.
Testing for Intraductal Papilloma
Intraductal papilloma is a type of benign, or non-cancerous, breast condition and is quite often difficult to detect using a mammogram – which is a type of X-ray specifically designed for breast tissue. If it does show up on a mammogram, it might be seen as a round or oval shape with either clear, well-defined edges or blurred, uncertain ones. It might also show up as tiny deposits of calcium, known as microcalcifications.
When done, an ultrasound – which uses high-frequency sound waves to create images of tissues inside the body – often reveals the lump near the nipple. The lump tends to be found in a widened milk duct and may show as having blood flow when checked using color or power Doppler, another kind of imaging that checks blood flow.
Another procedure called galactography can also be done. It involves using dye to better see inside the milk ducts with an X-ray. When an intraductal papilloma is present, it shows up as a gap, or filling defect, inside the milk duct which seems to expand, or dilate, as it leads up to the lump, at which point there is a sudden stop in the duct.
MRI, or Magnetic Resonance Imaging, can also aid in its diagnosis. MRI provides clear and detailed images using a large magnet and radio waves. In this case, an MRI would show an enhancing round or oval lump inside the milk duct and the type of enhancement regularly demonstrates either continuous growth or a steady state.
For a proper diagnosis, tissue samples are also needed alongside these imaging results. The patient undergoes a biopsy procedure where different methods such as the core needle or vacuum-assisted biopsy are used to extract these tissue samples for further analysis. Both of these methods are usually preferred over fine-needle aspiration because they provide more tissue for analysis. Fine-needle aspiration, on the other hand, uses a smaller needle, and there’s a chance that it may not collect enough tissue for testing.
Open tissue biopsy, a surgical method that gathers a chunk of tissue, is not typically done as it’s more invasive, which means it can potentially lead to long-term pain, as well as heightened feelings of anxiety and depression for the patient. The correct diagnosis is made when the imaging and tissue sample results match.
Treatment Options for Intraductal Papilloma
Intraductal papilloma, a type of breast tumor, is usually treated through a surgery that completely removes it. This approach is favored because there’s a risk that the condition may worsen to atypical ductal hyperplasia or DCIS (which stands for “ductal carcinoma in situ,” a type of non-invasive breast cancer) if untreated. The surgery commonly suggested is a lumpectomy, which is a procedure to remove the tumor while preserving most of the surrounding breast tissue. It’s crucial that the entire papilloma is removed during surgery.
What else can Intraductal Papilloma be?
There are many benign (non-cancerous) and malignant (cancerous) conditions that can look like an intraductal papilloma. For instance, material build-up within a duct or fat tissue breakdown with cystic and solid areas can appear like an intraductal papilloma. The absence of colored blood flow inside the lesion during an ultrasound can be a sign that the lesion is benign.
A type of benign tumor named Phyllodes, which is associated with high risk, can also look like a papilloma. On the other hand, some non-papillary malignant tumors, such as medullary carcinoma, can have central breakdown or expansion within a duct that makes them appear like papillary carcinomas.
However, to conclusively diagnose an intraductal papilloma, tissue sampling is required.
What to expect with Intraductal Papilloma
The outlook is generally very good for people with intraductal papilloma, a type of non-cancerous breast lump. In one study, nearly 89% of these lumps didn’t show any signs of abnormalities or ‘atypia’. However, about 9.2% did show atypia or abnormal changes in the cells. The rate of these lumps progressing to more serious conditions was low at 7.3%: 1.3% developed into invasive cancer, 2.7% developed into ductal carcinoma in situ (DCIS, a type of non-invasive breast cancer), and 3.3% developed into atypical ductal hyperplasia (an accumulation of abnormal cells in the breast duct).
The recommended treatment for intraductal papilloma is surgical removal of the lump. According to one study, the lumps came back after surgery in only about 2.4% of cases.
Possible Complications When Diagnosed with Intraductal Papilloma
Intraductal papilloma is generally safe and does not usually lead to significant health concerns. However, complications may occur after carrying out procedures such as a biopsy or surgical removal. These complications might include bleeding, infection, pain, damage to fatty tissues and potential changes in breast appearance.
List of Potential Complications:
- Bleeding
- Infection
- Pain
- Fat tissue damage
- Potential changes in breast appearance
Preventing Intraductal Papilloma
There are several factors that can increase a person’s risk of getting both non-cancerous and cancerous breast tumors. These factors include the use of birth control pills, hormone replacement therapy (treatment to replace hormones when your body can’t make enough), extensive lifetime exposure to estrogen (a female hormone), and having a family history of breast tumors. Medical experts advise women to take proactive measures like having yearly mammograms, which are breast X-rays, to detect any abnormalities early.
The American College of Radiology and Society of Breast Imaging – organizations that are top authorities on imaging and radiology – urge all women who are considered to be at “average risk” to start having these annual mammograms from the age of 40 onwards. Starting these health screenings early greatly increases the chances of catching any issues on time and ensuring the best possible treatment outcomes.
