Intraductal papilloma of the breast, also known as large ductal papilloma and intracapsular papilloma, is a benign papilloma that occurs in the large ducts of the nipple and areola.The tumor is composed of papillary neoplasms with multiple small branches, often isolated and solitary, and a few can also involve several large ducts.The clinical symptoms of the disease are mostly not obvious, and most of them are painlessNipple dischargeSome of them were found during pathological examination of other breast diseases.
Nipple dischargeIt accounts for about 80% of patients and is the main symptom of intraductal papilloma.Patients often inadvertently find blood stains on their shirts.Nipple dischargeIt comes from the laticiferous duct and is spontaneous, often bloody or serous.According to Stout's statistics, 78% of the cases were bloody and 22% were serous.The secretion of young women is often serous, while that of old women is turbid or milky.Because the tumor tissue is fragile and the blood vessels are abundant, slight squeezing can cause bleeding or the secretion is rust colored, which is the most common reason for intraductal papilloma presenting bloody milk discharge.
Whether papilloma occursNipple dischargeIt is related to the type and location of papillomaNipple dischargeSymptoms are most common.When the tumor is located at the edge of the nipple, nipple discharge is rare in small and medium-sized ducts or acini.
For male nipple discharge, ductal papilloma should be considered first, and the possibility of malignancy should be highly guarded.It has been reported in the literature that if nipple haemorrhagic fluid over 45 years old is accompanied by breast mass, the possibility of malignant transformation of ductal papilloma should be considered.
2. Pain
Only a few patients with this disease have local pain and tenderness, which are often caused by breast duct dilation, lipid like substance overflow and inflammation.
3. Breast lump
Breast mass is the main sign of intraductal papilloma.According to the domestic literature, 66%~75% of the patients with this disease have masses.During palpation, the mass can be palpated at the nipple, areola area or breast center, with the diameter of 1~2cm, or less than 1cm, or 3~7cm or more.Single intraductal papilloma may be caused by duct obstruction and dilation.The soft, smooth and moving mass was touched, and sometimes the radial cord could be touched near the areola.If the patient has nipple discharge and touches a small mass, 95% of them may be intraductal papilloma.Some patients can not touch the mass, but only touch a few punctate nodules in the areola area, which is actually the location of the lesion.When pressing the mass at the areola, it can be seen that the blood fluid flows out from the nipple of the corresponding glandular duct. Since the mass is mainly caused by papilloma hemorrhage, the mass often becomes smaller or disappears after pressing.Therefore, the mass should be gently pressed during the physical examination to leave some blood. During the operation, the breast section can be removed according to the corresponding breast tube marked with nipple bleeding.
The patient complained of bloody or brown serous fluid spilling from the nipple at the time of treatment, sometimes absent, intermittently.Small lumps can be touched in the breast, which may shrink or disappear due to the extrusion of liquid.During physical examination, a nodular mass with a diameter of about 1cm can be felt in the areola, accompanied by tenderness.During the examination, use the index finger to gently press from the breast base to the nipple along the breast tube, and press clockwise one by one to avoid missing symptoms and signs.Blood or serous liquid can be seen at the corresponding nipple feeding hole.According to these characteristics, clinical diagnosis is not difficult. For suspicious cases, the above methods can be used to determine the diagnosis.
differential diagnosis
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1. Cystic hyperplasia of breast
The discharge of the disease is mostly serous or yellowish green. Clinically, the disease presents periodic pain, with obvious pain before menstruation. Nodules can be felt in the breast, and tenderness can be felt.
No filling defect was found on galactography.Sclerosing adenosis is characterized by the thinning of the milk ducts and their branches, which are thin lines;Cystic type showed large cystic dilatation connected with the catheter;The small duct and acinar hyperplasia type showed that the terminal duct acini were uniformly expanded in small sacs or beads.
2. Inflammation of large duct or ampulla
Occasionally, nipple discharge can be seen, most of which is pyemia, and there is a clear history of inflammation. Cytological examination of the discharge smear shows inflammatory cells, which is not difficult to diagnose.
3. Catheter dilatation
The breast mass of the disease is located in the areola area, with local redness, burning pain, itching and swelling.In the acute stage of the disease, there are signs of acute breast infectionedemaandInverted nipple, inflammatory likemammary cancer。Some patients have nipple discharge, but the discharge is viscous clot like, non spontaneous, and most of them are squeezed out.Mammography showed that the large duct under the areola was significantly expanded and tortuous, and in severe cases, it was in the shape of a leaf sac, without filling defect.
4. Papillary carcinoma
Papillary cancer masses are mostly located in the center of the breast or deep in the areola, or in breast tissue outside the areola area, often accompanied by bloody nipple discharge, which is easily associated withIntraductal papillomaConfused.Pathological examination is necessary to distinguish the two.Microscopically, papilloma can be seen with papilla formed by glandular epithelium and myoepithelial cells and glandular tube cells in regular arrangement, without abnormity. Nuclear division is rare or absent, often accompanied by sweat gland like metaplasia.The nipple has fewer branches, more stroma and thicker nipple, which can fuse into complex glandular structure.Papillary carcinoma, on the contrary, has obvious cell abnormity and common mitosis. There is generally no sclerosing adenosis in the adjacent breast tissue, and the cribriform structure can be seen in the cancer cells.
5. Paget disease
Although Paget's disease originates from the large duct at the nipple, there areeczemaSuch changes, and thickening of the skin, often accompanied by nipple tingling, itching and burning sensation and other symptoms.Thickened skin often has a clear boundary with normal tissue, and there are not many bloody secretions, so it is easy to differentiate, but finally it must be confirmed by pathology.
treatment
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Intraductal papillomaAll patients need surgical treatment. Before operation, 2% methylene blue solution should be injected into the opening of the catheter for catheter angiography so as to identify the affected catheter during operation.Or a fine needle may be inserted into the catheter for guidance during the operation.Do not squeeze the breast two days before the operation, so as not to drain the accumulated fluid in the catheter, and it is difficult to identify the overflow catheter during the operation.Introduce two surgical methods:
1. Segmental mastectomy
It is suitable for intramammary papilloma with single tube discharge.When removing the diseased duct and its surrounding breast tissue, pay attention to the extent of removal, and do not leave lesions to avoid recurrence.
2. Subcutaneous mastectomy
Suitable for multi tube overflowIntraductal papilloma of breast；Or clinical only nipple discharge, without palpable breast mass;The lesion could not be located before operation and could not be found during operation;For older patients who are suspected of malignancy by cytological examination of effusion, subcutaneous total mastectomy or simple mastectomy can be performed.After surgery, the pathological report was cancer, and then radiotherapy and chemotherapy were performed.
prevention
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1. Adequate nutrition to keep breast muscles strong and fat.
2. Pay attention to protecting the breast from accidental injury.
3. Wear a soft, size appropriate bra according to your own breast condition, so that your breast can be well fixed and supported while presenting a beautiful shape.
4. Regularly carry out self-examination of the breast, regularly go to the specialist for physical examination of the breast, and regularly take mammograms when necessary.If you feel uncomfortable or find problems during the examination, you should see a doctor in time to diagnose and treat various breast diseases at an early stage.
