Mammary papilloma

Papilloma of the mammary gland is a benign nodular neoplasia in the tissues of the mammary glands in the form of microscopic foci of overgrown intraductal epithelium, which have a papillary structure. According to the American National Center for Biotechnology Information (NCBI), these tumors are most often found in women aged 35 to 55 years.

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

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Causes mammary papillomas

Today, the causes of papilloma of the mammary gland and risk factors for the occurrence of this formation are associated with hormonal imbalances in the body of women and with the human papillomavirus (HPV).

The pathology received the name "papilloma" due to its external resemblance to soft warts on a leg (in the form of a papilla), which appear on the surface of the skin, on the mucous membranes of the mouth, nasopharynx, vocal cords. And for a long time it was believed that papilloma of the mammary gland has nothing to do with the very same human papilloma virus, which has more than 130 types. The most common of them are skin and anogenital viruses transmitted by contact.

At least 40 types of HPV infect the cervical area. In the course of studying the mechanisms of breast carcinogenesis, it was found that the prevalence of papillomavirus DNA in biopsies of breast cancer neoplasms is almost 26%. And the HPV-16 and HPV-18 virus types, according to the American National Cancer Institute, are related to 80% of clinical cases of cervical malignant tumors.

Research in the field of molecular oncology and immunotherapy has shown that the integration of 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, tissues of the lungs, bladder and stomach; the number of patients with intraductal papillary mucinous neoplasms of the pancreas is growing. So, perhaps, the etiology of papilloma of the mammary gland will soon be finally established.

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Symptoms mammary papillomas

The main clinical symptoms of papilloma of the mammary gland are bloody-serous discharge from the nipple.

Intraductal or intraductal papilloma of the mammary gland is a small polypoid formation, which consists of myoepithelial cells and fibrous (connective) tissue with inclusion of blood vessels (fibrovascular tissue). A rather loose nodule up to 3 mm in diameter is attached to the wall of the milk duct on a fibrovascular stalk and protrudes into the lumen of the flow. Twisting of this stalk leads to necrosis, ischemia and intraductal bleeding.

A papillomatous node in the subareolar region of the mammary gland (near the nipple) is not palpable in all cases. Papillomas are found by touch in distant areas of the breast and only if the size of the node exceeds 1-2 cm. A slight increase in the breast or pain (from stretching of the tissue between the nipple and the papilloma) may also be observed, although, as mammologists note, intraductal papilloma is usually painless.

In 9 cases out of 10, intraductal papilloma is solitary (single) and is usually detected 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, papillomas are located in the milk ducts of the peripheral zones of the gland, and the pathological process very often affects both breasts at the same time. Many specialists classify papillomatosis as a factor of increased risk of oncology (by 1.5-2 times).

Intracystic papilloma of the mammary gland is when a papilloma is formed inside a cyst that is present in the mammary gland. In such cases, a dense node can be easily palpated.

And sclerosing papilloma of the mammary gland (a subtype of intraductal papilloma) consists of dense fibrovascular tissue, often with inclusions of calcifications, and this, as a rule, is detected only by ultrasound or histological analysis of a biopsy sample.

Diagnostics mammary papillomas

In specialized medical institutions, diagnostics of papilloma of the mammary gland is carried out using:

• palpation examination;
• general and biochemical blood tests;
• blood test for tumor markers;
• cytology of smears of nipple discharge;
• mammography (x-ray of the mammary glands);
• ultrasound echography (ultrasound) of the mammary glands;
• X-ray examination of the ducts with a contrast agent (ductography or galactography);
• aspiration biopsy and histological examination of papilloma tissue.

Foreign specialists claim that intraductal papillomas very often cannot be detected using conventional mammography. In the West, ductoscopy has been used for the last 15 years – an endoscopic method for diagnosing milk duct pathologies. A fiber-optic microendoscope with an external diameter of 0.55-1.2 mm is inserted under local anesthesia through the duct opening on the surface of the nipple, which allows for direct visualization of the duct epithelium and intraductal biopsy. There is also the possibility of therapeutic intervention (inflation, irrigation, washing).

Diagnosis of intraductal papillomas requires clear differentiation of this disease from fibroadenoma, ductal carcinoma and papillary breast cancer, which is very similar to papilloma.

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Treatment mammary papillomas

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

Surgery for intraductal papilloma of the mammary gland involves resection (excision) of the duct along with the nodular formation located in it through an incision near the areola of the nipple.

The diagnostic surgical procedure microductectomy is adapted by leading mammologist surgeons to remove one or all 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 preserve the ability of the operated woman to breastfeed. If an intraductal papilloma is detected in several ducts, then 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 of the nipple. These surgical interventions are performed under general anesthesia.

An ultrasound-guided excisional biopsy may be used as an alternative to surgery. After injecting a local anesthetic, a small incision is made in the skin of the mammary gland and a hollow probe connected to a vacuum device is inserted into the tissue. The affected mammary gland tissue is sucked into a collecting chamber (for subsequent histological examination).

Prevention

Is it possible to prevent papilloma of the mammary gland? There are no specific known methods for preventing papilloma of the mammary gland. Women can only increase the likelihood of early detection of pathology if they do monthly self-examinations of the mammary glands and do a mammogram once a year.

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Forecast

The prognosis for papilloma of the mammary gland (single and removed) in the long term is very good. Women who have several papillomas and women after 35 years of age with a diagnosis of papilloma should undergo examination.

As experts from the American Society of Clinical Oncology (ASCO) emphasize, given the increased risk of malignancy of multiple papillomas of the breast, screening should be performed for such patients.

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