HIGH RISK BREAST DISORDERS:

Intraductal Papilloma

Etiology: Array of normal epithelial cells that grow from the wall of a duct into its lumen; 2 types: central (90%) and peripheral

–     Central papilloma ia typically a solitary, 2-3mm, subareolar, broad-based/pedunculated polypoid mass that can obstruct/distend the involved duct, leading to cyst formation

–     Peripheral papillomas tend to develop in multiples within TDLUnits

Clinical significance: Risk of malignancy within papilloma: 7% without atypia - 37% with atypia; Lifetime 1.5 - 2x relative risk of developing invasive breast carcinoma

Classic presentation: Bloody/clear nipple discharge < 6 months duration; thought to be caused by twisting/shearing papilloma on its fibrovascular stalk

Diagnosis: Core needle biopsy

Imaging:     US: Intraductal mass frequently with visible dilated duct; may fill a duct or be partially outlined by fluid via cyst formation; vascular stalk/+Doppler flow; Mammogram usually normal

Management: Surgical excision is required; consider chemoprevention if atypia found on core biopsy

(Ikeda 2010, Georgian-Smith 2014, Sabel 2015, Kang papilloma 2016)