| Print Date: | May 24, 2013, 11:19 pm |
| Title | Papillary neoplasm of Breast |
| Text | Central solitary papilloma is the most common cause of clear or serosanguinous nipple discharge, which the patient reports as spontaneous. A frequent complaint is staining seen in the bra at the end of the day. This leads the patient to examine herself with the discovery of a focal discharge of fluid from the nipple with breast manipulation. Discharge may be intermittent. Although the actual lesion is usually not palpable, the patient may identify a trigger point within the breast, corresponding to the location of the lesion, compression of which will reliably produce a discharge. While mammography is usually unrevealing, some patients may be found to have a round to oval well circumscribed mass in relation to a dilated duct. The diagnostic modality of choice is ductography, in which the secreting orifice is cannulated with a 30 gauge sialographic needle followed by gentle injection of 0.2 to 0.4 cc’s of contrast. Usual findings are a dilated duct terminating in a polypoid lesion.
While solitary papillomas are histologically benign they are associated with an increase in the relative risk of breast cancer elsewhere of 1.5 to 2 X. The major alternative diagnosis is papillary carcinoma. Only one quarter of papillary carcinomas present with nipple discharge. Calcifications may be associated with either lesion. Papillary carcinomas tend to be larger, and more often palpable than papillomas. Histologically, benign papillomas are found to have normal myoepithelial cells under benign epithelium, while carcinomas lack myoepithelial cells. Papillary carcinomas may remain intraductal or become invasive. |
| References: | Cardenosa, Gilda: Breast Imaging Companion. Lippincott Williams and Wilkins, Philadelphia, 2001. pp. 224-228.
Dahnert, Wolfgang: Radiology Review Manual. Lippincott Williams and Wilkins, Philadelphia, 2000. p. 473. |
| Contributor | Thomas M Seay (Wilford Hall USAF Medical Center) |
| Peer Reviewer | Thomas M. Dykes (Penn State University) |
| Record Number | : 4780 |
| Created | 2003-05-02 06:57:16-04 |
| Modified | 2003-05-21 22:49:30-04 |
| Category: | Neoplasm, NOS |
| Location: | Breast and Mammography |
| Sublocation: | None Selected |
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