What is it
Papilloma grows inside the duct in the form of a growth on a vascular pedicle, covered with epithelium. Due to the good blood supply, it is easily injured, so the discharge is often bloody. There is a single central papilloma, located in a large duct under the areola, and multiple peripheral ones, located in small ducts further from the nipple. Central papilloma is more likely to produce discharge and is less likely to be associated with an increased risk, while multiple peripheral ones require a more careful approach and monitoring.
- Growth inside the milk duct
- Central - under the areola, often single
- Peripheral - in small ducts, often multiple
- Easily injured and bleeds
- Benign formation
- May be combined with atypia - histology decides
Causes and risk factors
The exact reason is unknown. It is believed that the development of papilloma is associated with hormonal influences on gland tissue, so it is more often found in women aged 35 to 55 years, that is, during a period when hormonal levels change. This is facilitated by menstrual irregularities, thyroid diseases, obesity, and fibrocystic mastopathy. Heredity plays a certain role. Smoking and injuries to the gland are not a direct cause, but they negatively affect the condition of the tissues as a whole.
- Hormonal changes in the body
- Age 35–55 years
- Fibrocystic mastopathy
- Menstrual irregularities
- Thyroid diseases
- Obesity
- Family predisposition
Symptoms
The main and often only manifestation is nipple discharge, usually from one gland and one duct. They appear on their own, leaving marks on the laundry, and can be transparent, yellowish, brown or clearly bloody. Sometimes it is possible to feel a small soft formation under the areola, and when you press on it, the discharge intensifies. Pain is not typical for papilloma, but discomfort is possible. Bilateral milky-white discharge from many ducts is usually associated not with papilloma, but with hormonal causes.
- Discharge from one nipple
- Bloody or clear discharge
- Spontaneous appearance, marks on underwear
- Small formation under the areola
- Increased discharge with pressure
- There is usually no pain
Diagnostics
The examination begins with an examination by a mammologist and an ultrasound of the mammary glands, which clearly shows the dilated duct and growth inside it. Women over 40 years old undergo mammography, although small papillomas are not always visible. To clarify the localization, ductography is used - contrasting the duct, as well as MRI of the mammary glands. The discharge is sent for cytological examination, but a negative result does not exclude formation. The final answer is given by histological examination of the removed tissue, so a biopsy or removal is almost always performed.
- Examination by a mammologist
- Ultrasound of the mammary glands
- Mammography by age
- Ductography or MRI of the mammary glands
- Cytology of discharge
- Biopsy and histological examination
Treatment and observation
The standard approach is surgical removal of the altered duct along with the papilloma through a small incision at the edge of the areola. The operation is organ-preserving, the shape of the gland practically does not change, and the discharge stops after it. The removed tissue must be examined: if atypical cells are found, the observation plan is changed and additional measures are discussed. There is no drug treatment that eliminates papilloma. After the operation, the woman is recommended the usual monitoring of the mammary glands with ultrasound and mammography according to age.
- Surgical removal of the duct with papilloma
- An incision at the edge of the areola, organ-preserving technique
- Mandatory histology of removed tissue
- Changing the observation plan when atypia is detected
- Regular ultrasound and mammography according to age
- Self-examination and attention to nipple discharge