Intraductal papilloma of the breast

Introduction to intraductal papilloma Intraductal papilloma, also known as large duct papilloma, intracapsular papilloma, etc., is a benign papilloma that occurs in the large duct of the nipple and areola. The tumor is composed of a number of small branches of papillary new organisms, often isolated, single, and a few can also involve several large catheters. The clinical symptoms of the disease are not obvious, most of them are treated with painless nipple discharge, and some are found when examining other diseases of the breast for pathological examination. basic knowledge The proportion of sickness: 0.003%-0.007% Susceptible people: women Mode of infection: non-infectious Complications: breast lumps nipple discharge

Causes of intraductal papilloma in the breast

Cause (30%):

The cause of the disease is not yet clear. Most scholars believe that the level of progesterone is low and the level of estrogen is high. It is the result of abnormal stimulation of estrogen. It is the same as the cause of cystic hyperplasia of the breast. Almost 70% of intraductal papilloma It is a concomitant lesion of mammary gland hyperplasia.

Pathogenesis (10%):

The main pathological changes are:

General form

Large intraductal papilloma, the tumor is located in the large catheter under the nipple or areola, the tumor diameter is generally 0.5 ~ 1.0cm, the boundary is clear, no fibrous capsule, most of them are single, a few can be in several large catheters at the same time Occurred inside, the tumor protrudes into the lumen of the catheter, and many small branches or nipples stick together to form a "jasmine-like" nodule. The nodules are thick and thin, different lengths of pedicles, and can also be pedunculated, generally short and short. Papilloma fiber has many components, the cut surface is grayish white, and the texture is tough; the slender papillary tumor with slender and scaly red on the top is brittle and easy to hemorrhage, and it is also easy to malignant. The duct where the tumor is located is dilated, with a pale yellow or Brown liquid persists, sometimes mixed with mucus or bloody fluid. Medium and small intraductal papilloma are located in small and medium-sized catheters. The tumor is white translucent and small granular, without pedicles, attached to the wall of the tube, and varies in size. Different, the tissue is more tough, the epithelial growth is strong, is a precancerous lesion, and the cancer rate is 5% to 10%.

2. Organizational form

A papillary mass formed by ductal epithelial cells and mesenchymal hyperplasia protrudes into a cavity surrounded by a dilatation catheter, and the fibrous tissue and blood vessels form the axis of the nipple, and the outer layer is covered with 1 or 2 layers of cubic or columnar epithelial cells, according to the papillary shape. The degree of tumor cell differentiation and the number of mesenchymal cells can be divided into the following three types.

(1) Fibrous intraductal papilloma: characterized by a short nipple and a rich fibrous tissue layer in the interstitium. The epithelium covered by the surface of the nipple is mostly cubic or columnar, and can also be a bilayer of epithelial and myoepithelial cells. It is neat, well-differentiated, and has no heteromorphism. Because of its many fibrous tissue components in the tumor, it is called a fibrous intraductal papilloma, which is a common clinical one.

(2) glandular intraductal papilloma: ductal hyperplasia of epithelial cells constitutes tiny nipples, repeated branching, tortuous, and anastomosed to form an irregular adenoid structure, less interstitial fibrous tissue, often in the form of thin strips Between epithelial cells.

(3) Transitional intraductal papilloma: characterized by hyperplasia of the ductal epithelium, formation of nipples, protruding into the lumen, hyperplastic epithelium is cubic or low columnar epithelial cells, cells are evenly arranged, no abnormalities, arranged like a transitional epithelium (Figure 2), Saphir believes that this type has no interstitial and adenoid-like solid cell mass, which is potentially malignant.

Breast intraductal papilloma prevention

1. Adequate nutrition, keeping the muscles of the breasts strong and full of fat. Sitting at the side of the line, maintaining a beautiful posture, especially can not contain the chest, should be chest, head up, abdomen, straight knee, so that the beautiful breasts can proudly stand out, women's style fully displayed.

2. Pay attention to protect your breasts from accidental injuries, especially when you are on a crowded bus and teasing children.

3. According to the condition of your own breast, wear a soft, sized and well-equipped bra, so that the breast can be well fixed and supported while presenting a beautiful shape.

4. Perform self-examination on the breast, regular physical examination of the breast at the specialist, and regular mammography if necessary. When you feel uncomfortable or have problems with your examination, you should seek medical advice promptly to diagnose and treat various breast diseases early.

Breast intraductal papilloma complications Complications breast nipple discharge

Local pain and tenderness.

Breast intraductal papilloma symptoms Common symptoms Nodular breast nipple nipple overflow bloody or... Nipple discharge

Nipple discharge

About 80% of the patients are the main symptoms of intraductal papilloma. Patients often inadvertently find blood on the shirt. The nipple discharge comes from the milk duct. It is self-contained and often bloody or serous. Stout statistics accounted for 78% of bloody discharges and 22% of serous discharges. The secretions of young women were often serous, while older women were mostly turbid or milky, due to weak tumor tissue, abundant blood vessels, and slight compression. It can cause bleeding or secretions with rust color, which is the most common cause of bloody milky discharge in intraductal papilloma.

Whether nipple discharge occurs in papilloma is related to the type and location of papilloma. The phenomenon of nipple discharge in papilloma occurring in the large duct at the center of the nipple is most common. When the tumor is located at the edge of the nipple, the small and medium catheter The occurrence of nipple discharge in the inner or acinar is less common.

For male nipple discharge, it should be considered as a ductal papilloma first, and it is highly vigilant. It is reported in the literature that if the nipple hemorrhagic fluid over the age of 45 is accompanied by a breast lumps, the malignant transformation of the ductal papilloma should be considered. Possible.

2. Pain

Only a small number of patients with this disease have local pain and tenderness, often caused by breast duct dilatation, lipid-like substance spillage and inflammation in the duct.

3. Breast lumps

Breast lumps are the main signs of intraductal papilloma in breast ducts. According to domestic literature, 66%-75% of the patients with lumps can be touched at the nipple, at the center of the areola or at the center of the breast. In 1 to 2 cm, and also less than 1 cm, or 3 to 7 cm or more, a single intraductal papilloma can be caused by a catheter obstruction expansion, touching a soft, smooth and active mass, sometimes in the areola The radial cord can be touched. If the patient's nipple overflows and touches a small mass, 95% of them may be intraductal papilloma, and some patients may not have a mass. Only a few nodular nodules are touched in the areola area. In fact, the lesion is where the lesion is pressed, and the lumps of the areola are seen. The bloody fluid flows out from the nipple of the corresponding gland duct. Since the mass is mainly caused by hemorrhage of the papilloma, the mass tends to become smaller or disappear after pressing, so the physical examination is performed. The mass should be gently pressed to leave part of the blood, and the breast segment can be removed according to the corresponding milk duct of the nipple during surgery.

Examination of intraductal papilloma

1. Effusion cytology: The nipple smear is cytologically examined. If the tumor cells can be found, the diagnosis can be confirmed, but the positive rate is low.

2. Needle aspiration cytology: For cases with accessible masses, needle aspiration cytology can be used for differential diagnosis with breast cancer.

3. X-ray breast plain film: The accuracy of positioning this disease is less than 30%, but the bleeding caused by recessive breast cancer can be ruled out. Because the papilloma in the milk duct is small in size and light in density, the X-ray film is very thin. It is difficult to find that when the tumor is large, it appears as a duct-like strip-like shadow, or a partial round dense shadow, the edges are completely sharp, and occasionally calcification is visible.

4. Selective mammography: It has a high diagnostic and localization value for papilloma in the milk duct, especially in cases where the tumor is not found in the tumor. The tumor is mostly located in the breast duct of grade 1-2, which is single or Multiple limitations of round or oval filling defects, visible distal duct dilatation or obstruction, visible "cup mouth" mass in the main catheter obstruction, the tube wall is smooth, no external dip phenomenon, the branch catheter is mainly a single Catheter truncation, ductal angiography can identify cystic hyperplasia or cancer, and can also find other lesions in the same catheter system.

Method: routinely disinfect the nipple and surrounding skin, find the opening of the galactorrhea, gently insert the lesion catheter with a blunt fine needle to avoid puncturing the milk duct. After the needle is 1~2cm, inject iodized oil or 76% compound diatrizoate. Then take a molybdenum target, taking care not to push the air in.

5. Breast transillumination test: In the dark room, the breast is transilluminated by a flashlight, and the hemorrhagic mass can show an opaque area. This method is convenient for determining the location of the mass.

6. Ultrasound examination: It is non-invasive, painless, simple and easy to perform. Ultrasound can be seen in the dilated catheter and the liquid dark area inside it. Sometimes the papilloma and filling defect in the catheter can be seen.

7. Breast tube endoscopy: the nipple discharge without touching the mass can improve the diagnosis rate. The breast tube endoscope observation shows that the papilloma is yellow or congested and red, and the surface is smooth and mulberry-like. Into the cavity, or a polypoid bulge and the surrounding tube wall is smooth, no unevenness.

Diagnosis and diagnosis of intraductal papilloma

diagnosis

When the patient visits, the patient complains of vaginal discharge of bloody or brown serous fluid, sometimes absent, intermittent, and can touch small bumps in the breast. It can be discharged due to squeezed liquid, and the mass shrinks or disappears. In the areola, it can be found in the areola. Nodular mass with a diameter of about 1cm, accompanied by tenderness. Use the index finger edge along the direction of the milk duct to gently press from the base of the breast to the nipple. Press one by one clockwise to avoid symptoms and missing signs. According to these characteristics, clinical diagnosis is not difficult, and the above methods can be used to check and diagnose the suspected cases.

Differential diagnosis

The disease should be differentiated from cystic hyperplasia of the dysplasia of the breast, ductal dilatation, large catheter or ampullary inflammation, papillary carcinoma, Paget's disease.

1. Cystic hyperplasia of the breast: The discharge of this disease is mostly serous or yellow-green. Clinically, the disease is periodic pain, and the pain before menstruation is obvious. The breast can be sputum and nodular, tough and tender.

The performance of the ductal angiography showed no filling defect. The sclerosing adenosis showed that the milk duct and its branches became thin and thin, and the cyst type showed a large cystic expansion connected with the catheter, small duct and acinar hyperplasia. It is characterized by a uniform small cystic or beaded expansion of the terminal ductal acinus.

2. Inflammation of large catheter or ampulla: Occasionally, nipple discharge is seen, mostly purulent, and there is a history of obvious inflammatory disease. The smear of effusion smear shows inflammatory cells, and it is not difficult to diagnose.

3. Catheter dilatation: The breast lumps of the disease are located in the areola area, local redness, burning pain, itching and swelling, etc. In the acute phase of the disease, there is an acute breast infection, all breast edema and nipple retraction, Like inflammatory breast cancer, some patients have nipple discharge, but the discharge is viscous clot, non-self-contamination, most of which is caused by extrusion. The contrast of the duct shows that the large duct under the areola is significantly dilated and distorted. Severe cystic, no filling defects.

4. Papillary carcinoma: papillary carcinoma is mostly located in the center of the breast or deep in the areola, or in the breast tissue outside the areola area, often accompanied by nipple bloody discharge, clinically easy to be confused with intraductal papilloma, want to The difference between the two must be pathological examination, microscopic observation, papillary tumors can be seen in the glandular epithelium, the nipples formed by the two layers of myoepithelial cells and the regular arrangement of ductal cells, no abnormalities, rare or absent nuclear division, often With apocrine glandular metaplasia, less nipple branches, more interstitial and larger nipples, can be merged into a complex adenoid structure, while papillary carcinoma is the opposite, cell abnormalities are obvious, nuclear division is common, and there is generally no hardening in adjacent breast tissue. Gonadal disease, a sieve-like structure can be seen in cancer cells.

5.Paget disease: Paget disease occurs from the large catheter at the nipple, but the surface of the nipple has eczema-like changes, and the skin is thickened, often accompanied by nipple tingling, itching and burning sensation, thickening of the skin is often normal The tissue demarcation is clear, there are not many blood secretions, so it is easy to identify, but in the end, it must be confirmed by pathology.

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