Breast Papilloma

Breast papilloma is a benign nodal neoplasia in the tissues of the mammary glands in the form of microscopic foci of proliferating intraluminal epithelium, which have a papillary structure. According to the US National Center for Biotechnology Information (NCBI), these tumors are most common in women aged 35 to 55 years.

In clinical mammology, this disease is classified as benign proliferative epithelial-fibrous lesions of the mammary glands.

[1], [2], [3], [4], [5], [6]

Causes of the papilloma of the mammary gland

To date, the causes of breast papilloma and the risk factors for this formation are associated with violations of hormonal balance in the body of women and with human papillomavirus (HPV or HPV).

The name "papilloma" pathology was due to external similarity to soft warts on the stem (in the form of a papilla) that appear on the surface of the skin, on the mucous membranes of the mouth, nasopharynx, and vocal cords. And for a long time it was believed that the papilloma of the breast had nothing to do with the human papillomavirus itself, which numbered more than 130 types. The most common of these are skin and anogenital viruses transmitted by contact.

At least 40 types of HPV infect the cervical region. In the course of studying the mechanisms of carcinogenesis of the mammary glands, it was found out that the prevalence of papillomavirus DNA in biopsy specimens of breast cancer neoplasia is almost 26%. And the types of HPV-16 and HPV-18 viruses, according to the data of the American National Cancer Institute, are related to 80% of clinical cases of cervical malignant tumors.

Studies in the field of molecular oncology and immunotherapy have proved that the integration of the DNA of this virus into the chromosome of the host cell not only plays a decisive role in the development of cervical cancer but is also associated with oncological neoplasms of the colon and rectum. In addition, papillomas can affect the ducts of the salivary glands, lung, bladder and stomach tissues; the number of patients with papular intracapsular papillary mucinous neoplasms is increasing. So, perhaps, the etiology of the papilloma of the breast will soon be established definitively.

[7], [8], [9], [10]

Symptoms of the papilloma of the mammary gland

The main clinical symptoms of the papilloma of the breast are blood-serous discharge from the nipple.

Intraductal or intraprostatic papilloma of the mammary gland is a small polypoid formation that consists of myoepithelial cells and fibrous (connective) tissue with the inclusion of blood vessels (fibrovascular tissue). A fairly loose knot with a diameter of up to 3 mm holds on the wall of the milk duct on the fibrovascular leg and protrudes into the lumen of the stream. The twisting of this leg leads to necrosis, ischemia and intra-flow bleeding.

The papillomatous node in the subareolar region of the mammary gland (near the nipple) is not palpable in all cases. To the touch, papillomas are found in the distant regions of the breast and only if the size of the node exceeds 1-2 cm. There may also be a slight chest enlargement or pain (from the stretching of the tissues between the nipple and the papilloma), although, as the mammologists note, intraprostatic papilloma is usually painless .

In 9 cases out of 10 intra-flow papilloma solitary (single) and is found, as a rule, after 40-45 years. Such neoplasia does not increase the risk of developing breast cancer. And multiple papilloma (papillomatosis) is more often diagnosed in younger women. In this case, the papillomas are located in the milk ducts of the peripheral zones of the gland, and the pathological process very often captures both breasts simultaneously. Many specialists attribute papillomatosis to factors of increased risk of oncology (by 1.5-2 times).

Intracystic papilloma of the breast is when the papilloma forms inside the cyst, which is present in the mammary gland. In such cases, a knot of dense consistency is palpable without difficulty.

A sclerosing papilloma of the mammary gland (subtype of intraprostatic papilloma) consists of a dense fibrovascular tissue, often with inclusions of calcifications, and this is usually detected only with ultrasound or histological analysis of a biopsy specimen.

Diagnostics of the papilloma of the mammary gland

In specialized medical institutions, the diagnosis of papilloma of the breast is carried out with the help of:

• palpation examination;
• general and biochemical blood tests;
• blood test for oncomarkers;
• cytology smears discharge from the nipple;
• mammography (mammary gland X-ray);
• ultrasonic echography (ultrasound) of the mammary glands;
• X-ray examination of ducts with contrast material (doktografii or galaktografii);
• aspiration biopsy and histological examination of papilloma tissue.

Foreign experts claim that intra-cellular papillomas very often can not be detected using conventional mammography. In the West, for the last 15 years, dactoscopy has been used - an endoscopic method for diagnosing pathologies of the milk ducts. Fiber-optic microendoscope with an external diameter of 0.55-1.2 mm under local anesthesia is inserted through the opening of the duct on the surface of the nipple, which allows direct visualization of the duct epithelium and an intraprostate biopsy. There is also an opportunity for therapeutic intervention (injection, irrigation, washing).

Diagnosis of intraprostatic papillomas requires a clear differentiation of this disease with fibroadenoma, ductal carcinoma and papillary breast cancer, very similar to papilloma.

[11], [12], [13], [14], [15]

Treatment of the papilloma of the mammary gland

Treatment of papilloma of the breast is surgical only. The standard treatment of this pathology includes the removal of intraprostatic papilloma of the mammary gland and the affected part of the milky duct. These tissues are necessarily examined for the presence of atypical cells. If such cells are found, further treatment (partial or complete mastectomy, chemotherapy, etc.) may be required.

The operation with intra-cellular papilloma of the breast is a resection (excision) of the duct, together with the nodal formation located in it through the incision near the areola of the nipple.

The diagnostic surgical procedure of microdectectomy by the leading mammal surgeons is adapted to remove one or all of the milk ducts, and when the papilloma is single and affects only one duct, this method is the standard of treatment. Often, it is even possible to maintain the ability of an operated woman to breastfeed. If intraprostatic papilloma is found in several canals, subareolar resection of the ducts is performed. The complication of this operation is a temporary or permanent change in the shape of the mammary gland in the area of the areola nipple. These surgical interventions are performed under general anesthesia.

As an alternative to surgery, excision biopsy can be used under the supervision of ultrasound. After injection of the local anesthetic, a small incision is made on the skin of the breast and a hollow probe connected to the vacuum device is inserted into the tissue. And the affected breast tissue is sucked into the collecting chamber (with their further histological examination).

Prevention

Can I prevent breast papilloma? There are no specific known methods for the prevention of papilloma of the breast. Women can only increase the likelihood of early detection of pathology if they do monthly self-examination of the mammary glands and do a mammogram once a year.

[16], [17]

Forecast

The prognosis of breast papilloma (single and remote) in the long run is very good. Women who have several papillomas, and women after 35 years of age with a diagnosis of papillomas should be screened.

As the specialists of the American Society of Clinical Oncology (ASCO) emphasize, considering the increased risk of malignancy of multiple papilloma of the breast, screening for such patients should be carried out.

[18], [19], [20], [21]