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WHO Classification of Tumours
Intraductal papilloma
Breast


Definition

Intraductal papilloma is an intraluminal papillary neoplasm arising within the ducts. The tumours are composed of fibrovascular stalks covered by a layer of myoepithelial cells and overlying proliferations of epithelial cells, resulting in arborescent structures. Two broad subtypes of intraductal papilloma of the breast are recognized: central (large duct) papilloma, and peripheral papilloma
Click to access Pubmed
Ohuchi N, Abe R, Takahashi T, Tezuka F (1984)
Origin and extension of intraductal papillomas of the breast: a three-dimensional reconstruction study.
Breast Cancer Res Treat 4: 117-28



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> Central papilloma
Central papilloma is usually located in the subareolar region. Tumour size ranges from a few millimeters to 3-4 cm or more. The larger lesions may present as palpable, well circumscribed, cauliflowerlike masses which are attached by one to several pedicles to the wall of a dilated duct. The affected ducts contain serous and/or sanguineous fluid. Histologically, papillary and ductal patterns coexist in some lesions. Papillomas with a predominating ductal pattern and associated marked sclerosis may be termed sclerosing papillomas. Morphological changes associated with papillomas include inflammation, necrosis, myoepithelial hyperplasia, apocrine, squamous, sebaceous, mucinous, osseous and chondroid metaplasia as well as usual intraductal hyperplasia.
Central papillomas occur in all age groups, but the majority of cases arise in the 4th and 5th decades. Patients frequently present with unilateral sanguineous/serosanguineous nipple discharge

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Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003



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> Peripheral papilloma
Peripheral papilloma arises in the terminal duct lobular unit (TDLU) and may extend into the larger ducts. The lesions are usually multiple. They are typically microscopical findings. Frequent manifestations are peripheral microcalcifications, prominent nodular ducts, or multiple, small, well circumscribed peripheral masses. The histological features are basically the same as for central papillomas.
Peripheral papillomas occur in the same age groups as central papillomas; the average age of patients is similar or slightly younger. Nipple discharge is far less frequent than with central papillomas, and the tumours are often clinically occult

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Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003



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Intraductal papillomas are associated with a slightly to highly increased relative risk of subsequent invasive carcinoma, depending on the extent of changes in the surrounding breast tissue and the presence of epithelial atypia. Recommended treatment for papillomas is complete excision and microscopic assessment of the surrounding breast tissue

Click for details
Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003



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