￼Intraductal Papilloma’s

There are multiple types of papillary breast lesions including:
- Benign intraductal papillomas
- Atypical papillomas
- Papillomas with atypical ductal hyperplasia (ADH)
- Papillary carcinomas
A solitary intraductal papilloma:
- Is a common breast lesion:
  - That can present with nipple discharge if arising in the large ducts, or
  - As a clinically occult mass on imaging if occurring in the periphery
  - Infrequently, an intraductal papilloma presents as a palpable mass
- Typically, atypia or carcinoma in situ:
  - Is more frequently associated with intraductal papillomas in the periphery of the breast:
    - However, due to intralesional heterogeneity and fragmentation, sampling error is a concern with core needle biopsy
- Recent studies suggest the risk of upgrade to carcinoma upon excision of an intraductal papilloma with atypia:
  - Is 21% to 37%:
    - Thus, removal of the entire lesion is sometimes required to rule out in situ or invasive cancer
- A wide margin is not required at the time of excision biopsy of a papillary lesion
- References:
  - Racz JM, Carter JM, Degnim AC. Challenging atypical breast lesions including flat epithelial atypia, radial scar, and intraductal papilloma. Ann Surg Oncol. 2017;24(10): 2842-2847.
  - Wei S. Papillary lesions of the breast: an update. Arch Pathol Lab Med. 2016;140(7):628-643
  - Swapp RE, Glazebrook KN, Jones KN, Brandts HM, Reynolds C, Visscher DW, et al. Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol. 2013;20(6):1900-1905.
  - Cheng TY, Chen CM, Lee MY, Lin KJ, Hung CF, Yang PS, et al. Risk factors associated with conversion from nonmalignant to malignant diagnosis after surgical excision of breast papillary lesions. Ann Surg Oncol. 2009;16(12):3375-3379.
  - Ko D, Kang E, Park SY, Kim SM, Jang M, Yun B, et al. The management strategy of benign solitary intraductal papilloma on breast core biopsy. Clin Breast Cancer.2017;17(5):367-372.