Ultrasound spectrum in intraductal papillary neoplasms of breast

Abstract

Intraductal papillary neoplasms (IPNs) of breast form a wide spectrum of pathological changes with benign intraductal papilloma occupying one end of the spectrum and papillary carcinoma at the other end. Intraductal papillomas are known to occur anywhere within the ductal system and are broadly classified into central and peripheral types. Intraductal papillary carcinoma is an uncommon ductal malignancy forming papillary structures, and these lesions characteristically lack the myoepithelial layer present in benign papillary neoplasms. Three basic patterns of IPNs are recognized on ultrasound - intraductal mass with or without ductal dilatation, intracystic mass and a predominantly solid pattern with the intraductal mass totally filling the duct. Benign papillomas are known to exhibit calcifications which tend to be extremely dense and coarse. IPNs are highly vascular tumours and have a propensity to bleed spontaneously. A distinct vascular pedicle is identified within the central core of IPNs, with branching vessels arborising within the mass. In an older age group, presence of a large solid component and evidence of spontaneous intracystic bleed are more suggestive of papillary carcinomas than benign papillomas. We have serially studied 42 cases of intraductal papillary neoplasms with sonomammography and mammography from 2001 to 2004.

Case series: imaging features of intraductal papillomas in patients presenting as nipple discharge

“…8 They observed that intraductal papillary neoplasms (IPNs) of breast form a wide spectrum from benign intraductal papilloma to papillary carcinoma and are broadly classified into central and peripheral types.…”

Intraductal papilloma of the breast: A case report

“…However, these tumors are not always visible on standard mammograms. Sonographically, they are associated with three basic patterns: that of an intraductal mass, with or without duct dilatation; that of an intracystic mass; and that of a predominantly solid formation that occupies virtually all of the duct [1]. Color and power Doppler imaging reveal abundant vascularization with branches arising from a central pedicle [6].…”

“…The incidence of these tumors is 2e3%; they develop in women between the ages of 30 and 77 years [1]. Two types of intraductal papillomas are generally distinguished: central and peripheral.…”

“…Histological analysis reveals proliferation of the ductal epithelium characterized by myoepithelial cells and a fibrovascular stroma [1]. Clinically, 72% of all cases present with bloody discharge from the nipple [3,4] caused by the fragility of the proliferating, disorganized epithelium, which tends to breakdown and bleed.…”

Characterisation of breast papillary neoplasm on automated breast ultrasound

“…The presence of dilatation of ducts associated with a mass is a good indicator for a papilloma [11], and a useful sign for differentiating intraductal papillary lesions from other benign lesions, such as fibroadenoma and fibrocystic diseases [12]. ABVS coronal view is a satisfactory plane for most breast papillary neoplasms because it could demonstrate duct dilation more frequently (Figures 2-4).…”