Intraductal papilloma -- why excision?
Hello, this may not be the right area for this topic, but am having problems clarifying something about my biopsy results. Fortunately, they turned out benign, but the lesion was identified as intraductal papilloma with no cellular atypia. (There has been no nipple discharge.) I don't know yet whether it was a single or multiple papilloma.
I am supposed to meet with a surgeon on Monday for a consultation about having the papilloma removed, but was told that the standard practice is excision to check if cancerous cells can be seen.
But if it is benign, then why is it checked for cancer? Or does it mean that the surgeon takes out the papilloma to see if a cancerous area lies in the duct underneath it?
I've seen the general information about intraductal papilloma online but just wanted to clarify further. Any information would be much appreciated. I've told friends that the biopsy results were benign, but now am wondering whether that was premature.
Thanks very much,
Llywelyn
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I don't have exact answers for you, but I can tell you how it worked for me. I was originally told that I had intraductal papilloma, too, and it needed to be excised. I was also told that a papilloma is unusual tissue, but not cancerous. I never thought twice about it being otherwise. However, the excision results did show cancer for me. A biopsy is a small piece of tissue, which might not represent the entire suspicious area. An excisional biopsy gets the entire piece (hopefully) and allows the lab to get a full look at all the tissue. This is the only way they can determine what is truly going on. Short of that, they are making an educated guess. The excisional biopsy is not a difficult procedure, although you are generally put to sleep for it. Recovery is about a day or so. Best wishes to you. - KC
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In the "Not Diagnosed But Worried" forum is a thread titled "papilloma." It's on the first page if you want to check it out. I am having surgery for mine next Wed. Below is a copy of my contribution to the papilloma thread- (sorry, it's kinda like a mini doctoral disseration
I was diagnosed with a peripheral papilloma on Feb. 9 and have an appointment Tuesday with a surgeon. Here's what I have learned in the last few days.
Papillomas are masses believed to be caused by the human papilloma virus (HPV); most of us have heard of HPV due to it's highly publicized link to cervical cancer and benign vocal cord lesions. The incidence of papillomas is 1-3% and they can be classified as central or peripheral. Central papillomas are located in the large ducts under or around the nipple, are typically solitary and cause nipple discharge in 70% of cases. Peripheral ones are the opposite: they are located in the outer margins of the breast in the terminal ductal lobular units, typically appear in groups, and do not cause nipple discharge. Papillomatosis refers to the development of multiple papillomas. Any of these may or may not be palpable. Lay person websites state that papillomas are benign which is not entirely true. Papillomas can be benign, malignant, or mixed. They are heterogeneous masses-they can contain multiple tissue types-so an excisional biopsy is required to confidently rule out malignancy. A core needle biopsy can accurately identify this mass but is not reliable in classifying it as benign as the sample may miss malignant cells in the lesion (false negative). Even when the papilloma is benign, it is associated with a higher rate of abnormal cells in the surrounding tissues (margins). It is the possibility of these "false negative" results and the potential for malignancies in the margins that lead most doctors to recommend surgical excision. Peripheral papillomas are more often associated than central papilloma with DCIS and invasive carcinoma. That being said, the majority of papillomas and their margins are benign. The rate of upgrade from benign is approximately 10-30% depending on which study you look at, and malignancy in persons under the age of 30 is very rare.
That pretty much sums up what I have learned so far. To get good info I have had to look to professional websites and research. Layperson websites were not the best sources. If anyone else has good info please post it.
Best wishes.
Addendum: The info above is in reference to general papillomas. There are also atypical papillomas which I did not discuss
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I didn't have a papilloma, but I did have a benign fibroadenoma, which I was told are always benign in and of themsleves. It was in the excision of the fibroadenoma that cancer was found in the surrounding tissues. I read online, later, that the body develops these benign tissues as a body's defense mechanism...guarding against what doesn't belong in there (i.e. cancer). Best bet is to have it removed no matter what the doctors tell you. Nothing is as sure as a pathology report.My doctor was shocked and in tears giving me the news that I had breast cancer. I think even he learned something new that day.
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Thanks very much for sharing that information! I really appreciate it. That clears up some things. And, KorynH and kchshreve, I certainly send you my best wishes for good health and strength for what you're going through. Horsewing, best of luck for the surgeon's appointment this Tuesday. Sounds like we're in a similar boat. Will keep you all in my prayers. All the best, Llywelyn
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I was reading what you had to say about the papilloma and was wondering what kind of discharge do you usualy have when everyone says bloody discharge is it red or orange tinged. I have had breast implants for almost 5 years and last year the right side started to capsilate the Dr said to watch and see what happens well the past 4 months its gotten realy bad then about 4 weeks ago I noticed an orange tinged liquid like discharge from the same breast went to Dr and he ordered mamogram and ultra sound which showed fluid outside of the right breast implant. the radiologist then ordered an MRI which showed mild to moderate back ground contrast enhancement, a small amount of ductal dilation on right, asymmetric from the left. the ductal dilation appears to be laterally rather than medialy. there is no evidence of abnormal ductal enhancement. then it showed a moderate amount peri-implant fluid on the right and a physiologic amount of fluid on the left. They said to follow up on clinical management of the nipple discharge and if it persists consideration should be made for galactography or excision of the affected ductal system.
my plastic surgeon took a culture to test for infection and also had me squeeze the discharge in a tub to be tested for cancer cells. I am waiting on the results any imput would be great as this is all new to me.
Thank you Angela
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Hello Ladies,
I want to take this opportunity to thank you for additional information on Intraductal Papillomas. This has truly been a learning experience for me - being that I have been diagnosed with a benign papilloma, and now my discharge has turned into more of a bloody/brown discharge. I am seeing a surgeon March 10 for consultation and then from there, surgery. Now that I've read a little more about my diagnoses, I'm a little nervous about what this lump could actually contain. What a mystery this has been. I am praying for a good outcome for me as well as for everyone else.
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I shared this on the other papilloma thread but I thought I'd add it here because it may make you feel a little more positive.
My very small left breast had significant DCIS along with a 1.2cm IDC tumor in one quadrant. It also had 2 papillomas- each in a different quadrant which had to be removed. So mastectomy was my only option and I chose to do bilateral. The only (hah---ONLY) cancer I had was in that one quadrant, the papillomas were just that...benign papillomas but their removal was mandatory.
I pray you receive the same result.
God Bless,
Ellen
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I have just been diagnosed with multiple (3) intraductal papillomas found on core needle biopsy for 6 microcalcifications. The breast surgeon recommends a wire guided excisional biopsy of my right breast to check the surrounding area. I had no symptoms up until this point (until this last screening mammo which showed the 6 microcalcifications). I am 54, and my Mom has had breast cancer.
I am terrified of this next procedure as the core biopsies were extremely painful to me, and I almost was not able to complete the procedure. But - I am also terrified of having breast cancer....I just don't know what to do...
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According to recent research, approx. 25% of the time with intra-ductal papillomas a nearby early cancer can be found. This is why its considered standard of care to remove them for further interpretation by the pathologist.
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Hi,
Do you mind sharing your status? How did your surgery go? I am going through the same process. Few weeks ago, I found a nipple discharge and went for a check up and then ended up doing ultra sound guided core needed biopsy. They found that it is "Intraductal papilloma with florid adenosis but no atypia". The recommendation is to remove it by "Excisional" which will be again sent for biopsy. I am confused of whether to do the surgery or not.
I would appreciate any input on it.
Thanks
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I would like to add my thanks to those who posted in this thread. When I heard it was benign, I wondered at going through a procedure that might not be necessary. But now I am confident in moving forward with surgery to fully determine what is going on.
I am doing my research on the heels of 3d immaging for mammos coming into use to help identify cancer earlier. In 2013, we are getting a fast track breast screening clinic and it can't come fast enough. But, we are talking Canada.....grrrrrrr
Blessings to all, you are truely amazing ladies.
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I know this is a couple of years old, but I wanted to reply to horsewing who stated; "Papillomas are masses believed to be caused by the human papilloma virus (HPV); most of us have heard of HPV due to it's highly publicized link to cervical cancer and benign vocal cord lesions."
This is not true. "Intraductal (breast) papillomas are not at all related to the 'papilloma's (otherwise know as 'warts'), which occur and skin surfaces and are caused by exposure to the Human Papilloma Virus (HPV). They simply share the name because they have similar features." Source: http://www.breast-cancer.ca/type/papilloma.htm
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This is a great forum. I was worried about bloody discharge from my right nipple, I was scared and shocked. To shorten up this story I sought treatment immediately. The first doctor patted me on the head and said don't worry this has a low incidence of cancer. It is a ducal papilloma and that they do not take an aggressive approach to removing them. That is were I don't agree...so went to Northwestern Lynn Sage Breast Center. They listened to my fears and the logic of symptoms that did not go away and seemed to continue. I had more than 1 papilloma removed. The previous doctor, after biopsies (glad he made money on something he believes in!!! not of the papillomas, and an area that was not even suspect of cancer by the radiologist report) I had surgery @ Northwestern, I now don't have worries! and I don't have any more papillomas. For me it is a logical approach to get rid a symptomatic tumors that are going inside an area they don't belong. I cared for a friend (48 years old) who died of breast cancer because of a wait and see attitude by her physicians. I learned something very valuable from her, use common sense when it comes to medical decisions. Seek knowledge about your condition, and a doctor who does not work in conjunction with you is not a good choice. I am 57 and don't think scars are scary...Cancer is....
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Hi, I have two papillomas that I am supposed to have removed on March 27. I do understand the need for the excision, however the surgeon said that he wants to remove a "golf ball" size piece for each one. The papillomas are about 7mm and the core needle biopsy showed no malignancy or atypical cells. He said he is taking so much extra tissue to get clear margins. However, since no cancer has been detected as of yet I don't understand the need for such a large clear margin. It would seem to make more sense to just take out the papilloma and a small area around it, test it, and then only remove more if it proves to be cancer. A golf ball size out of each breast is going to be cosmetically devastating. Does anyone know if this is really the standard amount to remove?
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Those dang pesky papillomas, I currently have six of them. In fact, I've had so many, I have lost count, 17 years of them. I honestly do not know how much extra tissue they take out, I have never asked in relevance to the size of the papilloma, although it does seem like with you they are taking a lot. A couple of times, they have found ADH along side the papilloma, but in your case they didn't find atypical cells in the core biopsy. Maybe your physician is being cautious since the core biopsy could miss some cells and/or you have dense tissue so they can't see too much. My first papilloma removal was a whole ductal excision, I was afraid of what I would look like afterwords, but the BS moved tissue around the area, so when it healed you couldn't tell. It wasn't until they removed a third of my breast did I look misshapen and ended up with reconstruction surgery. You can always request to see a plastic surgeon.
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When I had my second ductal excision (The first one doesn't count - see bio) they took a 2x 4x 6 cm piece of tissue. I think they take that much because they want to check the surrounding cells. In my case I had ALH and ADH. It seemed like a pretty big piece of tissue but my breast "filled in" pretty well afterwards (I was a B/C cup). Better safe than sorry. In my case the discharge was a blessing that prompted me to do something I otherwise would not have.
Mine was wired guided. That was reassuring because I knew there was NO WAY they could miss the offending duct.
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this is an oldddddd posting but i need to say this
%s from studies may somewhat be valid but we must all put everything into context... often not read in the right hands it can easily be misinterpreted. For example what was the mammo or us in relation to each case upgrade. Was there a clean sample and was it biopsied with core or fna. It can even come down to how much experience was the technician reading screens or handling equipment. All i am saying is yes stats are somewhat valid but there are many variables around everything that is individual. The only thing from case studies i have read is they suggest excision because they cannot validate that it will be 100% benign. But i bet if you line every benign growth up minus a cyst and you can find a number of women who will say i had a fibroadenoma but it turned into idc. What variables surround her diagnosis upgrade is another story
Thanks but i felt this was needed incase people just read others posts and think 25 out of 100 women with pappimollas are going to find they have cancer and i dont believe this to be at all validated
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I hap two papilloma a excised. First biopsy included lcis. 5 years later 2 ms papilloma excised included dcis and lcis. Both same breast. I don't have that breast anymore. Dcis was not found on mammo or us. Lit up on mri tho.
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I had one removed on 2/7 while having a lumpectomy for breast cancer on the same breast in a different spot. Radiologist decided to biopsy it when they were doing the biopsy for the mass that turned out to be cancer. She said she is taking out because cancer can hide behind it. I can tell you I had virtually no pain from the papilloma removal - all my pain has been from the sentinel node biopsy which you will not be getting. The anesthesia was the worst right after surgery and the next day. It is very stressful to have this done when you have no symptoms but I think you will be fine and sending prayers your way that is it.
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Tying to decide what to do. I had a biopsy done last week. Doctor called today and said it was benign and that it was a multiple papilloma and I would need to see the surgeon on Monday for a consult. After thinking about the test results and looking at some things I am trying to decide if I really need to do the surgery. I have not had any problems from this breast and just don't know if it is worth going under the knife to have them removed. I have had multiple surgeries from miscarriages and a full hysterectomy and don't do real well with being put to sleep. I just don't if it is something that needs to be done. Is there still a risk that there is cancer under it or not? I know alot of you can't answer these questions but just needed a place to voice them out loud.
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SJMorgan, this thread hasn't been active for several months, so you might not get the feedback that you'd like. You might try starting a new thread with your questions. IMO you need to discuss the risks associated with your specific pathology with the surgeon. Ask about the risks if you don't remove it vs the risks associated for you undergoing anesthesia (given your history). It is a reasonable discussion to have with him/her. The risks of a removal should never outweigh the risks associated with leaving something alone. Sorry I can't be of more help. ((hugs))
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thank you so much for this information. Very helpful. I was diagnosed with an intraductal papilloma and I'm quite anxious. Since I have other health issues it's been very difficult getting my surgery scheduled, hence adding to my anxiousness. I hope to get it removed and tested soon.
Best wishes.
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Hi everyone ,
I was diagnosed with an intraductal papilloma with sclerosis ,also found was a blood clot with " questionable admixed tissue " according to the pathologist . Has anyone heard of a pathologist using the word "questionable" to describe something ? I am not sure what to make of it . Thank you for any help .
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