intraductal papilloma - this one-sided growth of breast duct epithelium in the form of buds, benign origin.Most often, intraductal papilloma breast cancer is localized near the nipple (at a depth of not less than five centimeters) and has the form of money, did not exceed 2cm, outgrowth inner surface of the output ducts.Less common in breast ducts formed multiple papillomas.Multiple epithelial proliferation in the ducts of the breast is considered to be potentially dangerous because of possible malignancy (malignancy).
Under benign tumor processes intraductal papilloma is not a leader (10%).Most often it is registered in 35-55 years and can be detected in women without comorbidities.Lack of birth and smoking increase the risk of intraductal papillomas in the mammary gland.
understanding of the causes of pappilomy in breast ductal limited assumptions.To talk about the presence of predisposing factors for its occurrence.
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location intraductal papilloma may be central or peripheral.Papilloma appear in any part of the breast ductal system, but their "favorite" localization believe areola region (hyperpigmented area around the nipple), which is the terminal part of the main flow.Located in the peripapillary area papillomas are central.
intraductal papilloma is not always clinically evident.Often it detected during routine inspection.The surface of the papillomavirus contains many blood vessels, so some patients from the nipple (one!) Of the breast is removed thick secretion with blood.
Diagnostics intraductal papilloma begins with a careful inspection and palpation.With its central location papillomavirus can be felt.The diagnosis is confirmed by X-ray and ultrasound.
Since credible causes of intraductal papillomas in the breast are not known, predict its consequences as possible.Available infrequent case of malignant transformation require that preventive removal.
Removing intraductal papilloma always surgery alone.
reasons intraductal papilloma
As already mentioned, the origin of the intraductal papilloma is unknown.History of patients with this pathology to determine the presence of certain triggering factors for its development.
intraductal papilloma may appear on the background of hormonal dysfunction.This assumption is confirmed by the small number of cases the diagnosis of intraductal papillomas of the breast on a background of hormonal contraceptives that are artificially maintained constant hormonal homeostasis.
Any pathology, leading to disruption of proper operation of the ovaries, or, conversely, which arose due to their improper function, increases the risk of papillomas.These are:
- menstrual dysfunction;
- endocrine diseases (hypothyroidism, diabetes mellitus, adrenal pathology and the like), especially accompanied by obesity;
- multiple abortions;
- inflammatory diseases of appendages (oophoritis, salpingitis);
- psycho-emotional disorders;
- fibrocystic breast disease (mostly nodular or domination fibrosis).
There is a significant relationship the presence of a patient with intraductal papilloma familial predisposition to the formation of pathology in the breast.Their family history is often composed of various origin tumors (malignant) in the immediate family.
Symptoms intraductal papilloma
speak about the symptoms of intraductal papilloma difficult as specific clinical signs, it is not.Small papilloma may be present in the ducts and symptoms manifest themselves only with increasing size.
Most patients with intraductal papilloma note the following signs:
- The presence of abundant spontaneous discharge from the nipple (required one!) Of the breast.Appearance of discharge can vary from serous to bloody.Sometimes patients indicate that the profuse discharge from the nipple flow so freely that leave stains on the bra.The most reliable quality at any discharge vnturiprotokovoy papilloma of the breast is considered to be the presence of blood in them, because of what they are painted in pink, red or brown.
- seal or a knot, like a small elastic "ball."Most nodule located in the areola (if papilloma located in the main duct), and when you try to probe occurs moderate pain.If, during the examination the doctor compresses the sealing area of the nipple is released a few drops of bloody discharge, and the bundle is reduced in size.
Essentially intraductal papilloma is similar to a bottle of bloody content that appears after trauma easily damaged "buds" of the tumor.This explains the presence of blood in the discharge from the nipple.When papilloma squeezed, the liquid contents comes out, therefore it decreases in magnitude.
If the duct zone papillomavirus infection process begins in the secretions of pus may appear.
For diagnosis is important to have a bloody discharge from the nipple.In intraductal papilloma it appears in the 92%.
- Soreness in the affected areola area.Sometimes, in the area of inflammation papillomas formed because joining a secondary infection.Develop local swelling that compresses the nerve endings located in the peripapillary region and provoke pain.
Like most pathological conditions breast intraductal papilloma appears on the background of hormonal dysfunction.Therefore, complaints of patients with all of these pathologies can be identical.For example, serous discharge from the nipple accompany breast, inflammatory breast disease, as well as appear in the background dishormonal changes during menopause.The appearance of the seal in the chest also includes a large group of diseases of different nature.This complicates the primary diagnosis and requires further diagnosis with the help of instrumental methods.
So, if the initial examination the presence of intraductal papilloma more likely if:
- are abundant spontaneous nipple discharge mixed with blood;
- when probing the areola area is defined by a small sensor myagkovata nodule that may diminish or disappear when pressed;
- patient present hormonal disorders.
During the inspection necessarily taken droplet discharge nipple and placed on the glass for subsequent cytology.In the presence of breast intraductal papilloma point detected papillary cells and blood.
detect intraductal papilloma of the breast help:
1. Ultrasound scans the breast.It detects the presence of surface or deep formations that do not exceed half a centimeter in size.Papilloma visualized by ultrasound as a cyst like a normal education, filled with dense contents.The inner surface of a cyst is irregular, formed by numerous appendages (like cauliflower).Most intraductal papilloma formed expanded milk ducts, often against the background of the formation of small cysts in their hormonal nature.With the help of ultrasound in the area can be seen papilloma advanced flow with liquid contents.The advantage of ultrasonic method of diagnostics is its absolute safety, the ability to "see" the internal structure of any education, that is, to distinguish a cyst from the liquid contents from the dense knot.Also, the method helps to clarify the status of the lymph nodes surrounding the breast.
2. Mammography.X-ray diagnostic method.Like ultrasound to identify the different pathology of the breast, including the tumor.
Often the patient is asked about the reliability and usefulness of ultrasound and mammography, ask which method is best.The reliability of both methods is high, but it all depends on the specific clinical situation.Sometimes both methods are used as complementary, and in other cases only one.
3. Ductography.Mammography and ultrasound do not allow flow from the inside to inspect and evaluate its condition."See" inside the duct allows radiopaque Ductography method.The lumen of the ducts of the breast is filled with a contrast agent and X-rays are made.Papilloma of them looks like a filling defect.
Treatment intraductal papilloma
In terms of the origin and consequences of intraductal papillomas are not well understood, and the current situation of their malignant transformation suggest experts on a logical conclusion: to leave uncontrolled formation in the channel it is inappropriate and possibly dangerous.If the doctor provides the patient surgical removal of the intraductal papilloma, she should not be afraid.This proposal implies a reasonable solution.The final verdict on the origin of papillomas and its "quality" shall histology laboratory, studying the remote surgeon tumor and surrounding tissue.
Solitary papillomas formed in the main ducts of the breast and can be felt in the peripapillary area (or rather, behind the nipple), they are harmless in terms of the development of malignancy.However, they often are injured or become a cause of inflammation.
Multiple papillomas are located in the peripheral (distant from the nipple) ducts.Small multiple education can not be felt, but are identified during instrumental examination (ultrasound, mammography).Their presence can manifest atypical beginning unwanted changes.
Not all produced in mammary gland papillomas are dangerous, but it is better to remove surgically, regardless of structure.
methods of specific prevention of intraductal papillomas does not exist.According to the most reliable hormonal theory of intraductal papillomas, timely removal of hormonal imbalance helps to reduce the risk of recurrence.
Operation at intraductal papilloma
what way and to what extent will be removed intraductal papilloma, the surgeon decides, after analyzing the data from all surveys.
When single papillomas localized in the main ducts (around the nipple or behind him) made sectoral resection (literally cutting out a small section of) breast cancer.After preliminary general anesthesia incision in the areola area, inspect ducts, their condition is estimated and then removed a small portion of breast tissue containing papilloma and damaged ducts.
Most patients worried about the question of preserving the aesthetic appearance of the breast after surgery.Sectoral resection does not lead to deformation of the breast, and modern methods of surgical procedures on the chest allow it to maintain the proper shape and size to avoid further scarring complications.
If papilloma shows signs of malignancy, breast lesions to remove.Also received in the case of multiple papillomas disposed in a peripheral portion of the breast.
Over the next three years for the operation papillomavirus can "go back".Recurrence of the disease is usually not associated with incorrect treatment, because the surgeon removes itself intraductal papilloma, but the cause of its occurrence persists and this could trigger a re-formation of the tumor.To exclude such a scenario, after removal of the tumor is performed preventive treatment.