Intraductal Papilloma

Carrie Thompson & Olevia Dunn

DMS 495
Spring 2019
 45-year-old female

History of current intermittent clear

nipple discharge from left breast
Case History Labs: no labs pertinent to intraductal
papilloma

Other breast pathology labs: hormone

receptor test and the HER2/neu test
 First mammogram in 2016 at Methodist Hospital
• No suspicious findings

Mammogram on December 27, 2018

• Findings: no findings of concern

Case History Followed by US exam on same day

• Findings: dilated duct with echogenic debris
• Impression: likely represents debris, intraductal papilloma
cannot be ruled out.
• Bi-Rads 4: Suspicious abnormality

Recommendation: US guided biopsy

 Sonographic Findings

Figure 1: 12:00 left breast with echogenic Figure 2: 12:00 left breast with color
material in dilated duct Doppler showing no flow.
 Sonographic Findings

Figure 3: Intraductal Papilloma Figure 4: Biopsy of the Intraductal

Papilloma
 Differentials
Intraductal Papilloma Ductal Ectasia with debris

Figure 3: Echogenic Figure 4: Echogenic debris

papilloma in dilated duct. in dilated duct.
Other Modalities
Diagnosis
• Pathology Report : diagnosis of Intraductal Papilloma
• Overgrowth of epithelial and myoepithelial cells
within a major lactiferous duct
• Benign breast lesion
• Can degenerate into malignancy; excision
recommended
• Represents 10% of all benign breast tumors
• Most common intraductal mass lesion of the
breast
Diagnosis
• Clinical symptoms:
• Possibly asymptomatic
• Nipple discharge
• Palpable region
 Surgical excision/lumpectomy is
general treatment plan

After excision recurrence rate is less

than 10%
Follow Up
No surgical excision slightly increases
the risk of developing breast cancer

Patient did not follow up with

complete excision
 • 45 y/o female
• Intermittent clear nipple
discharge
• Inconclusive mammogram
Conclusion • Bi-rad level 4
• Biopsy
• Positive intraductal papilloma
• Patient did not follow
recommendation for excision
 • Pitfall
• Use power Doppler
Pitfall and
Teachable • Teachable Moment
Moment • Investigate thoroughly
• Not every pathology is seen by
every modality
References
Azavedo E. Breast Imaging in Nipple Discharge Evaluation . Lin EC, ed. Medscape .

https://emedicine.medscape.com/article/347305-overview#a4. Accessed March 7, 2019.

Boisserie-Lacroix M, Ferron S, Hurtevent-Labrot G, Lippa N. Nipple discharge: The role of

imaging. Diagnostic & Interventional Imaging . 2015;29(2):1017-1032.

doi:https://doi.org/10.1016/j.diii.2015.07.004.

Dhar A, Dinda AK, Srivastava A, Vuthaluru S, Ramalingam K. Ultra structural changes occurring in

duct ectasia and periductal mastitis and their significance in etiopathogenesis. Ultra structural changes

occurring in duct ectasia and periductal mastitis and their significance in etiopathogenesis. March

2017. doi:https://doi.org/10.1371/journal.pone.0173216.

.
 References
Herndon J, Reed-Guy L. Intraductal Papilloma. Wilson DR, ed. HealthLine . https://www.healthline.com/health/intraductal-

papilloma. Accessed March 7, 2019.

Intraductal Papilloma of Breast. https://www.dovemed.com/diseases-conditions/intraductal-papilloma-breast/. Accessed

March 8, 2019.

Mestrovic T. Mammary duct ectasia. News Medical Life Sciences . https://www.news-medical.net/health/Mammary-Duct-

Ectasia-Diagnosis.aspx. Accessed March 8, 2019.

Niknejad MT. Intraductal papilloma of breast. Radiopaedia. https://radiopaedia.org/articles/intraductal-papilloma-of-

breast?lang=us. Accessed March 8, 2019.

Solitary Intraductal Papillomas Of The Breast: MRI Features And Differentiation From Small Invasive Ductal

Carcinomas. American Journal of Roentgenology . 2012;199(4). https://www.ajronline.org/doi/10.2214/AJR.12.8507.

Accessed March 8, 2019