Intraductal papilloma

#breast #Pathology

Proliferation of ductal epithelium on fibrovascular core. Common cause of pathologic nipple discharge. Considered B3 lesions.

Imaging:

Mammography: Often occult; may show solitary dilated retroareolar duct or circumscribed mass.
Ultrasound: Solid nodule within a fluid-filled duct (intracystic) or solid ductal mass.
Galactography: Filling defect (meniscus sign).

Management:

Biopsy required to exclude papillary carcinoma (lack of myoepithelial layer).
Without atypia: B3a. Vacuum assist excision (VAE) is curative and diagnostic to exclude adjacent atypia.
With atypia: B3b. High association with DCIS. Requires complete excision (VAE or Surgery).