Synopsis
Recognise central and peripheral intraductal papillomas, obtain image-guided diagnosis, and choose surveillance or complete removal according to atypia, multiplicity, residual lesion and radiology-pathology concordance.
- An intraductal papilloma is a papillary epithelial proliferation supported by fibrovascular cores within a breast duct and is commonly benign.
- A solitary central papilloma often presents with spontaneous unilateral clear or blood-stained discharge, whereas multiple peripheral papillomas may be image detected.
- Ultrasound may show a vascular intraductal mass or solid component in a dilated duct; mammography can reveal an associated density or calcification.
Investigation priorities
Identify a dilated duct and vascular intraductal mass that can be sampled directly.
Management branches
A 56-year-old has repeated spontaneous blood-stained discharge from one nipple duct and no palpable mass.
- Confirm duct origin and inspect for Paget-like change, then examine retroareolar tissue and regional nodes.
- Arrange mammography and targeted ultrasound and mark any intraductal or peripheral target for image-guided sampling.