Breast
Fibrocystic changes
Intraductal papilloma


Minor changes: 29 September 2020

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PubMed Search: Papilloma of the breast [title]

Samuel Bidot, M.D.
Xiaoxian (Bill) Li, M.D., Ph.D.
Page views in 2019: 22,298
Page views in 2020 to date: 19,208
Cite this page: Bidot S, Li X. Intraductal papilloma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastpapilloma.html. Accessed October 29th, 2020.
Definition / general
  • Benign intraductal proliferation of epithelial cells with fibrovascular cores and underlying myoepithelial cells
Essential features
  • Common benign breast lesion
  • Distinction with malignant papillary lesions may be difficult on biopsy and immunohistochemistry may be necessary
  • No consensus regarding management of papilloma without atypia
  • Surgical excision of intraductal papilloma with atypical epithelial proliferation is recommended
Terminology
  • Duct papilloma of the breast
  • Intracystic papilloma of the breast (old terminology)
ICD coding
  • ICD-10: D24 - benign neoplasm of the breast
Epidemiology
Sites
Pathophysiology
  • Poorly understood
  • Intraductal papilloma might originate from bipotent progenitor cells that differentiate as luminal and myoepithelial cells (Am J Pathol 2018;188:1106)
Clinical features
  • Solitary central intraductal papilloma may present as a retroareolar mass with serous or serosanguineous nipple discharge
  • Peripheral intraductal papilloma is often discovered incidentally
Diagnosis
Radiology description
Radiology images

Contributed by Mark R. Wick, M.D.

Mammogram



Images hosted on other servers:

Round or ovoid mass on mammogram and ultrasound

Well circumscribed
mass with
calcifications

Ductal dilatation on mammogram

Prognostic factors
Case reports
Treatment
Clinical images

Images hosted on other servers:

Male with nipple discharge

Gross description
Gross images

Contributed by Mark R. Wick, M.D.
Intracystic mass

Intracystic mass



Images hosted on other servers

Intraductal polypoid mass

Frozen section description
  • Frozen section not performed on lesions suspected to be intraductal papilloma
Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Xiaoxian (Bill) Li, M.D., Ph.D.
Minute intraductal papillomas

Minute intraductal papillomas

Papillary cores

Papillary cores

Involved by usual ductal hyperplasia Involved by usual ductal hyperplasia Involved by usual ductal hyperplasia Involved by usual ductal hyperplasia

Involved by usual ductal hyperplasia


Involved by apocrine metaplasia

Involved by apocrine metaplasia

Involved by ductal carcinoma in situ Involved by ductal carcinoma in situ Involved by ductal carcinoma in situ Involved by ductal carcinoma in situ

Involved by ductal carcinoma in situ



Contributed by Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.

Intraductal papilloma with DCIS immunoprofile

Intraductal papilloma with DCIS, CK5/6

Intraductal papilloma with DCIS, p63

Virtual slides

Images hosted on other servers:

Sclerosing intraductal papilloma

Cytology description
Positive stains
Videos

Intraductal papilloma

Sample pathology report
  • Right breast, 9 o'clock, 1 cm from the nipple, ultrasound guided core biopsy:
    • Intraductal papilloma with apocrine metaplasia
    • Comment: Patchy positivity for CK5 and ER supports the above diagnosis.
Differential diagnosis
Board review style question #1

Regarding this breast specimen, what is the correct diagnosis?

  1. Intraductal papillary carcinoma
  2. Intraductal papilloma with apocrine metaplasia
  3. Intraductal papilloma with DCIS
  4. Intraductal papilloma with LCIS
  5. Invasive carcinoma
Board review answer #1
B. This intraductal papilloma shows typical features of apocrine metaplasia.

Comment Here

Reference: Intraductal papilloma
Board review style question #2
What is the staining pattern of p63 for intraductal papilloma of the breast without atypia?

  1. At the periphery of involved duct only
  2. In the fibrovascular cores only
  3. Intraductal papillomas do not stain for p63
  4. At the periphery and in the fibrovascular cores
Board review answer #2
D. p63 stain for myoepithelial cells is positive throughout the lesion, including in the fibrovascular cores and at the periphery of the involved duct.

Comment Here

Reference: Intraductal papilloma
Board review style question #3
What is the typical staining pattern of atypical epithelial proliferation involving an intraductal papilloma of the breast?

  1. Diffusely positive for ER and patchy positive for CK5/6, negative for p63
  2. Diffusely positive for ER, negative for p63 and CK5/6
  3. Diffusely positive for ER, p63 and CK5/6
  4. Negative for ER, p63 and CK5/6
  5. Patchy positive for ER, negative for p63 and CK5/6
Board review answer #3
B. The atypical low grade epithelial proliferation is diffusely positive for ER, negative for CK5/6 and negative for p63.

Comment Here

Reference: Intraductal papilloma
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