Intraductal Papilloma (IDP)

Rodrigo Arrangoiz MS, MD, FACS, FSSO

Introduction

  • In the breast, intraductal papilloma (IDP) is a benign lesion that consists of branching fibrovascular cores occurring within a cystic cavity with overlying layers of epithelial and myoepithelial cells:
    • The classic pathologic features of intraductal papilloma (IDP) include an encysted solid mass with a branching fibrovascular pattern.

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  • The large/central subtype (L/C ST) specifically refers to an IDP arising from a large duct.
    • IDP (L/C ST) is generally grossly apparent, solitary, and centrally located in the breast; it has accordingly been referred to as “solitary papilloma” and “central papilloma.”

 

  • IDP (L/C ST) stands in contrast to IDP small/peripheral subtype (S/P ST), which originates at the terminal duct lobular unit (TDLU) and is usually located peripherally in the breast, is not grossly apparent, and generally occurs in multiples.

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Epidemiology

  • IDP (L/C ST) is primarily found in middle-aged women.
    • In a study of 179 women with solitary / central  papilloma:
      • The mean age at diagnosis was 48 years, and occurrence substantially decreased after age 75 years.
      • Younger women were also identified in this series:
        • The youngest was aged 18 years.
  • IDPs are relatively common and are found in 1% to 5% of breast biopsies.
  • Current evidence suggests that IDP (L/C ST) is more common that IDP (S/P ST).

Etiology

  • Molecular evidence has shown that IDPs frequently demonstrate loss of heterozygosity (LOH):
    • Involving specific loci on chromosome 16:
      • This suggests they are clonal neoplasms.
        • However, the studies showing this do not distinguish between IDP (L/C ST) and IDP (S/P ST):
          • Therefore, they are unable to evaluate genetic differences between these lesions.

Presentation

  • IDP (L/C ST) frequently presents as a unilateral serous or bloody nipple discharge:
    • It may also present as a palpable breast mass and may on occasion present as breast pain.
  • Mammography reveals no abnormality in most cases but may show duct ectasia, microcalcifications, or a mass.
  • Ultrasonography may be more sensitive than mammography for detecting IDP (L/C ST) and can reveal duct ectasia, nodules, or a cyst with or without a polyp.

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  • On MRI, IDP (L/C ST) appears as dilated ducts with an associated enhancing, well-circumscribed mass:
    • MRI is currently the most sensitive imaging modality for detecting IDP (L/C ST).

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Rodrigo Arrangoiz MS, MD, FACS a surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

  • He is an expert in the management of breast cancer:

    • If you have any questions about intraductal papilloma and bloody nipple discharge please fill free to ask Dr. Arrangoiz

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

 

 

Sociedad Quirúrgica S.C. multidisciplinary breast cancer clinic:

 

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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